Currently, personality disorders are capturing the interest of the majority of researchers, giving rise to numerous studies, investigations, conferences… One of the possible causes of this are the various discussions about how to consider these disorders, that is, where Is the exact point of determining if it is a disorder itself or a dysfunctional personality?
This gradient has been debated in various editions of the DSM. On the other hand also They are known for their high comorbidity with other disorders, especially borderline personality disorder (TLP), a topic we will talk about in this article.
Comorbidity is a medical term that means the presence of one or more disorders (or diseases) in addition to the primary disease or disorder, and the effect they cause. This phenomenon in BPD is so significant that it is even more common and representative to see it together with other disorders than alone. There are many studies and a lot of variation in results regarding which disorders it is comorbid with and which it is not, but there is sufficient uniformity with Axis I (especially) and Axis II in both clinical and community samples.
Research indicates that 96.7% of people with BPD have at least one comorbid diagnosis with Axis I, and that 16.3% would have three or more, which is significantly higher than other disorders. On the other hand, it has also been studied that 84.5% of patients met the criteria for having one or more Axis I disorders for at least 12 months, and 74.9% for having an Axis II disorder. for life.
Regarding comorbidity with axis II, numerous studies indicate that there are differences between sexes. That is to say, men diagnosed with BPD are more likely to have axis II comorbidity with antisocial, paranoid and narcissistic type disorders, while women with histrionic. On the other hand, the percentages for dependent and avoidant disorders remained similar.
Of the aforementioned axis I disorders, the one that would be most common to be associated with BPD would be major depressive disorder, ranging between 40 and 87%. Anxiety and affective disorders in general would follow and we would highlight the relevance of post-traumatic stress disorder due to the number of studies on the matter; with a lifetime prevalence of 39.2%, it is common but not universal in patients with BPD.
In the also very common eating and substance abuse disorders, there are differences between sexes, with the former being more likely to be associated with women with BPD and the latter, with men. This impulsive substance abuse would lower the threshold of other self-destructive or sexually promiscuous behaviors. Depending on the severity of the patient’s dependency, they would have to be referred to specialized services and even admission for detoxification as a priority.
In the case of personality disorders, we would have comorbid dependence disorder with rates of 50%, avoidant disorder with 40%, paranoid disorder with 30%, antisocial disorder with 20-25%, histrionic disorder with rates oscillating between 25 and 63%. Regarding the prevalence of ADHD, it is 41.5% in childhood and 16.1% in adulthood.
Borderline Personality Disorder and Substance Abuse
The comorbidity of BPD with substance abuse would be 50-65%. On the other hand, just as in society in general, the substance that is most often abused is alcohol. However, these patients are usually polydrug addicts with other substances, such as cannabis, amphetamines or cocaine, but they can be addicts of any addictive substance in general, such as some psychotropic drugs.
In addition, This consumption is usually done impulsively and episodically. Regarding comorbidity with alcohol in particular, the result was 47.41% for life, while 53.87% was obtained with nicotine addiction.
Following the same line, numerous studies have verified the relationship of BPD symptoms with the frequency of cannabis use and dependence. Patients have an ambivalent relationship with it, since it helps them relax, mitigate the dysphoria or general discomfort they usually have, better tolerate the loneliness to which they refer so much, and focus their thoughts on the here and now. However, it can also lead them to binge eat (aggravating bulimic or binge eating disorder behaviors, for example), increase pseudoparanoid symptoms and the possibility of derealization or depersonalization, which would be a vicious circle.
On the other hand, it is also interesting to highlight the analgesic properties of cannabis, relating it to the common self-harm by patients with BPD.
BPD and eating disorders
Roughly, comorbidity with EDs and PDs is high, ranges between 20 and 80% of cases. Although the restrictive anorexia nervosa disorder may have comorbidity with BPD, it is much more common to have it with other passive-aggressive disorders, for example, while purgative bulimia is strongly associated with BPD, with the proportion being of 25%, added to binge eating disorders and unspecified eating disorders, for which a relationship has also been found.
At the same time, various authors have related as possible causes of the origin of EDs to stressful events at some early stage of life, such as physical, psychological or sexual abuse, excessive control… along with personality traits such as low self-esteem, impulsiveness or emotional instability. , along with society’s own beauty canons.
It is important to highlight that the high comorbidity of BPD with other disorders makes early detection of disorders more difficult which makes treatment difficult and obscures the therapeutic prognosis, in addition to being a criterion of diagnostic severity.
Finally, we conclude with the need for more research on BPD and personality disorders in general, since there is a lot of disparity in opinions and little data that is truly empirically contrasted and with consensus in the mental health community.
Bibliographic references:
Grant, B., Chou, S., Goldstein, R., Huang, B., Stinson, F., Saha, T., et al. (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry.69(4):533-45.
Lenzenweger, M., Lane, M., Loranger, A. & Kessler, R. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication (NCS-R). Biol Psychiatry. 62:553–64.
Skodol, A., Gunderson, J., Pfohl, B., Widiger, T., Livesley, W., et al. (2002) The borderline diagnosis I: Psychopathology, comorbidity, and personality structure. Biol Psychiat 51:936–950.
Szerman, B. & Peris, D (2008). Cannabis and personality disorders. In: Psychiatric aspects of cannabis use: clinical cases. Spanish Cannabinoid Research Society. Madrid: CEMA. 89-103.
Zanarini, M., Frankenburg, F., Hennen, J., Reich, D & Silk, K. (2004). Axis I Comorbidity in Patients With Borderline Personality Disorder: 6-Year Follow-Up and Prediction of Time to Remission. Am J Psychiatry. 161:2108–2114.
