Comorbidities

Common Comorbidities of Borderline Personality Disorder and Their Symptoms

1. Depressive Disorders

  • Major Depressive Disorder (MDD):
    Symptoms: Persistent feelings of sadness, hopelessness, loss of interest in activities, fatigue, changes in appetite or sleep, feelings of guilt or worthlessness, and thoughts of death or suicide.
    • Treatment: Antidepressants like SSRIs (e.g., fluoxetine) and Cognitive Behavioral Therapy (CBT) are commonly used to treat depression and help manage negative thought patterns.

2. Anxiety Disorders

  • Generalized Anxiety Disorder (GAD):
    Symptoms: Excessive and uncontrollable worry, restlessness, fatigue, difficulty concentrating, irritability, and physical symptoms like muscle tension and sleep disturbances.
  • Panic Disorder:
    Symptoms: Recurrent, unexpected panic attacks, rapid heartbeat, sweating, shortness of breath, chest pain, dizziness, and fear of losing control.
  • Post-Traumatic Stress Disorder (PTSD):
    Symptoms: Flashbacks, nightmares, emotional numbness, heightened arousal (e.g., irritability, hypervigilance), and avoidance of trauma reminders.
    • Treatment: CBT, exposure therapy for PTSD, and medications like SSRIs (e.g., sertraline) and SNRIs (e.g., venlafaxine) for managing anxiety and depression.

3. Substance Use Disorders (SUD)

  • Alcohol Use Disorder:
    Symptoms: Drinking more than intended, inability to cut down, cravings, and continuing to drink despite negative consequences in relationships or health.
  • Drug Use Disorder:
    Symptoms: Similar to alcohol use disorder, including using substances despite harm.
    • Treatment: Dual diagnosis care involving DBT for emotional regulation and medications such as naltrexonefor alcohol or buprenorphine for opioid use disorders.

4. Eating Disorders

  • Bulimia Nervosa:
    Symptoms: Recurrent episodes of binge eating followed by inappropriate compensatory behaviors (e.g., vomiting, excessive exercise) to prevent weight gain.
  • Anorexia Nervosa:
    Symptoms: Extreme fear of gaining weight, distorted body image, and significant food restriction leading to unhealthy weight loss.
    • Treatment: CBT is the most effective treatment for bulimia and anorexia. Family-Based Therapy (FBT) is particularly useful in adolescents.

5. Attention Deficit Hyperactivity Disorder (ADHD)

  • Symptoms: Difficulty focusing, disorganization, impulsivity, and sometimes hyperactivity.
    • Treatment: Stimulant medications like methylphenidate or non-stimulants like atomoxetine, combined with DBT or CBT, to address impulsivity and attention challenges.

6. Bipolar Disorder

  • Symptoms: Extreme mood swings, from depressive episodes to manic or hypomanic episodes. Manic episodes include elevated energy, impulsivity, and irritability.
    • Treatment: Mood stabilizers (e.g., lithium, valproate) are used to treat bipolar disorder. DBT can help with emotional instability related to BPD.

7. Other Personality Disorders

  • Antisocial Personality Disorder (ASPD):
    Symptoms: Disregard for others’ rights, deceit, and impulsivity.
  • Histrionic Personality Disorder (HPD):
    Symptoms: A need for attention and approval, often through dramatic behavior.
  • Avoidant Personality Disorder (AVPD):
    Symptoms: Extreme sensitivity to criticism and a fear of rejection, leading to avoidance of social situations.
    • Treatment: DBT, CBT, and Schema Therapy can help address emotional struggles and improve relationships.

8. Psychotic Spectrum Disorders

  • Brief Psychotic Episodes:
    Symptoms: Sudden, short-lasting episodes of hallucinations, delusions, or disorganized thinking, often triggered by stress.
  • Schizophrenia Spectrum:
    Symptoms: Persistent psychosis, including hallucinations, delusions, and disorganized behavior lasting more than six months.
    • Treatment: Antipsychotic medications (e.g., aripiprazole, quetiapine) and DBT to manage emotional dysregulation.

9. Obsessive-Compulsive Disorder (OCD)

  • Symptoms: Intrusive thoughts (obsessions) and repetitive behaviors (compulsions) meant to reduce anxiety caused by obsessions, such as hand washing or checking things repeatedly.
    • Treatment: CBT, particularly Exposure and Response Prevention (ERP), and DBT to help manage emotional distress.

10. Self-harm and Suicidal Behaviors

  • Suicide Attempts:
    Symptoms: Persistent suicidal thoughts or actions, often triggered by emotional distress, relationship issues, or feelings of abandonment.
  • Self-Injurious Behavior:
    Symptoms: Cutting, burning, or hitting oneself to cope with overwhelming emotions.
    • Treatment: DBT is effective in reducing self-harm and suicidal behaviors, by teaching emotional regulation and distress tolerance. SSRIs may also help treat underlying depression and anxiety.

References:

  • Zanarini, M. C., Frankenburg, F. R., Hennen, J., & Silk, K. R. (2004). The longitudinal course of borderline personality disorder. JAMA, 292(12), 1589–1596. https://doi.org/10.1001/jama.292.12.1589
  • Bender, D. S., Morey, L. C., & Skodol, A. E. (2001). Borderline personality disorder, anxiety disorders, and the impact of childhood trauma. Journal of Abnormal Psychology, 110(2), 388-396.
  • Dolan-Sewell, R., Rounsaville, B. J., & Oldham, J. M. (2002). Substance use disorders in patients with borderline personality disorder: The role of impulsivity. Journal of Clinical Psychiatry, 63(9), 93-98.
  • McGlashan, T. H., & Whittemore, R. (2000). Eating disorders in borderline personality disorder: A review of their relationship. Journal of Clinical Psychiatry, 61(11), 95-98.
  • Stepp, S. D., Whalen, D. J., & Morey, L. C. (2012). The relationship between ADHD and borderline personality disorder. Psychiatric Clinics of North America, 35(1), 91-106. https://doi.org/10.1016/j.psc.2011.11.003
  • Gunderson, J. G., & Ridolfi, M. E. (2001). The overlap between borderline personality disorder and bipolar disorder. Journal of Clinical Psychiatry, 62(11), 875-881.
  • Torgersen, S. (2009). Borderline personality disorder and other comorbid personality disorders. Psychiatric Clinics of North America, 32(2), 219-226. https://doi.org/10.1016/j.psc.2009.01.002
  • Paris, J. (2008). Psychotic features in borderline personality disorder. The American Journal of Psychiatry, 165(2), 163-165. https://doi.org/10.1176/appi.ajp.2007.07091152
  • McGlashan, T. H., & Whittemore, R. (2000). The relationship between obsessive-compulsive disorder and borderline personality disorder. Journal of Clinical Psychiatry, 61(10), 839-845.