Comorbidity of Personality Limit Disorder
Currently, personality disorders are attracting the interest of most researchers, leading to numerous studies, research, conferences ... One of the possible causes of this is the various discussions on how to consider such disorders, ie, where Is the exact point of determining whether it is a disorder itself or a dysfunctional personality?
This gradient has been the subject of debate in various editions of the DSM. On the other hand also are known for their high comorbidity with other disorders, especially borderline personality disorder (TLP), subject of which we will speak in the present article.
- Related article: "Personality Limit Disorder (BPD): Causes, Symptoms and Treatment"
Generic comorbidity in the TLP
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 is so significant in the TLP, 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 of results as to which disorders are comorbid and which are not, but there is sufficient uniformity with those of 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 to have one or more disorders of Axis I at least, 12 months, and 74.9% to have a disorder of axis II of 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 comorbidity of axis II with disorders of the antisocial, paranoid and narcissistic type, while women with histrionics. On the other hand, the percentages for the dependent and avoidance disorders remained similar.
Of the aforementioned disorders of axis I, the one that would be more common to associate with BPD would be major depressive disorder, ranging between 40 and 87%. Follow the anxiety and affective disorders in general and we would highlight the relevance of post-traumatic stress disorder for the amount of studies in this regard; with a lifetime prevalence of 39.2%, it is common but not universal in patients with BPD.
In the also very frequent eating disorders and substance abuse, there are differences between sexes, being the first most likely to be associated with women with BPD and the latter, men. This abuse of substances impulsively would reduce the threshold of other self-destructive or sexual promiscuity behaviors . Depending on the severity of the patient's dependence, it would have to be referred to specialized services and even income for detoxification as a priority.
In the case of personality disorders, we would have comorbidity by dependency with rates of 50%, the avoidant with 40%, the paranoid with 30%, the antisocial with 20-25%, the histrionic with oscillating rates between 25 and 63%. The prevalence of ADHD is 41.5% in childhood and 16.1% in adulthood.
Personality Limit Disorder and Substance Abuse
The comorbidity of TLP with toxic abuse would be 50-65% . On the other hand, just as in society in general, the substance that is most commonly abused is alcohol. However, these patients are usually politoxicómanos with other substances, such as cannabis, amphetamines or cocaine, but can be any addictive substance in general, as some psychoactive drugs.
In addition, said consumption is usually done impulsively and episodically . Regarding comorbidity with alcohol in particular, the result was a 47.41% lifetime, while 53.87% with nicotine addiction was obtained.
Following the same line, numerous studies have verified the relationship of the BPD symptomatology with the frequency of use and dependence of cannabis . Patients have an ambivalent relationship with this, as it helps them relax, mitigate the dysphoria or general malaise they usually have, better withstand the loneliness they refer to and focus their thoughts on the here and now. However, it can also lead to binge eating (aggravating bulimic behavior or binge eating, 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 usual self-harm on the part of patients with BPD.
BPD and eating disorders
Roughly, Comorbidity with TCAs with TP is high , ranges between 20 and 80% of cases.Although the disorder of restrictive anorexia nervosa may have comorbidity with BPD, it is much more frequent than it has other passive-aggressive disorders, for example, while purging bulimia is strongly associated with BPD, the proportion being of 25%, added to binge eating disorders and TCA not specified, of which relationship has also been found.
In parallel, various authors have related as possible causes of the origin of the TCA 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 , together with the own beauty canons of society itself.
It is important to note that the high comorbidity of BPD with other disorders makes early detection of disorders more difficult , which makes treatment difficult and darkens the therapeutic prognosis, as well as being a criterion of diagnostic severity.
To conclude, we conclude with the need for more research about BPD and personality disorders in general, since there is a great disparity of opinions and few data really empirically contrasted and with consensus in the mental health community.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, Inc.
- Bellino, S., Patria, L., Paradiso, E., Di Lorenzo, R., Zanon, C., Zizza, M. & Bogetto, F. (2005). Major Depression in Patients With Borderline Personality Disorder: A Clinical Investigation. Can J Psychiatry.50: 234-238.
- Biskin, R. & Paris, J. (2013). Comorbidities in Borderline Personality Disorder. Excerpted from: //www.psychiatrictimes.com
- Del Río, C., Torres, I. & Borda, M. (2002). Comorbidity between purging bulimia nervosa and personality disorders according to the Millon Multiaxial Clinical Inventory (MCMI-II). International Journal of Clinical and Health Psychology. 2 (3): 425-438.
- 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 Society of Cannabinoid Research. 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.