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 about how to consider such disorders, that is, where is the exact point of determining whether it is a disorder itself or a dysfunctional personality?

This gradient has been discussed in several editions of the DWS. On the other hand, also are known for their high comorbidity with other disorders, especially borderline personality disorder (BPD), which we will discuss in this article.

Generic Comorbidity in the TLP

Comorbidity is a medical term meaning the presence of one or more disorders (or diseases) in addition to the primary disease or disorder, and the effect they cause. So significant is this phenomenon in PDL that it is even more common and representative of seeing it alongside other disorders, rather than alone. There are many studies and much variation in results as to which disorders it is comorbid with and which it is 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 LPD have at least one comorbid diagnosis with Axis I, and 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 at least 12 months, and 74.9% for having a lifelong Axis II disorder.

With regard to comorbidity with Axis II, numerous studies indicate that there are differences between the sexes. That is, men diagnosed with LPD are more likely to have Axis II comorbidity with antisocial, paranoid and narcissistic type disorders, while women with histrionics. On the other hand, the percentages for dependent and avoidance disorders remained similar.

Specific Comorbidity

Of the above-mentioned Axis I disorders, the one that would be most common if associated with BPD would be the major depressive disorder, ranging from 40 to 87%. Anxiety and affective disorders in general would follow, and we would highlight the relevance of post-traumatic stress disorder because of the number of studies on the subject; 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 the sexes, with the former being more likely to be associated with women with BPD and the latter with men. Such impulsive substance abuse would lower the threshold for other self-destructive or sexually promiscuous behavior . Depending on the severity of the patient’s dependence, referral to specialized services and even admission for detoxification would be a priority.

In the case of personality disorders, we would have comorbidity disorder by dependence with rates of 50%, the avoidant with 40%, the paranoid with 30%, the antisocial with 20-25%, the histrionic with rates ranging between 25 and 63%. The prevalence of ADHD is 41.5% in childhood and 16.1% in adulthood.

Borderline Personality Disorder and Substance Abuse

The comorbidity of the TLP with toxic abuse would be 50- 65% . On the other hand, as in society in general, the substance most often abused is alcohol.However, these patients are usually polydrug addicts with other substances, such as cannabis, amphetamines or cocaine, but can be of any addictive substance in general, as with some psychotropic drugs.

In addition, such consumption is usually done impulsively and episodically . With respect to comorbidity with alcohol in particular, the result was 47.41% for life, while 53.87% was obtained with nicotine addiction.

Along the same lines, numerous studies have proven the relationship of LPD symptomatology to the frequency of cannabis use and dependence . Patients have an ambivalent relationship with it, as it helps them to relax, reduce the dysphoria or general discomfort they usually have, better withstand the solitude to which they refer and focus their thoughts on the here and now. However, it can also lead them to binge eating (aggravating bulimic or binge eating behaviors, for example), increase pseudo-paranoid symptoms and the possibility of de-realization 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-injury by patients with BPD.

BPD and eating disorders

Broadly speaking, the comorbidity with TCAs is high , ranging from 20 to 80% of cases. Although restricting anorexia nervosa may have comorbidity with BPD, it is much more common to have comorbidity with other passive-aggressive disorders, for example, while purging bulimia is strongly associated with BPD, with the proportion being 25%, in addition to binge eating disorders and unspecified ACT, of which a relationship has also been found.

At the same time, several authors have linked the possible causes of the origin of ATD to stressful events in some early stage of life, such as physical, psychological or sexual abuse, excessive control… together with personality traits such as low self-esteem, impulsiveness or emotional instability, together with the very beauty canons of society itself.

In conclusion…

It is important to note that the high comorbidity of LPD with other disorders makes early detection of the disorders more difficult , thus making treatment more difficult and clouding the therapeutic prognosis, in addition to being a criterion of diagnostic severity.

Finally, we conclude that more research is needed on BPD and personality disorders in general, since there is a great disparity of opinions and little really empirically tested and consensual data in the mental health community.

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