The Stigmatization of Borderline Personality Disorder and High Comorbidity Rates

By Vidya Koesmahargyo

Comorbidity is defined as the simultaneous presence of two chronic conditions in a patient. (Comorbidity) One particular personality disorder, borderline personality disorder (BPD) has a markedly high rate of comorbidity with a variety of other mental health conditions. In fact, the majority of people diagnosed with BPD are comorbid with depression, anxiety, and substance abuse. This makes it harder to treat patients with BPD given only few have straightforward clinical presentations with no comorbidity. (Biskin & Paris, 2013)

Borderline personality disorder itself is characterized by symptoms such as identity disturbance, unstable and intense interpersonal relationships, chronic feelings of emptiness, inappropriate and intense anger, and emotional instability. (American Psychiatric Association, 2013) Individuals with BPD are affected by pervasive patterns of instability in interpersonal relationships, self-image and emotions.

Due to the nature of these patterns, they can cause significant distress and impairment across a broad range of social, work, and interpersonal situations.

Borderline personality disorder is one of the most highly stigmatized mental illnesses. However, unlike other illnesses, the stigma associated with BPD often comes from mental health professionals (NAMI). Many psychiatrists will not treat BPD patients, or claim they are “treatment resistant.” Often, attempts to treat these people fail, and some professionals blame the patient for not responding to treatment. (Brain Blogger)

If the bias in psychiatric resources and high rates of comorbidity among these individuals are taken into account, functioning in day-to-day life can be even more complicated.

One specific disorder with the highest comorbidity with BPD is major depressive disorder. According to psych times, 70% of patients with BPD were found to be comorbid with depression. Almost 96% of patients were comorbid with at least one mood disorder, a category of mental disorders in which the underlying problem primarily affects a person’s persistent emotional state or mood. (McGlashan, et al. 2012) Other comorbidities, such as any anxiety disorder (88%) and alcohol and substance abuse (50%) also frequent. (Robert & Biskin, 2013)

The high comorbidity rate in individuals with borderline personality disorder is disconcerting. It creates an added strain on the people who have multiple conditions, and often adds further complications to the course of their treatments. Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. (Valderas, et al. 2009) This further decreases the outlook, or prognosis, of these patients and their quality of life.

The high rates of comorbidity in these individuals warrant more research done on successful treatments for co-occurring illnesses and how it further impacts the individual. Further assessment and prevention of risk factors that contribute to the development of borderline personality disorder is also important. It is crucial that mental health care is rid of their biases against patients who are in need of their help, and understanding the facets of this disorder is a step towards progress.

Sources:

Comorbidity. (n.d.). In New Oxford American Dictionary. Retrieved October 23 2015, from http://www.oxforddictionaries.com/us/definition/american_english/comorbidity

Biskin, R., & Paris, J. (2013, January 9). Comorbidities in Borderline Personality Disorder. Retrieved October 23, 2015, from http://www.psychiatrictimes.com/borderline-personality/comorbidities-borderline-personality-disorder

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). doi:10.1176/appi.books.9780890423349

NAMI. (2007). Borderline Personality Disorder: A Most Misunderstood Illness. National Alliance on Mental Illness. Retrieved October 21, 2015.

Elisa, S. (2006, June 20). Psychiatry Discriminates Against People with Borderline Personality Disorder. Retrieved October 25, 2015, from http://brainblogger.com/2006/06/20/anti-stigmatization-psychiatry-discriminates-against-people-with-borderline-personality-disorder/

McGlashan, T. H., Skodol, A. E., Gunderson, J. G., Shea, M. T., Morey, L. C., Sanislow, C. A., Stout, R. L. (2005). THE COLLABORATIVE LONGITUDINAL PERSONALITY DISORDERS STUDY (CLPS): OVERVIEW AND IMPLICATIONS. Journal of Personality Disorders, 19(5), 487–504. http://doi.org/10.1521/pedi.2005.19.5.487

Valderas, J. M., Starfield, B., Sibbald, B., Salisbury, C., & Roland, M. (2009). Defining Comorbidity: Implications for Understanding Health and Health Services. Annals of Family Medicine, 7(4), 357–363. http://doi.org/10.1370/afm.983