Borderline Personality Disorder and Substance Abuse: Consequences of Comorbidity

Paul S. Links · Ronald J. Heslegrave · M. Janice E. Mitton · Robert van Reekum · Jayne Patrick

106 citations0/0 files storedThe Canadian Journal of Psychiatry

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Personality Disorders and Psychopathology Substance Abuse Treatment and Outcomes Bipolar Disorder and Treatment

Abstract

The objective of this paper was to examine the prognostic significance of borderline personality disorder (BPD) and substance abuse in a cohort of former inpatients screened for BPD and followed up prospectively seven years after the index admission. The impact of comorbidity on borderline psychopathology, impulsivity and psychosocial functioning was examined. The original cohort was assembled between April 1983 and December 1985. Admissions were screened for borderline characteristics which resulted in a sample of 130 subjects, 88 of whom were positive for BPD based on the Diagnostic Interview for Borderlines. At seven years follow-up, 81 out of 130 (62.3%) subjects were re-interviewed. Six (4.6%) had committed suicide, two (1.5%) were deceased and 41 (31.6%) were lost to follow-up. The subjects with BPD and substance abuse were significantly differentiated from subjects with BPD only, substance abuse only and neither disorder on the basis of demonstrating more borderline psychopathology and more self-destructive and suicidal thoughts and behaviours. Probands with initial diagnoses of BPD and substance abuse were twice as likely to be diagnosed BPD on follow-up as probands with initial diagnosis of BPD only (relative risk = 2.19, 95% CI, 1.21 to 3.97). These findings and other research suggest that patients with comorbid BPD and substance abuse should be encouraged to focus on their abuse problems as a priority.

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References

1978Research Diagnostic Criteria 1978A Diagnostic Interview 1989The Revised Diagnostic Interview for Borderlines: Discriminating BPD from other Axis II Disorders 1981The diagnostic interview for borderline patients 1984The Chestnut Lodge Follow-up Study 1990Estimating the Prevalence of Borderline Personality Disorder in the Community 1978Discriminating features of borderline patients 1986The Chestnut Lodge Follow-up Study

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2003Assessing Suicidal Youth with Antisocial, Borderline, or Narcissistic Personality Disorder 2008New onsets of substance use disorders in borderline personality disorder over 7 years of follow‐ups: findings from the Collaborative Longitudinal Personality Disorders Study 2004Borderline or Bipolar? Distinguishing Borderline Personality Disorder from Bipolar Spectrum Disorders 2010Impulsivity and risk-taking in borderline personality disorder with and without substance use disorders.1997Personality disorders and completed suicide: A methodological and conceptual review.

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