Co-Occurring Disorders Often Accompany Borderline Personality Disorder

People living and coping with borderline personality disorder (BPD) are often dealing with other mental health disorders at the same time. Health conditions that co-occur is called comorbidity.

Borderline personality disorder is comorbid with depression more often than anything else. Estimates of how often depression accompanies BPD range from 70-100 percent of the time. Other accompanying disorders are substance use (35 percent), narcissism (25 percent), eating disorders (25 percent), bipolar disorder (15 percent) and histrionic personality disorder, though no one is sure how often this coexists with BPD.

Substance Use Disorder

Drugs and alcohol can quickly and easily numb unpleasant and hard to manage emotions. Since the person with BPD struggles greatly with relationships and emotional outbursts this problem is not unusual.

When substance abuse is present it’s best to seek out help for that problem, at least concurrently with BPD treatment. It would be ideal to deal with the substance abuse before attempting to work on BPD, but the truth is that BPD is often an underlying driver for substance abuse. Thus, if the person addresses only the substance use, they may simply turn to some other maladaptive forms of coping.

Eating Disorders

Eating disorders can be a way to gain control, something very important to the person with BPD. They can also be an outlet for self-injury. Whatever the reason, eating disorders are inherently life-threatening.

Anorexia is essentially self-induced starvation. Bulimia is usually a binge and purge form of disordered eating. The person will eat normally, or even large amounts, but will attempt to compensate for it through self-induced vomiting, laxatives or over-exercise. In addition to weakening health the constant vomiting can also do permanent damage to the stomach and teeth.

Narcissistic Personality Disorder (NPD)

Around one third of those with BPD also struggle with NPD. Individuals with this condition need near-constant affirmation, unique treatment and reinforcement of their own superiority. Part of narcissism is an inability to empathize with others. Sympathy is the ability to feel with or for another person, while empathy is the ability to put oneself in another person’s shoes and imagine life from their perspective. This is quite beyond the person with NPD.

When you meet someone with NPD they may initially appear exceptionally confident, but this is a ruse. They will verbally inflate their own skills while minimizing the contributions or abilities of others, but the truth is their arrogance is a mask for shatteringly low self-esteem. The narcissist is overly sensitive to any perceived slight and cannot bear with being directly or indirectly challenged by others because they are so desperately insecure. It’s easy to see how this could seriously aggravate the symptoms of interpersonal inadequacy that go with BPD.

Borderline Personality Disorder

Borderline and bipolar are often confused because of the similar names and symptoms, but BPD is a personality problem and bipolar is a mood problem

Although BPD does involve mood shifts, those swings tend to be a reaction to real-life situations. The person may have an explosive outburst in the morning and then be fearful or anxious by the afternoon. Moods cycle very quickly and are connected to events.

Bipolar disorder also involves changing moods, but they tend to cycle less quickly and are unconnected to any current situation. Unipolar depression describes a person who is consistently depressed. Bipolar disorder describes a person who can be deeply depressed one week and wildly happy the next – emotions swing sharply from one end of the spectrum to the other with little variation in between.

Because mental health disorders can develop in tandem with one another it can be quite difficult to tease them apart and develop a clear diagnosis. However, just knowing that having BPD most likely means also dealing with one more thing can help patients find determination and willingness to confront issues layer upon layer.