Researchers have found that those who have a personality disorder and a co-occurring mental health disorder are at a greater risk for long-term psychopathology. In addition, co-occurring disorders can have an intensely negative impact on the quality of life of those suffering with a mental illness.
Borderline personality disorder (BPD) is characterized by impairments in interpersonal relationships, self-image, and an instability of affect, impulse control and emotion. Of all the personality disorders, BPD is one of the most disabling. Recent research published in the Journal of Clinical Psychiatry found rates of BPD at 5.9% in the general population.
BPD is frequently cited as comorbid with substance use and mood, anxiety and other personality disorders. Studies have found that borderline personality disorder is highly comorbid with depression. Researchers have found that 83% of those diagnosed with BPD have a history of major depressive disorder. Because of the shared biological features between the two disorders individuals with BPD may be particularly vulnerable to depressive episodes.
Certain symptoms of a major depressive episode may be present in an individual with BPD. In particular, the individual with BPD may experience a persistent irritable or depressed mood and a decreased interest in activities that were previously pleasurable. A significant change in appetite or weight may also be a sign of major depression.
Sleep patterns may also be affected, as the individual may experience difficulty falling asleep or may sleep more often and feel more fatigue. A general loss of energy and decreased physical activity are also symptoms of a major depressive episode. Increases in worry or agitation may be present, along with feelings of worthlessness and guilt. Recurring thoughts of suicide, death and dying are also symptoms. Individuals may plan or attempt suicide during an episode.
A major depressive episode and depressed mood in borderline personality disorder have distinguishing symptoms. A depressed mood may manifest as feelings of sadness, depression or loneliness. These can be triggered by stressful life events. Because individuals with BPD fear abandonment, these feelings may arise during a depressed mood.
A major depressive episode and depressed mood also differ in that the symptoms of a depressed mood should decrease as the situation improves. For example, the symptoms of sleep disturbances or appetite loss should improve when the stress is managed. Stressful events may trigger suicidal thoughts or self-injurious behavior. However, unlike major depressive disorder these are typically related to a specific interpersonal issue such as an argument.
Affect plays an important role in BPD and major depressive disorder. Negative affect in particular has been linked to most psychological disorders. Negative affect is characterized by calmness and serenity on the lower end of the dimension and distress, hostility and nervousness at the high end. Those with high positive affect are active and elated, while those with low positive affect are drowsy and sluggish.
Studies have shown that affect intensity is related to BPD and depression. Because affect intensity is also associated with depressive symptoms, the relationship between BPD and major depressive disorder may be partially explained by affect. Because emotion regulation deficits exist in both BPD and major depressive disorder the combination of high negative affect may result in deleterious effects.
Licensed medical professionals, including psychiatrists and psychologists, can provide the proper treatment for depression with co-occurring borderline personality disorder. Typically a dosage of antidepressants is used in combination with behavioral techniques.
Studies have demonstrated that depression is resistant in patients who have a personality disorder. ECT may be used for patients who are depressed for whom other treatments have not been successful. However a study published in the American Journal of Psychiatry found that patients with borderline personality disorder respond more poorly to ECT than those with depression and other comorbid personality disorders, or those with depression and no personality disorder.