Implications for Treatment and Prognosis of Borderline and Substance Use Disorders By Ulrike Feske, PhD, Paul H. Soloff, MD, and Ralph E. Tarter, PhD, Psychiatric Times
http://www.psychiatrictimes.com/article/showArticle.jhtml?articleId=196902120 January 2007, Vol. XXIV, No. 1
Borderline personality disorder (BPD) is a severe disorder characterized by a pervasive pattern of instability in the regulation of emotion,interpersonal relationships, self-image, and impulse control. Approximately2% of the general population meet criteria for BPD.
In psychiatric treatment settings, prevalence rates for BPD are considerably higher, with rates of 8% for outpatients and 15% for inpatients.
An estimated 3% to 10%of persons with BPD commit suicide.
The disorder constitutes a significant social and economic burden on family resources and health care systems since it is associated with severe functional impairment and high rates of treatment utilization.BPD and substance use disorder (SUD) often co-occur. Comorbid BPD and SUD is related to a variety of severe adverse outcomes, including participation in the sex trade; a large number of sexual partners; needle sharing; polysubstance use; more frequent and more serious drug overdoses; increased risk of suicide attempts; and more severe psychiatric, family, and legal problems.
BPD has also been found to complicate the treatment of SUD.
This article provides an overview of the prevalence of co-occurring BPD and SUD, neurobiologic hypotheses for the link between BPD and SUD, and treatment options that have proved effective for persons with comorbid BPD and SUD.
BPD and SUD comorbidity
Apart from antisocial personality disorder, BPD is probably the most common personality disorder in persons with SUD. Nearly one third of those with a lifetime SUD diagnosis also have BPD (median, 27%; range, 5.2% to74.0%).
BPD appears to be less prevalent in persons with alcohol use disorders (median, 16%; range, 3.2% to 27.4%) than in those with drug use disorders, especially cocaine and opioid abuse.
For example, Ross and colleagues found that almost half (47%) of individuals using heroin who entered treatment for SUD also had BPD. Note that the prevalence of BPD in this sample is far higher than that reported in other studies. Diagnostic discrepancies across studies examining the rates of comorbidity in persons with SUD are probably due to confounding methodologic factors, including the use of different assessment instruments, variable evaluator training, and differing sample characteristics (eg, treatment-seeking vs nontreatment-seeking). Women with SUD are more likely to have BPD than men.
For complete article go to:http://www.psychiatrictimes.com/article/showArticle.jhtml?articleId=196902120
For Wikipedia discussion on dialectical behavioral therapy go to:http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy
Contriutor: Don Phillips
