Analyzing comorbidity data is a complex matter that probably exceeds most of our laymen skills    

In medicine, comorbidity describes the effect of all other diseases an individual patient might have other than the primary disease of interest.

In psychiatry it is a bit different.  In psychology and mental health counseling comorbidity refers to the presence of more than one diagnosis occurring in an individual at the same time. However, in psychiatric classification, comorbidity does not necessarily imply the presence of multiple diseases, but instead can reflect our current inability to supply a single diagnosis that accounts for all symptoms. The term comorbidity was first used in psychiatry in 1970's.

The current DSM-IV definitions have so much overlap, just about everyone with a personalty disorder has a co-morbidity with another mental conditions.  The Amercican Psychiatric Association is trying to reduce this up in a revised version of the DSM (DSM-5) due to be published in 2013.

In a study of 34,653 people in the general population by the Laboratory of Epidemiology and Biometry, National Institutes of Health (NIH), Bethesda, MD, USA the incidence of comordibities with BPD were very high.  

Comorbidity with another personality disorder (Axis II) was very high at 74% (77% for men, 72% for women) and as such, the PD are being redefined.

Comorbid w/BPD--------- Paranoid Schizoid Schizotypal Antisocial Histrionic Narcissistic Avoidant Dependent OCD

Men----------- 17% 11% 39% 19% 10% 47% 11% 2% 22%

Women------- 25% 14% 35% 9% 10% 32% 16% 4% 24%

But even with the changes in the DSM-5, co-morbidity is real with Axis I disorders.

In the NIH study comorbidity with mood disorders was very high at 75% as was anxiety disorders 74%.

Comorbid w/BPD--------- Anxiety Disorder (Axis I ) -Posttraumatic stress -Panic with agoraphobia -Panic w/o agoraphobia -Social phobia -Specific phobia -General anxiety Mood Disorder (Axis I ) -Major depressive -Dysthymia -Bipolar I -Bipolar II

Men--------- - 30% 8% 16% 25% 27% 27% - 27% 7% 31% 7%

Women------ - 47% 15% 21% 33% 47% 42% - 37% 12% 33% 9%

Male and female borderline patients were also found to be significantly different comorbidities in the areas of substance use disorders and eating disorders (Axis I).

Comorbid w/BPD--------- Alcohol abuse Drug abuse Anorexia* Bulimia*

Men---- 52% 22% 7% 10%

Women---- 33% 14% 25% 30%

* From a separate study of 515 inpatients at McLean Hospital (Harvard University)

Looking at all this comorbidity, it's easy to see why a therapist might initially focus on the more "treatable" and episodic Axis I disorders (e.g., depression, anxiety disorders, bipolar disorder, ADHD, anorexia nervosa, bulimia nervosa) before diagnosing and tackling the more difficult to treat and stigmatized borderline personality disorder (Axis II).  In many ways, this makes sense.


Please note:  This soon to be published study data is provided to give a general idea of the magnitude of comorbidity. I selected this study because it was comprehensive and the data are easy to understand and because it was a general population study -- a representative sample of the civilian population, 18 years and older, residing in households and group quarters in the United States. There are (and will be) numerous other studies that update and further refine these findings.

Good points, Skip! Sometimes there is a tendency to attribute every undesirable or problematic trait to BPD.  It is important to distinguish what is caused by BPD and what is attributable to another disorder or factor.  Otherwise, we may miss other disorders that need to be treated also.  Each of these separate disorders can influence the other.

 

One fairly common example would be substance abuse/addiction and BPD.  If one treats the substance abuse but neglects to treat the BPD, the chances of relapse are much greater.  :)rug abuse and alcohol can make the BPD worse.  In particular, withdrawal from alcohol (12 to 72 hours after drinking) can bring on dysphoria.  Seeking release from the dysphoria, they are apt to drink again.  

And the cycle continues.

 

Abigail

Something I read online. The most co morbid diagnosis with BPD's is eating disorders. How many of you folks here on this message board know if your ex BPD has an eating disorder. Mine does. In fact she has had it ever since she was in her 20's and she is now 49 yrs old. She was able to keep it from me for 8 years by staying up later than me, binging, then she would go and vomit. Once in awhile I would hear her vomit and she would say that something did not agree with her. I took it at face value, being the naive trusting person that I am.

My SO is also diagnosed as Bi Polar, & having Major Depressive Syndrome. I'm currently trying to figure out whether or not the Bi Polar diagnosis has any bearing on her mood swings (or phasing as I've come to call it). I'm documenting her moods on a daily basis, so I may look back & see if there is a pattern. Also she is on Sertraline (Brand name: Zoloft), which seems to take the edge off, but certainly does not prevent her mood swings, hostility & occasional dis associative aggression.

Any comments or advice would be greatly appreciated.

PS   I'm also trying to subtly suggest that she may be happier if she returns to DBT (I'll let you know how that one goes )

42 Years... .Man oh Man !

I commend you sir. You must have a Masters Degree in dealing with BPD by now !. Thank you for your input regarding mood swings, & naturally you are correct in recommending the lessons. I am finding both the workshops & the forums very helpful & informative. I'm finding that a lot of the material is pretty subjective, & at the moment I'm finding it easier to cope by detaching emotionally, hence my desire to make sense of this all in an empirical manner. I am relatively new to this having only been in my relationship for 5 years, during which time my efforts to help her have basically involved getting her involved with case management & calling them when she gets violent, to leaving for 9 months. Like most people who share their lives with BPD"s, I'm just trying to make sense of it all. I realize the only person I can help is myself, but at least by learning as much about this disorder as I can, perhaps I can circumvent & maybe prevent some of the more extreme symptoms. We have a young child, so I feel obligated to see this through.

 

Matyr, I don't have the same issues you are facing. My H has been diagnosed with depression and ADD but not BPD.  However I did see this article in our archives.  See if this is of any benefit to you.  I think we can drive ourselves crazy trying to make sense of our spouses' behavior.  Understanding can lead to more compassion on our part but ultimately our main focus needs to be on our part of the dysfunctional dance.  Is she in any therapy at all right now?


What are the diffences/similarities between BPD & bipolar? Comorbidity?

Yeah I hear you all.  Good information Skip.

It seems like sometimes BPD is used as a "catchphrase", when therapists really can't pin a definitive diagnosis to the symptoms. As I've stated before, it's blatantly obvious that my SO's behavior stems from her childhood trauma, but why are some people affected more than others ?. I too had a "rough" childhood, but in my instance , it just made me stronger & more self reliant. I make friends easily & maintain relationships, & have a generally positive outllook on life, & I am able to deal with "drama" when it arises, without letting emotion cloud the issue.

I'm going to continue documenting her mood swings & her behavior, & try & look for a pattern. In the meantime, I'll continue with the workshops & lessons (thanks for the link Jay Bird). It's all good therapy for me, as well as leading to a greater understanding of BPD, which can certainly aid me in maintaining this relationship.

Thanks guys ! 

Hey peacebaby (cool handle !)

Yeah, I'm way over thinking I & now just focus on what I can change (ME), while doing my best to accept what I can't change.

It's very difficult when "what you can't change" impacts your life so much, & the only option to change the situation your left with is to dig out !. I'm hoping that my SO will return to DBT, so that we may both work on our relationship.

At this point I see little hope... .at least while she is in denial, & projecting all the BS onto me, & yes, it is a sad fact that most BP's were "damaged as children.

AnOught has some very helpful things to say about this topic in another thread I'm participating in.  Try check it out !

https://bpdfamily.com/message_board/index.php?topic=140686.0

This is a very interesting topic, I've been wondering the same thing.  My uBPDm has the official mental illness diagnosis of "bipolar disorder", which I DO NOT think she has.  In my opinion, she has been "acting" with her psychiatrist (to get on disability) and really doesn't exhibit any of the real traits of bipolar disorder.  She is a classic borderline. But like immadone said, the therapist can only go by what the patient tells them, and my mom is a master manipulator.

I think it's a spectrum as Skip points out. I think also some things are actually symptoms.

I'm not a doctor so I could be off base, but it seems to me that hoarding is simply a symptom of something else. From my research, I don't think I've ever come across anyone who is "just" a hoarder.  :)epression, PTSD, a personality disorder - something like that always seems to be present. So some people have a PD and end up as hoarders. Some have a PD and end up as neat freaks. Some people have a PD and the state of their house is not affected and it shows itself in other ways instead.

My mom is a hoarder. It runs in my family. Child abuse, child neglect, depression and alcoholism also run in the family. It's definitely related.

I see that in my family. I don't know where it started, but going back at least 3 generations we have abusive parents who raise children who grow up to be abusive parents. And the alcohol abuse/alcoholism is part of them trying to make the pain go away.

Unless you know for a fact that they have been officially diagnosed by a mental health professional, it's speculation and conjecture to say that they have a personality disorder.

But I will say that you didn't end up on this board by accident.

You still witnessed bad behavior and were traumatized by your ex's actions. If it turns out that your ex doesn't have BPD but his behavior is cruel, does that change anything? Does that lack of a BPD diagnosis suddenly make him a healthy candidate for a stable, mature relationship?

I find that the need to "prove" that my ex has BPD is not so important. I told the story of my ex to a lot of people, and some said "You need to go check out bpdfamily.com" and others said "I don't think BPD is the answer here, but I can tell you that something was amiss inside of her to do what she did."

So to me it is the behavior that is important and the label not so much. What I can tell you is that the feelings I have had, and the journey that I am on, I have seen others here with the same feelings, the same questions, and they are on the same journey that I am.

So whether my ex was BPD or not, I feel like I belong here.

I've had relationships end before, and had women behave in inconsiderate fashion towards me before when it came to romance, but I never felt the need to seek out answers like this and I've never felt so traumatized. When my ex-ex and I broke up, I never felt like something was wrong with her or that she might be psychologically unwell. I read somewhere that it is normal to continually need reassurance that it was them and not us, that what you went through was not "normal." If you get involved with somebody that is not well, it is going to have an impact on your mental health and I think this questioning, the Whys when it comes to what they did and the reasoning behind it, as well as questioning whether or not they were sick, is normal. Your brain is trying to process and make sense of something that doesn't make any sense.

Is it typical for a Cluster B/borderline to abruptly spring a breakup on you when things are going well? Yes. It is typical for them to avoid any responsibility for their actions and evade accountability? Yes. Is it typical for them to carry on in the aftermath as if you don't exist and ignore you as if you are a non-entity? Yes.

From the time I read about BPD after my breakup, I knew that my ex was indeed personality-disordered (he even mentioned that he had been diagnosed with a PD). He exhibited all 9 of the DSM characteristics to varying degrees of severity. I had read about BPD before, in the context of a friend who committed suicide about 5 years before I met my ex.

Whether or not you'll ever learn about a diagnosis is irrelevant. Questioning ourselves on the severity of our loved one's problems is how a lot of us got really deep into destructive relationships.

The term I was looking for is; "Operant Conditioning"

Dear jalk,

My wife does too. The more she's stressing, the more she eats. Later, she'll spend entire days starving so she doesn't gain weight... .It's like a cycle.