Co-occurring Disorders

Many people with borderline personality disorder have another disorder in addition to BPD. Depression is the most common co-occurring disorder (up to 70 percent; however other sources believe it’s almost universal). The rest of them are substance abuse (35 percent), eating disorders (25 percent), narcissistic personality disorder (25 percent), and bipolar disorder (formerly called manic-depression) (15 percent) and histrionic personality disorder (unknown).

Substance Abuse and BPD

Alcohol and other drugs temporarily relieve emotional pain. But only temporarily, of course. Substance dependence should be addressed before treating the underlying borderline personality disorder. If borderline patients undergo treatment only for substance dependence and not the underlying BPD, they may be more prone to relapse or put another unhealthy coping mechanism in its place.

People with BPD with substance abuse issues have a marked decrease in the effectiveness of both medications and psychotherapy. They also are at an increased risk of suicide attempts and other severe psychiatric problems. Borderline men are especially at risk for substance abuse.

Eating Disorders and BPD

Those with bulimia binge then rid themselves of the food by vomiting, taking enemas, exercising obsessively, or abusing laxatives. The long-term effects can include stomach rupture, tooth loss, and even death. Eating disorders (particularly bulimia) are more prevalent among females with BPD. Eating disorder may be an alternative type of self-harm and another way to capture control.

Narcissistic Personality Disorder and BPD

About  a third of people with BPD also have narcissistic personality disorder (NPD). People with NPD require a continual supply of admiration, special treatment, and confirmation of their superiority. A hallmark of the disorder is that they don’t have empathy for other people; that is, they can’t put themselves in another person’s place. To the person with NPD, other people are objects whose function is to meet their needs.

People with NPD may come off as quite charming and confident, even arrogant. They may overestimate their abilities and devalue yours. But don’t let that fool you. Narcissists are actually needier than most people, with low self-esteem and feelings of emptiness and worthlessness. If anyone crosses them or challenges them in any way, they feel empty, jealous, and angry.

Bipolar Disorder and BPD

While many people get the two confused, the two are very different. Bipolar is a mood disorder, and BPD is a personality disorder characterized, in part, by mood swings. BPD and bipolar are different in that

• While people with bipolar disorder swing between mania and major depression, the mood swings typical in BPD are for a variety of emotions: fear, anger, etc
• People with BPD cycle much more quickly, often several times a day.
• The moods in people with BPD are more dependent, either positively or negatively, on what’s going on in their life at the moment.