BPD co-occurs quite commonly with depressive disorders. We reviewed several proposed explanations for this co-occurrence and concluded that several mechanisms might be operative. The presence of BPD usually complicates the treatment of depressive disorders with CT, as well as other treatments, and is associated with a poorer long-term outcome of depression. Understanding the mechanisms that maintain the pattern of behaviors referred to as BPD and focusing treatment strategies on those mechanisms are essential for a good clinical outcome. Several theoretical constructs from the CT model, including specific dysfunctional attitudes and beliefs, cognitive processing styles, and information-processing biases, have been shown to be associated with BPD. We also described the biosocial theory of BPD, which is a foundation of DBT though space has precluded discussion of emerging supportive evidence regarding emotional sensitivity and experiences of invalidation. We have discussed several self-report questionnaires that screen for and assess features of BPD, adaptations of standard CT specific for BPD, and some principal features of the DBT model and how they might be integrated into CT. Emerging evidence that indicates DBT, and possibly CT, have efficacy in greatly decreasing the severity of several problems associated with BPD, including depression. We have illustrated the use of these principles and strategies in a case example.


Abela, J. R. Z., Payne, A. V L., & Moussaly, N. (2003). Cognitive vulnerability to depression in individuals with borderline personality disorder. Journal of Personality Disorders, 17, 319-329.

Akiskal, H. S. (2004). Demystifying borderline personality: Critique of the concept and unorthodox reflections on its natural kinship with the bipolar spectrum. Acta Psychiatrica Scandinavica, 110, 401-407.

Arntz, A. (1994). Treatment of borderline personality disorder: A challenge for cognitive-behavioural therapy. Behaviour Research and Therapy, 32, 419-430.

Arntz, A., Appels, C., & Sieswerda, S. (2000). Hypervigilance in borderline disorder: A test with the emotional stroop paradigm. Journal of Personality Disorders, 14, 366-373.

Arntz, A., Dietzel, R., & Dreessen, L. (1999). Assumptions in borderline personality disorder: Specificity, stability and relationship with etiological factors. Behaviour Research and Therapy, 37, 545-557.

Arntz, A., Dreessen, L., Schouten, E., & Weertman, A. (2004). Beliefs in personality disorders: A test with the Personality Disorder Belief Questionnaire. Behaviour Research and Therapy, 42, 1215-1225.

Bagge, C., Nickell, A., Stepp, S., Durrett, C., Jackson, K., & Trull, T.J. (2004). Borderline personality disorder features predict negative outcomes 2 years later. Journal of Abnormal Psychology, 113, 279-288.

Beck, A. T. (1983). Cognitive therapy of depression: New perspectives. In P.J. Clayton & J. E. Barrett (Eds.), Treatment of depression: Old controversies and new approaches (pp. 265-290). New York: Raven Press.

Beck, A. T., Freeman, A., Pretzer, J., Davis, D. D., Fleming, B., Ottaviani, R., et al. (1990). Cognitive therapy of personality disorders. New York: Guilford Press.

Blatt, S.J. (1974). Levels of object representation in anaclitic and introjective depression. Psychoanalytic Study of the Child, 27, 107-157.

Blatt, S. J., & Shichman, S. (1983). Two primary configurations of psychopathology. Psychoanalysis and Contemporary Thought, 6, 187-254.

Brown, G. K., Newman, C. F., Charlesworth, S. E., Crits-Christoph, P., & Beck, A. T.

(2004). An open clinical trial of cognitive therapy for borderline personality disorder. Journal of Personality Disorders, 18, 257—271.

Butler, A. C., Brown, G. K., Beck, A. T., & Grisham,J. R. (2002). Assessment of dysfunctional beliefs in borderline personality disorder. Behaviour Research and Therapy, 40, 1231-1240.

Daley, S. E., Burge, D., & Hammen, C. (2000). Borderline personality disorder symptoms as predictors of four-year romantic relationship dysfunction in young women: Addressing the issue of specificity. Journal of Abnormal Psychology, 109, 451-460.

Deltito,J., Martin, L., Riefkohl, J., Austria, B., Kissilenko, A., Corless, P., et al. (2001). Preliminary communication: Do patients with borderline personality disorder belong to the bipolar spectrum? Journal of Affective Disorders, 67, 221-228.

Farmer, R., & Nelson-Gray, R. O. (1990). Personality disorders and depression: Hypothetical relations, empirical findings, and methodological considerations. Clinical Psychology Review, 10, 453-476.

Fava, M., Alpert, J. E., Borus,J. S., Nierenberg, A. A., Pava, J. A., & Rosenbaum, J. F. (1996). Patterns of personality disorder comorbidity in early-onset vs. late-onset major depression. American Journal of Psychiatry, 153, 1308-1312.

First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. (1996). User's guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). New York: Biometrics Research Department, New York State Psychiatric Institute.

Freeman, A., & Fusco, G. M. (2004). Borderline personality disorder: A therapist's guide to taking control. New York: Norton.

Grilo, C. M., Sanislow, C. A., Shea, M. T., Skodol, A. E., Stout, R. L., Gunderson, J. G., et al. (2005). Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity. Journal of Consulting and Clinical Psychology, 73, 78-85.

Gunderson, J. G., & Elliott, G. R. (1985). The interface between borderline personality disorder and affective disorder. American Journal of Psychiatry, 142, 277288.

Gunderson, J. G., & Phillips, K. A. (1991). A current view of the interface between borderline personality disorder and depression. American Journal of Psychiatry, 148, 967-975.

Hart, A. B., Craighead, W E., & Craighead, L. W. (2001). Predicting recurrence of major depressive disorder in young adults: A prospective study. Journal ofAbnor-mal Psychology, 110, 633-643.

Hirschfeld, R. M. A., Klerman, G. L., Clayton, P. J., Keller, M. B., McDonald-Scott, M. A., & Larkin, B. H. (1983). Assessing personality: Effects of the depressive state on trait measurement. American Journal of Psychiatry, 140, 695-699.

Hirschfeld, R. M. A., Klerman, G. L., Lavori, P., Keller, M. B., Griffith, P., & Coryell, W (1989). Premorbid personality assessment of first onset of major depression. Archives of General Psychiatry, 46, 345-350.

Hyler, S. E., Oldham, J. M., Kellman, H. D., & Doidge, N. (1992). Validity of the Per-

sonality Diagnostic Questionnaire—Revised: A replication in an outpatient sample. Comprehensive Psychiatry, 33, 73-77. Ilardi, S. S., Craighead, W E., & Evans, D. D. (1997). Modeling relapse in unipolar depression: The effects of dysfunctional cognitions and personality disorders. Journal of Consulting and Clinical Psychology, 65, 381-391. Kehrer, C. A., & Linehan, M. M. (1996). Interpersonal and emotional problem solving skills and parasuicide among women with borderline personality disorder. Journal of Personality Disorders, 10, 153-163. Klein, D. N., & Schwartz, J. E. (2002). The relation between depressive symptoms and borderline personality disorder features over time in dysthymic disorder. Journal of Personality Disorders, 16, 523-535. Layden, M. A., Newman, C. F, Freeman, A., & Morse, S. B. (1993). Cognitive therapy of borderline personality disorder. Needham Heights, MA: Allyn & Bacon. Leihener, F., Wagner, A., Haaf, B., Schmidt, C., Lieb, K., Stieglitz, R., & Bohus, M.

(2003). Subtype differentiation of patients with borderline personality disorder using a circumplex model of interpersonal behavior. Journal of Nervous and Mental Disease, 191, 248-254.

Linehan, M. M. (1993a). Cognitive-behavioral treatment of borderline personality disorder.

New York: Guilford Press. Linehan, M. M. (1993b). Skills training manual for treating borderline personality disorder.

New York: Guilford Press. Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically suicidal borderline patients. Archives of General Psychiatry, 48, 1060-1064. MacLeod, A. K., Tata, P., Tyrer, P., Schmidt, U., Davidson, K., & Thompson, S.

(2004). Personality disorder and future-directed thinking in parasuicide. Journal of Personality Disorders, 18, 459-466.

McGlashan, T. H. (1987). Borderline personality disorder and unipolar affective disorder: Long-term effects of comorbidity. Journal of Nervous and Mental Disease, 175, 467-473.

McGlashan, T. H., Grilo, C. M., Skodol, A. E., Gunderson, J. G., Shea, M. T., Morey, L. C., et al. (2000). The collaborative longitudinal personality disorders study: Baseline Axis I/II and II/II diagnostic co-occurrence. Acta Psychiatrica Scan-dinavica, 102, 256-264. Meyer, B., Pilkonis, P. A., Proietti, J. M., Heape, C. L., & Egan, M. (2001). Attachment styles and personality disorders as predictors of symptom course. Journal of Personality Disorders, 15, 371-389. Morse, J. Q., Robins, C. J., & Gittes-Fox, M. (2002). Sociotropy, autonomy, and personality disorder criteria in psychiatric patients. Journal of Personality Disorders, 16, 549-560.

Mulder, R. T. (2002). Personality pathology and treatment outcome in major depression: A review. American Journal of Psychiatry, 159, 359-371. O'Leary, K. M., Cowdry, R. W., Gardner, D. L., Leibenluft, E., Lucas, P. B., & De

Jong-Meyer, R. (1991). Dysfunctional attitudes in borderline personality disorder. Journal of Personality Disorders, 5, 233—242.

Ouimette, P. C., Klein, D. N., Anderson, R., Riso, L. P., & Lizardi, H. (1994). Relationship of sociotropy/autonomy and dependency/self-criticism to DSM-III-R personality disorders. Journal of Abnormal Psychology, 103, 743—749.

Robins, C.J. (2002). Zen principles and mindfulness practice in dialectical behavior therapy. Cognitive and Behavioral Practice, 9, 50—57.

Robins, C. J., & Chapman, A. L. (2004). Dialectical behavior therapy: current status, recent developments, and future directions. Journal of Personality Disorders, 18, 73-89.

Rose, D. T., Abramson, L. Y, Hodulik, C. J., Halberstadt, L., & Leff, G. (1994). Heterogeneity of cognitive style among depressed inpatients. Journal of Abnormal Psychology, 103, 419-429.

Segal, Z. V, Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression. New York: Guilford Press.

Shea, M. T., Glass, D. R., Pilkonis, P. A., Watkins, J., & Docherty, J. P. (1987). Frequency and implications of personality disorders in a sample of depressed outpatients. Journal of Personality Disorders, 1, 27-42.

Shea, M. T., Widiger, T. A., & Klein, M. H. (1992). Comorbidity of personality disorders and depression: Implications for treatment. Journal of Consulting and Clinical Psychology, 60, 857-868.

Skodol, A. E., Stout, R. L., McGlashan, T. H., Grilo, C. M., Gunderson, J. G., Shea, M. T., et al. (1999). Co-occurrence of mood and personality disorders: A report from the Collaborative Longitudinal Personality Disorders Study (CLPS). Depression and Anxiety, 10, 175-182.

Soloff, P. H. (2000). Psychopharmacology of borderline personality disorder. Psychiatric Clinics of North America, 23, 169-192.

Southwick, S. M., Yehuda, R., & Giller, E. L. (1995). Psychological dimensions of depression in borderline personality disorder. American Journal of Psychiatry, 152, 789-791.

Veen, G., & Arntz, A. (2000). Multidimensional dichotomous thinking characterizes borderline personality disorder. Cognitive Therapy and Research, 24, 23-45.

Westen, D., Moses, M. J., Silk, K. R., Lohr, N. E., Cohen, R., & Segal, H. (1992). Quality of depressive experience in borderline personality disorder and major depression: When depression is not just depression. Journal of Personality Disorders, 6, 382-393.

Young,J. E. (1990). Cognitive therapy for personality disorders: A schema focused approach. Sarasota, FL: Professional Resource Exchange.

Happiness Today

Happiness Today

Unhappy With Your Current Situation? Follow The Principles Within This New audio series and Guide and Create True Happiness Everyday Of Your Life. Download To Discover How To Live A More Fulfilling And Happy Life Starting Today.

Get My Free Ebook

Post a comment