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BORDERLINE PERSONALITY DISORDER

Clive J. Robins C. Virginia Fenwick Jacqueline E. Donnelly Jennie Lacy

Many patients with mood disorders also meet criteria for borderline personality disorder (BPD), which significantly complicates treatment of the mood disorder. Aggregating across numerous studies, it appears that criteria for BPD are met by around 10% of outpatients and up to 65% of inpatients with major depressive disorder (MDD), with early-onset MDD associated with about twice the rate of BPD as later-onset MDD (Fava et al., 1996). Estimates of BPD prevalence are similar in dysthymic disorder and bipolar disorders. These reported co-occurrence rates may be inflated, however, by the fact that individuals are more likely to endorse PD criteria when depressed than when in remission (e.g., Hirschfeld et al., 1983). Among depressed patients, co-occurring BPD is associated with a greater number of major depressive episodes, symptom severity of current depressive episode, early-onset dysthymic disorder, and co-occurrence of MDD and dysthymic disorder (Skodol et al., 1999). Looking at co-occurrence from the opposite direction, McGlashan et al. (2000) reported that for 175 outpatients with

BPD, lifetime rates were 71% for MDD, 17% for dysthymic disorder, 12% for bipolar disorder type I, and 8% for bipolar disorder type II, and other studies have indicated that between 25% and 65% of patients with BPD report a concurrent mood disorder.

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