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Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population
Open accessAbstract
While placed on different axes of the DSM classification system, borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) have important relationships with trauma, and overlap between these disorders has long been recognized. The current study is the first to examine comorbidity of PTSD and BPD in a large nationally representative sample using a reliable and valid method of assessing Axis I and II mental disorders. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Wave II (N = 34,653; response rate 70.2%). Multiple regression models were used to examine differences in psychopathology, traumatic events and health-related quality of life across individuals with PTSD alone (n = 1820), BPD alone (n = 1290) and those with comorbid PTSD-BPD (n = 643). The lifetime prevalence of PTSD and BPD were 6.6% and 5.9%, respectively. Of individuals with BPD, 30.2% were also diagnosed with PTSD, whereas 24.2% of individuals with PTSD were also diagnosed with BPD. Individuals with comorbid PTSD-BPD had a poorer quality of life, more comorbidity with other Axis I conditions, increased odds of a lifetime suicide attempt, and a higher prevalence of repeated childhood traumatic events than individuals with either condition alone. These results show that PTSD and BPD have a high degree of lifetime co-occurrence but are not entirely overlapping. Their concurrence is associated with poorer functioning compared to either diagnosis alone, emphasizing the clinical utility of diagnosing both conditions. Future research should explore the determinants of having either or both diagnoses with an aim toward improved identification, prevention, and intervention.
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“Comorbid anxiety disorders (Pagura et al., 2010; Sareen, 2011) and heightened aggression (Evren, Cınar, Evren, & Celik, 2011) increase the odds for suicidal behavior in a variety of clinical presentations, including BPD.”
From Impact of dialectical behavior therapy versus community treatment by experts on emotional experience, expression, and acceptance in borderline personality disorder (2014) · cites this paper as Pagura et al., 2010
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“Among individuals with BPD, the rate of co-occurring PTSD is approximately 30% in community samples (Grant et al., 2008; Pagura et al., 2010) and 50% in clinical samples (Harned, Rizvi, & Linehan, 2010; Zanarini, Frankenburg, Hennen, Reich, & Silk, 2004).”
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“Individuals with both BPD and PTSD are a particularly high risk group, with rates of suicide attempts two and five times higher than individuals with BPD or PTSD alone (Pagura et al., 2010).”
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Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-s1-s1 · Cited by 1,090
“Patients with comorbid PTSD and BPD had a poorer QoL, more comorbidity with other psychiatric conditions, and increased odds of a lifetime suicide attempt versus patients with either condition alone [20,874].”
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Metadata
- Authors
- Pagura, J., Stein, M. B., Bolton, J. M., Cox, B. J., Grant, B., & Sareen, J.
- Affiliations
- University of Manitoba (CA)
- University of California San Diego (US)
- National Institutes of Health (US)
- Corresponding author
- Sareen, Jitender
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2010-12
- Volume
- 44
- Issue
- 16
- Pages
- 1190-1198
- ISSN
- 0022-3956 (ISSN-L)
- PMC
- PMC4209725
- OpenAlex
- W2111282764
- Cited by
- 330
- References
- 57
- Citations by year
- 2026: 14 · 2025: 20 · 2024: 22 · 2023: 38 · 2022: 34 · 2021: 25 · 2020: 23 · 2019: 18 · 2018: 15 · 2017: 16 · 2016: 19 · 2015: 20 · 2014: 23 · 2013: 19 · 2012: 15
- FWCI
- 14.80
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- Canadian Institutes of Health Research (82894)
- National Institute on Alcohol Abuse and Alcoholism (Z01AA000449)
- National Institute of Mental Health (MH-64122, K24MH064122)
- National Institute on Drug Abuse
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- borderline personality disorder, post-traumatic stress disorder, comorbidities, trauma exposure, childhood trauma, health-related quality of life, suicide attempts, lifetime prevalence, psychopathology, NESARC
- MeSH terms
- Adult, Aged, Borderline Personality Disorder, Data Collection, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Psychiatric Status Rating Scales, Quality of Life, Severity of Illness Index, Stress Disorders, Post-Traumatic, Suicide, Attempted, United States, Comorbidity, Prevalence, Age of Onset, Young Adult
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