Abnormal Psychology

Personality Disorders 601

People with borderline personality disorder may have comorbid depression, as

this individual does:

Thoughts of the past are prominent in my head. Bad person, naughty baby, no wonder

my birth mother didn’t want me. I’m not deserving of anything good in my life. I need

to be punished just because I’m alive. Mind swirling, too many thoughts at once, can’t

cope. Worthless, burden, angry. The anger is initially directed at the right people. How-

ever, it doesn’t stay there for long. I soon turn it around and, consequently, the anger

returns to me, as it should do, because that’s my lot in life. I should be used to it by now.

Once more a failure.

(Castillo, 2003, p. 120)

Comorbid depression frequently contributes to increased suicidal thoughts, plans,

or attempts. As borderline personality disorder symptoms diminish—including a

decrease in emotional sensitivity—depression is likely to improve (Gunderson et al.,

2004). Donna, in Case 13.6, exhibits extreme emotional sensitivity.

Prevalence

• Borderline personality disorder occurs in 2% of the general population, 10% of outpatients,
  and 20% of inpatients.


• Among the personality disorders, borderline personality disorder is the most common:
  30–60% of those diagnosed with a personality disorder have borderline personality disorder
  (Adams, Bernat, & Luscher, 2001; Widiger & Frances, 1989; Widiger & Trull, 1993).


• Borderline personality disorder is fi ve times more common among fi rst-degree relatives of
  someone with the disorder than in the general population.
  Comorbidity


• Common comorbid disorders include mood disorders, substance-related disorders, eating
  disorders (especially bulimia), and anxiety disorders (Grilo et al., 2004; Gunderson, Weinberg,
  et al., 2006; Zanarini et al., 2004).
  Onset


• As with all personality disorders, symptoms for borderline personality disorder emerge in
  childhood or adolescence.
  Course


• There is a high suicide rate among people with borderline personality disorder, with almost
  10% dying by suicide (Linehan & Heard, 1999; Paris, 1993).


• The early adulthood years of people with this disorder are marked by mood episodes and
  serious impulse control problems, including suicide attempts; the risk of suicide peaks during
  early adulthood.


• Those who survive into their 20s and 30s are likely to improve within 10 years (Paris & Zweig-
  Frank, 2001; Zanarini, Frankenburg, Hennen, et al., 2006; Zanarini et al., 2007). Not all people
  improve, however (Skodol, Gunderson, et al., 2005).


• Those patients who meet fewer of the diagnostic criteria and who don’t have a history of child-
  hood trauma have a better prognosis 2 years after diagnosis (Gunderson, Daversa, et al., 2006).
  Gender Differences


• Around 75% of those diagnosed with borderline personality disorder are female.
  Cultural Differences


• The diagnostic criteria for borderline personality disorder—and its conceptual underpinnings—
  may not apply equally well in all cultures, especially Asian cultures (Lee, 2008).
  Source: Unless otherwise noted, citations should be for American Psychiatric Association, 2000.

Table 13.15 • Borderline Personality Disorder Facts at a Glance

CASE 13.6 • FROM THE OUTSIDE: Borderline Personality Disorder

[A woman, Donna, exhibited] episodes of explosive anger and bitter tirades, along with

weekly (sometimes daily) expressions of bitterness and resentment. Frustrations and dis-

appointments, which are inevitable within any relationship and would only be annoying