The complexities of the borderline patient: how much more complex when considering physical health?

Abstract

Objective: Borderline Personality Disorder is associated with a substantially reduced life expectancy, mostly due to physical health conditions that are life-shortening. This clinical review highlights pertinent risk issues for such conditions in Borderline Personality Disorder and suggests ways in which clinicians might address these. Methods: Selective literature review. Results: People with Borderline Personality Disorder have a reduced life expectancy of some 20 years, attributable largely to physical health maladies, notably cardiovascular. Risk factors include obesity, sedentary lifestyle, poor diet and smoking. Added to these are other physical health problems, including poor sexual health, self-harm, substance use and blood-borne viruses. Chronic pain and opioid and benzodiazepine use are also common in people with Borderline Personality Disorder. Some psychiatric medications commonly used in people with Borderline Personality Disorder – notably certain antipsychotic agents – can add to the metabolic burden. Barriers to care include self-stigma and erratic adherence to medical care, as well as stigma on the part of clinicians, who often do not screen or provide adequate care for the physical health problems suffered by people with Borderline Personality Disorder. Conclusions: Clinicians need to be aware of the physical health problems in people with Borderline Personality Disorder and ensure appropriate screening and interventions, both preventative and therapeutic, are offered routinely.

Cardiovascular Autonomic Modulation during Metronomic Breathing and Stress Exposure in Patients with Borderline Personality Disorder

“…Several authors reported reduced life expectancy in persons diagnosed with BPD [47][48][49][50][51]. A number of factors might contribute to this shorter life expectancy, such as suicide, drug abuse, bodily comorbidities, and poorer general health [52,53]. Reduced cardiovascular autonomic modulation and sympathetic predominance may conceivably be another causal factor in the relationship between BPD and impaired life expectancy.…”

“…The authors commented that small sample size was a limitation in their study [7]. Furthermore, BPD is a polythetic mental disease with heterogeneity in symptom severity, comorbidity, psychotropic drug intake, and treatment status within the patient population [17,52,58]. The analysis of percentage ranks from the BSL, which we used to assess BPD symptom severity, showed range from 2 to Neuropsychobiology 2021;80:359-373 DOI: 10.1159/000511543 98%, indicating a vast broad distribution of symptom severity in BPD patients participating in our study.…”

The Impact of Stress Within and Across Generations: Neuroscientific and Epigenetic Considerations

“…152 Individuals with borderline personality disorder (a very high percentage of whom suffered early abuse) 163 show higher rates of promiscuity and precipitousness in entering sexual relationships. 164 Life expectancy in individuals with borderline personality disorder has been shown to be decreased by up to 27.5 years, [165][166][167] with a small percentage being attributable to suicide (the disorder has been associated with medical comorbidity contributing to decreased lifespan). As such, behaviors geared toward survival may be physiologically relevant.…”

Are physical activity and nutrition linked to personality disorders? Health habits and personality disorders: A scoping review

“…Although suicide and trauma accounts for a proportion of premature mortality, current data show that people with PD also present with more chronic life‐threatening conditions than the general population (Cailhol et al, 2017). To date, PDs have been associated with more cerebral‐vascular events, coronary hearth diseases, hypertension, diabetes, hepatic diseases, gastrointestinal diseases, and sexually transmitted diseases (Castle, 2019; Quirk et al, 2016).…”