BPD more prevelant than previously thought?
When I was reading the Time article on BPD – which is cited below and provides a nice new overview of BPD – I was struck by this quotation:
A 2008 study of nearly 35,000 adults in the Journal of Clinical Psychiatry found that 5.9%–which would translate into 18 million Americans–had been given a BPD diagnosis. As recently as 2000, the American Psychiatric Association believed that only 2% had BPD. (In contrast, clinicians diagnose bipolar disorder and schizophrenia in about 1% of the population.) BPD has long been regarded as an illness disproportionately affecting women, but the latest research shows no difference in prevalence rates for men and women. Regardless of gender, people in their 20s are at higher risk for BPD than those older or younger.
Because generally, it has been acknowledged that BPD occurs in about 2% of the population (which is already equal to the level of bipolar and schizophrenia combined, yet the condition gets much less attention or funding); however, this article states that research has shown that BPD is more than twice as prevalent than previously thought (at 5.9%, which would be almost three times as much as bipolar and schizophrenia combined). Also, the article states that, against the previously published data, there is no difference in prevalence rates between men and women. Typically, the research has shown that BPD patients are 75% female. So, I decided to track down this study and did so. Here is an abstract of the study:
Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ.
Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9304, USA. bgrant@willco.niaaa.nih.gov
OBJECTIVES: To present nationally representative findings on prevalence, sociodemographic correlates, disability, and comorbidity of borderline personality disorder (BPD) among men and women. METHOD: Face-to-face interviews were conducted with 34,653 adults participating in the 2004-2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Personality disorder diagnoses were made using the Wave 2 Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS: Prevalence of lifetime BPD was 5.9% (99% CI = 5.4 to 6.4). There were no differences in the rates of BPD among men (5.6%, 99% CI = 5.0 to 6.2) and women (6.2%, 99% CI = 5.6 to 6.9). BPD was more prevalent among Native American men, younger and separated/divorced/widowed adults, and those with lower incomes and education and was less prevalent among Hispanic men and women and Asian women. BPD was associated with substantial mental and physical disability, especially among women. High co-occurrence rates of mood and anxiety disorders with BPD were similar. With additional comorbidity controlled for, associations with bipolar disorder and schizotypal and narcissistic personality disorders remained strong and significant (odds ratios > or = 4.3). Associations of BPD with other specific disorders were no longer significant or were considerably weakened. CONCLUSIONS: BPD is much more prevalent in the general population than previously recognized, is equally prevalent among men and women, and is associated with considerable mental and physical disability, especially among women. Unique and common factors may differentially contribute to disorder-specific comorbidity with BPD, and some of these associations appear to be sex-specific. There is a need for future epidemiologic, clinical, and genetically informed studies to identify unique and common factors that underlie disorder-specific comorbidity with BPD. Important sex differences observed in rates of BPD and associations with BPD can inform more focused, hypothesis-driven investigations of these factors.
I suppose that the idea that BPD “is associated with considerable mental and physical disability, especially among women” points to the fact that more women seek treatment for the disorder because of the “disability” aspect of its presentation among women. Perhaps that can explain the previously acknowledged statistics of 75% occurrence in women.
9 Comments
John Grohol
I was struck by that number as well, and was doing a little more research on this issue. I wonder if the disconnect is looking at 12-month prevalence versus lifetime prevalence levels…
Another large-scale population survey with results published just a year earlier showed a 1.6% 12-month prevalence level:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2044500
Bon Dobbs
Yes, that makes sense – lifetime vs. 12 month. I have always heard the 1.5-2% rate and didn’t know to which time frame it was related. Thanks for the comment!
Bon Dobbs
You know though… I was thinking about this 12 month vs. lifetime prevalence level – it’s this supposed to be a personality disorder? It would seem that the differences in those statistics would facilitate a discussion about taking the term “personality” out of the name of the disorder.
John Grohol
Good point, but I’d come at it from the opposite direction. Given that personality disorders are, by definition, long-lasting and not always easy to change, they aren’t like Axis I disorders which are typically shorter in duration. So I’m not sure it makes much sense to talk about a 12-month prevalence rate for a personality disorder, since for most people and most personality disorders, they tend to last a lot longer than 12 months.
Bon Dobbs
It seems though that the opposite would make more sense for me. Let’s take bipolar disorder, which is Axis I and no “shorter in duration” than borderline personality disorder. Is it? It seems without medication, since it is a recognized organic disorder, that it would be just as long-lasting as BPD. Clinical Depression or Major Depressive Disorder also, untreated, seems like they would last longer. It seems that your argument can’t go both ways… I mean, if we compare life-time rates in this study of 35,000 individuals and comes up with 5.9% and then we compare 12 month prevalence and come up with 1.6%, how is that explained? To me it makes no sense unless the “personality” disorder falls off at some point, or do I have it wrong.
What I am saying here is that if you ask someone if they have EVER had BPD traits or behaviors (the 5 of 9 criteria) and they say “yes” and then if you ask, have these occurred in last 12 months and they say “no” – it appears that those responses would debunk the “personality” disorder part of the argument.
Amanda
Bon, you wrote: I was thinking about this 12 month vs. lifetime prevalence level – it’s this supposed to be a personality disorder? It would seem that the differences in those statistics would facilitate a discussion about taking the term “personality” out of the name of the disorder.
Exactly! I think that this is just another reason to eventually move BPD to an Axis I disorder. We know that BPD is highly treatable and that over 80% of patients no longer meet criteria for BPD after 10+ years. Add effective treatment, psychoeducation, and an excellent support system and you’ve got a really good prognosis.
We know that some BPD traits (feelings of emptiness, anger) may be more stubbornly enduring than others but, overall, I think you’re right—this isn’t always a lifetime “personality” issue.
Bon Dobbs
No, it’s not a personality disorder. IMO it is a combo of three things – two of which can be attributed to biology and one of which can be attributed to environment – those are emotional dysregulation (biology), impulsiveness (biology) and shame (environment). But shame is only develops when the previous two are rejected as invalid by others. It is a biological disorder of emotional dysregulation and impulsiveness. And when those two collide, the behaviors that result are rejected as invalid by parents, peers and others – which spurs shame. I believe it is a biological disorder which is not recognized as such by current science. It is categorized as a personality disorder in error. Sure, it’s long-term – but IMO so is biploar I and epilepsy. Right? It is time to lay down the Axis II (for ALL the axis II disorders) and meet the challenges head on. I’m sorry (I’m just a lay person) but I can’t understand how I have two twin girls (fraternal), raised in the same environment, the same womb, the same room and with the same rules – and have one that is BPD-ish and one who is not. Explain that to me doctors, please.
Bon
Tormented
Bon Dobbs,
It seems that BPD has a genetic component and recent research is backing up that assessment. As you know, fraternal twins have different genes, so that could provide some of the answer to your question.
A Missouri University research working with Dutch associates and their twin registry database came to the conclusion that chromosome 9 looks like it most likely has genetic linkage for BPD, but chromosomes 1, 4, and 18 might also have some involvement.
BPD Linked to Human Chromosome 9
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