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BPD and Depression

When BPD and Depression Co-Occur

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Updated April 28, 2014

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Many people with borderline personality disorder (BPD) also experience problems with depression — in fact, it is very uncommon that BPD and depression do not co-occur. But what is unique about depression in BPD, and how might having both conditions affect your treatment options?

What is Depression?

The term “depression” is actually not a specific diagnosis. Instead, this term refers to the experience of depressed (blue or low) mood. Depression is more than normal sadness. There are a number of mental health conditions that may include elements of depression, including the mood disorders, schizoaffective disorder (a psychotic disorder that includes mood symptoms), and some personality disorders (such as BPD).

Individuals who experience one or more episodes of depressed mood may be diagnosed with major depressive disorder or another disorder depending on whether other symptoms are also present.

For example, someone who experiences both episodes of depressed mood and elevated mood (mania) may be diagnosed with a bipolar disorder (a condition that is frequently confused with BPD). However, depression may also take other forms, such as is dysthymic disorder, which is characterized by chronic, low levels of depressed mood. Depression can also happen outside of these diagnostic categories, such as in bereavement.

BPD and Depression: Scope of the Problem

There is a very high rate of comorbidity between borderline personality disorder (BPD) and depression; meaning many people who have BPD also experience problems with depressed mood. In fact, one study found that about 96% of patients with BPD met criteria for a mood disorder. In this study, about 83% of patients with BPD also met criteria for major depressive disorder, and about 39% of patients with BPD also met criteria for dysthymic disorder.

Is Depression Different in BPD?

Many experts have noticed that depression often presents differently in patients with BPD than in those without. In other words, the quality of depression seems to be different in BPD. For example, whereas depression is typically associated with feelings of sadness or guilt, depression in BPD has been described as being associated with feelings of anger, deep shame (i.e., feeling emotionally like a bad or evil person), loneliness, and emptiness.

People with BPD often describe feeling intensely bored, restless, and/or desperately lonely when they are depressed. Further, depressed episodes in people with BPD are often triggered by interpersonal losses (for example, the breakup of a relationship).

How Does BPD Affect the Course of Depression?

There is fairly conclusive evidence that patients with both a personality disorder and depression have poorer responses to treatment than those without a personality disorder. A meta-analysis of studies examining depression treatment outcome in individuals with both personality disorders (PDs) and depression found that individuals with PDs have poorer responses to treatment regardless of the treatment modality (i.e., medications or psychotherapy).

The good news is that research has shown that if a patient with both BPD and depression is treated for BPD and sees improvement in those symptoms, the symptoms of depression also seem to lift. But, this effect seems to only work in one direction (i.e., treatment solely focused on depression does not seem to alleviate BPD symptoms in patients who have both conditions).

What If I Have BPD and Depression?

If you think you may suffer from BPD and depression, talk to your mental health provider about the best approach to treatment. Research suggests that treatment focused on the BPD symptoms may be most effective in reducing the symptoms of both conditions. For treatment options, see “A Primer on BPD Treatments.”

Sources:

Gunderson JG, Morey LC, Stout RL, Skodol AE, Shea MT, McGlashan TH, et al. "Major Depressive Disorder and Borderline Personality Disorder Revisited: Longitudinal Interactions." Journal of Clinical Psychiatry, 65:1049–1056, 2004.

Newton-Howes G, Tyrer P, Johnson T. "Personality Disorder and the Outcome of Depression: Meta-Analysis of Published Studies." British Journal of Psychiatry, 188:13-20, 2006.

Silk KR. "The Quality of Depression in Borderline Personality Disorder and the Diagnostic Process." Journal of Personality Disorders, 24:25-37, 2010.

Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, Reynolds V. “Axis I Comorbidity of Borderline Personality Disorder.” American Journal of Psychiatry, 155:1733-1739, 1998.

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