Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs.

Keywords:
Risk factors, Substance use disorder, Borderline personality disorder, Comorbidity
1.
Maniglio R: The role of child sexual abuse in the etiology of substance-related disorders. J Addict Dis 2011;30:216-228.
2.
Hasin D, Fenton MC, Skodol A, Krueger R, Keyes K, Geier T, Greenstein E, Blanco C, Grant B: Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders. Arch Gen Psychiatry 2011;68:1158-1167.
3.
Kranzler HR, Rounsaville BJ: Dual Diagnosis and Psychiatric Treatment: Substance Abuse and Comorbid Disorders, ed 2. New York, Dekker, 2004.
4.
Trull TJ, Sher KJ, Minks-Brown C, Durbin J, Burr R: Borderline personality disorder and substance use disorders: a review and integration. Clin Psychol Rev 2000;20:235-253.
5.
Leichsenring F, Leibing E, Kruse J, New AS, Leweke F: Borderline personality disorder. Lancet 2011;377:74-84.
6.
Sher KJ, Trull TJ: Substance use disorder and personality disorder. Curr Psychiatry Rep 2002;4:25-29.
7.
Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ: Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord 2010;24:412-426.
8.
Tomko RL, Trull TJ, Wood PK, Sher KJ: Characteristics of borderline personality disorder in a community sample: comorbidity, treatment utilization, and general functioning. J Pers Disord 2014;28:734-750.
9.
Zanarini MC, Frankenburg FR, Weingeroff JL, Reich DB, Fitzmaurice GM, Weiss RD: The course of substance use disorders in patients with borderline personality disorder and Axis II comparison subjects: a 10-year follow-up study. Addiction 2011;106:342-348.
10.
Verheul R: Co-morbidity of personality disorders in individuals with substance use disorders. Eur Psychiatry 2001;16:274-282.
11.
Morgenstern J, Langenbucher J, Labouvie E, Miller KJ: The comorbidity of alcoholism and personality disorders in a clinical population: prevalence rates and relation to alcohol typology variables. J Abnorm Psychol 1997;106:74-84.
12.
Kraemer HC, Kazdin AE, Offord DR, Kessler RC, Jensen PS, Kupfer DJ: Coming to terms with the terms of risk. Arch Gen Psychiatry 1997;54:337-343.
13.
Kilpatrick DG, Acierno R, Saunders B, Resnick HS, Best CL, Schnurr PP: Risk factors for adolescent substance abuse and dependence: data from a national sample. J Consult Clin Psych 2000;68:19-30.
14.
Hemphill SA, Heerde JA, Herrenkohl TI, Patton GC, Toumbourou JW, Catalano RF: Risk and protective factors for adolescent substance use in Washington State, the United States and Victoria, Australia: a longitudinal study. J Adolesc Health 2011;49:312-320.
15.
Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF: Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics 2003;111:564-572.
16.
Distel MA, Trull TJ, de Moor MM, Vink JM, Geels LM, van Beek JH, Bartels M, Willemsen G, Thiery E, Derom CA, Neale MC, Boomsma DI: Borderline personality traits and substance use: genetic factors underlie the association with smoking and ever use of cannabis, but not with high alcohol consumption. J Pers Disord 2012;26:867-879.
17.
Hernandez A, Arntz A, Gaviria AM, Labad A, Gutierrez-Zotes JA: Relationships between childhood maltreatment, parenting style, and borderline personality disorder criteria. J Pers Disord 2012;26:727-736.
18.
Bradley R, Jenei J, Westen D: Etiology of borderline personality disorder: disentangling the contributions of intercorrelated antecedents. J Nerv Ment Dis 2005;193:24-31.
19.
Chanen AM, Kaess M: Developmental pathways to borderline personality disorder. Curr Psychiatry Rep 2012;14:45-53.
20.
Hawkins JD, Catalano RF, Miller JY: Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychol Bull 1992;112:64-105.
21.
Widiger TA, Trull TJ: Borderline and narcissistic personality disorders; in Sutker P, Adams H (eds): Comprehensive Textbook of Psychopathology. New York, Plenum, 1993, pp 371-394.
22.
van Emmerik-van Oortmerssen K, van de Glind G, Koeter MW, Allsop S, Auriacombe M, Barta C, Bu ET, Burren Y, Carpentier PJ, Carruthers S, Casas M, Demetrovics Z, Dom G, Faraone SV, Fatseas M, Franck J, Johnson B, Kapitany-Foveny M, Kaye S, Konstenius M, Levin FR, Moggi F, Moller M, Ramos-Quiroga JA, Schillinger A, Skutle A, Verspreet S, van den Brink W, Schoevers RA: Psychiatric comorbidity in treatment seeking substance use disorder patients with and without ADHD: Results of the IASP study. Addiction 2014;109:262-272.
24.
van de Glind G, Van Emmerik-van Oortmerssen K, Carpentier PJ, Levin FR, Koeter MW, Barta C, Kaye S, Skutle A, Franck J, Konstenius M, Bu ET, Moggi F, Dom G, Demetrovics Z, Fatseas M, Schillinger A, Kapitany-Foveny M, Verspreet S, Seitz A, Johnson B, Faraone SV, Ramos-Quiroga JA, Allsop S, Carruthers S, Schoevers RA, van den Brink W: The International ADHD in Substance Use Disorders Prevalence (IASP) study: background, methods and study population. Int J Meth Psych Res 2013;22:232-244.
25.
Williams JB, Gibbon M, First MB, Spitzer RL, Davies M, Borus J, Howes MJ, Kane J, Pope HG Jr, Rounsaville B, et al: The structured clinical interview for DSM-III-R (SCID). II. Multisite test-retest reliability. Arch Gen Psychiatry 1992;49:630-636.
26.
Spitzer RL, Williams JB, Gibbon M, First MB: The structured clinical interview for DSM-III-R (SCID). I: history, rationale, and description. Arch Gen Psychiatry 1992;49:624-629.
27.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(suppl 20):22-33.
28.
Epstein JN, Johnson D, Conners CK: Conners Adult ADHD Diagnostic Interview for DSM-IV Technical Manual. North Towanda, Multihealth Systems, 2001.
29.
Widiger TA, Weissman MM: Epidemiology of borderline personality disorder. Hosp Community Psychiatry 1991;42:1015-1021.
30.
Bernardi S, Faraone SV, Cortese S, Kerridge BT, Pallanti S, Wang S, Blanco C: The lifetime impact of attention deficit hyperactivity disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Psychol Med 2012;42:875-887.
31.
Zanarini MC, Horwood J, Wolke D, Waylen A, Fitzmaurice G, Grant BF: Prevalence of DSM-IV borderline personality disorder in two community samples: 6,330 English 11-year-olds and 34,653 American adults. J Pers Disord 2011;25:607-619.
32.
Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ: Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2008;69:533-545.
33.
Paris J: The treatment of borderline personality disorder: implications of research on diagnosis, etiology, and outcome. Annu Rev Clin Psychol 2009;5:277-290.
34.
Bornovalova MA, Hicks BM, Iacono WG, McGue M: Longitudinal twin study of borderline personality disorder traits and substance use in adolescence: developmental change, reciprocal effects, and genetic and environmental influences. Personal Disord 2013;4:23-32.
35.
Bernstein DP, Fink L: Childhood Trauma Questionnaire: A Retrospective Self-Report Manual. San Antonio, The Psychological Corporation, 1998.
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2015
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