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Borderline personality disorder co-morbidity: relationship to the internalizing–externalizing structure of common mental disorders

Published online by Cambridge University Press:  14 September 2010

N. R. Eaton ,
R. F. Krueger ,
K. M. Keyes ,
A. E. Skodol ,
K. E. Markon ,
B. F. Grant  and
D. S. Hasin
N. R. Eaton*
Affiliation:
University of Minnesota, Minneapolis, MN, USA
R. F. Krueger
Affiliation:
University of Minnesota, Minneapolis, MN, USA
K. M. Keyes
Affiliation:
Columbia University, New York, NY, USA
A. E. Skodol
Affiliation:
Columbia University, New York, NY, USA University of Arizona, Tucson, AZ, USA
K. E. Markon
Affiliation:
University of Iowa, Iowa City, IA, USA
B. F. Grant
Affiliation:
National Institute on Alcohol Abuse and Alcoholism, USA
D. S. Hasin
Affiliation:
Columbia University, New York, NY, USA
*
*Address for correspondence: N. R. Eaton, M.A., Department of Psychology, 75 East River Road, University of Minnesota, Minneapolis, MN 55455-0344, USA. (Email: nreaton@gmail.com)
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Abstract

Background

Borderline personality disorder (BPD) shows high levels of co-morbidity with an array of psychiatric disorders. The meaning and causes of this co-morbidity are not fully understood. Our objective was to investigate and clarify the complex co-morbidity of BPD by integrating it into the structure of common mental disorders.

Method

We conducted exploratory and confirmatory factor analyses on diagnostic interview data from a representative US population-based sample of 34 653 civilian, non-institutionalized individuals aged ⩾18 years. We modeled the structure of lifetime DSM-IV diagnoses of BPD and antisocial personality disorder (ASPD), major depressive disorder, dysthymic disorder, panic disorder with agoraphobia, social phobia, specific phobia, generalized anxiety disorder, post-traumatic stress disorder, alcohol dependence, nicotine dependence, marijuana dependence, and any other drug dependence.

Results

In both women and men, the internalizing–externalizing structure of common mental disorders captured the co-morbidity among all disorders including BPD. Although BPD was unidimensional in terms of its symptoms, BPD as a disorder showed associations with both the distress subfactor of the internalizing dimension and the externalizing dimension.

Conclusions

The complex patterns of co-morbidity observed with BPD represent connections to other disorders at the level of latent internalizing and externalizing dimensions. BPD is meaningfully connected with liabilities shared with common mental disorders, and these liability dimensions provide a beneficial focus for understanding the co-morbidity, etiology and treatment of BPD.

Keywords

Borderline personality disorderco-morbidityinternalizing–externalizinglatent structure
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 5 , May 2011 , pp. 1041 - 1050
Copyright
Copyright © Cambridge University Press 2010

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