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Borderline personality disorder: health service use and social functioning among a national household population

  • J. Coid (a1), M. Yang (a1), P. Bebbington (a2), P. Moran (a3), T. Brugha (a4), R. Jenkins (a5), M. Farrell (a5), N. Singleton (a6) and S. Ullrich (a1)...

It is unclear whether Axis II psychopathology or co-morbid clinical syndromes result in the treatment-seeking behaviour and social impairment of patients with borderline personality disorder (BPD). This study examined the independent associations between social functioning and service use and Axis I and Axis II disorders in persons with BPD in the national household population of Britain.


The study was a cross-sectional survey of adults aged 16–74 years in households (n=8397). Data included self-reported consultations with health-care professionals and behavioural problems. Diagnosis was determined by computer-assisted interviews. Analyses included logistic regression adjusting for demography, co-morbid Axis I clinical syndromes and other Axis II disorders.


Consultation in the past year was reported by 57.5% of persons with BPD but only 13.4% reported lifetime psychiatric admission. BPD was not independently associated with impaired functioning but was associated with co-morbid psychotic, depressive and anxiety disorders. Only general practitioners (GPs) were consulted for problems independently due to BPD.


Functional effects of BPD are mediated through co-morbid clinical syndromes, not Axis II psychopathology. A subgroup do not have co-morbid disorders or seek treatment, and are high functioning.

Corresponding author
*Address for correspondence: Professor J. Coid, Forensic Psychiatry Research Unit, St Bartholomew's Hospital, William Harvey House, 61 Bartholomew Close, London EC1A 7BE, UK. (Email:
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DS Bender , RT Dolan , AE Skodol , CA Sanislow , IR Dyck , TH McGlashan , MT Shea , MC Zanarini , JM Oldham , JG Gunderson (2001). Treatment utilization by patients with personality disorders. American Journal of Psychiatry 158, 295302.

M Chiesa , P Fonagy , J Holmes , C Drahorad , A Harrison-Hall (2002). Health service use costs by personality disorder following specialist and nonspecialist treatment: a comparative study. Journal of Personality Disorders 16, 160173.

J Coid , A Petruckevitch , P Bebbington , T Brugha , D Bhugra , M Farrell , G Lewis , N Singleton (2002). Ethnic differences in prisoners. II: Risk factors and psychiatric service use. British Journal of Psychiatry 181, 481487.

J Coid , M Yang , P Tyrer , A Roberts , S Ullrich (2006). Prevalence and correlates of personality disorder in Great Britain. British Journal of Psychiatry 188, 423431.

JW Coid (1993). An affective syndrome in psychopaths with borderline personality disorder? British Journal of Psychiatry 162, 641650.

KA Comtois , J Russo , M Snowden , D Srebnik , R Ries , P Roy-Byrne (2003). Factors associated with high use of public mental health services by persons with borderline personality disorder. Psychiatric Services 54, 11491154.

KM Connor , JRT Davidson , DC Hughes , MS Swartz , DG Blazer , LK George (2002). The impact of borderline personality disorder on post-traumatic stress in the community: a study of health status, health utilization, and functioning. Comprehensive Psychiatry 43, 4148.

R Frankenburg-Francis , MC Zanarini (2006). Personality disorders and medical comorbidity. Current Opinion in Psychiatry 19, 428431.

G Goodman , JW Hull , JF Clarkin , FE Yeomans (1998). Comorbid mood disorders as modifiers of treatment response among inpatients with borderline personality disorder. Journal of Nervous and Mental Disease 186, 616622.

C Hunt , A Gavin (1992). Measuring personality disorder: the use of self-report questionnaires. Journal of Personality Disorders 6, 125133.

HW Koenigsberg , I Anwunah , AS New , V Mitropoulou , F Schopick , LJ Siever (1999). Relationship between depression and borderline personality disorder. Depression and Anxiety 10, 158167.

MF Lenzenweger , MC Lane , AW Loranger , RC Kessler (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62, 553564.

PS Links , M Steiner , J Mitton (1989). Characteristics of psychosis in borderline personality disorder. Psychopathology 22, 188193.

TH McGlashan (1983). The borderline syndrome: II. Is it a variant of schizophrenia or affective disorder? Archives of General Psychiatry 40, 13191323.

TH McGlashan (1987). Borderline personality disorder and unipolar affective disorder: long-term effects of comorbidity. Journal of Nervous and Mental Disease 175, 467473.

M O'Connell , S Cooper , JC Perry , L Hoke (1989). The relationship between thought disorder and psychotic symptoms in borderline personality disorder. Journal of Nervous and Mental Disease 177, 273278.

J Paris , H Zweig-Frank (2001). A 27-year follow-up of patients with borderline personality disorder. Comprehensive Psychiatry 42, 482487.

JC Perry (1988). A prospective study of life stress, defenses, psychotic symptoms, and depression in borderline and antisocial personality disorders and bipolar type II affective disorder. Journal of Personality Disorders 2, 4959.

HG Pope Jr, JM Jonas , JI Hudson , BM Cohen , JG Gunderson (1983). The validity of DSM-III borderline personality disorder: a phenomenologic, family history, treatment response, and long-term follow-up study. Archives of General Psychiatry 40, 2330.

A Rendu , P Moran , A Patel , M Knapp , A Mann (2002). Economic impact of personality disorders in UK primary care offenders. British Journal of Psychiatry 181, 6266.

AE Skodol , JG Gunderson , TH McGlashan , IR Dyck , RL Stout , DS Bender , CM Grilo , MT Shea , MC Zanarini , LC Morey , CA Sanislow , JM Oldham (2002). Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. American Journal of Psychiatry 159, 276283.

AE Skodol , JM Oldham , SE Hyler , DJ Stein , E Hollander , PE Gallaher , AE Lopez (1995). Patterns of anxiety and personality disorder comorbidity. Journal of Psychiatric Research 29, 361374.

AE Skodol , RL Stout , TH McGlashan , CM Grilo , JG Gunderson , T Shea , LC Morey , MC Zanarini , IR Dyck , JM Oldham (1999). Co-occurrence of mood and personality disorders: a report from the Collaborative Longitudinal Personality Disorders Study (CLPS). Depression and Anxiety 10, 175182.

T Stockwell , D Murphy , R Hodgson (1983). The Severity of Alcohol Dependence questionnaire: its use, reliability and validity. British Journal of Addiction 78, 145155.

S Torgersen , E Kringlen , V Cramer (2001). The prevalence of personality disorders in a community sample. Archives of General Psychiatry 58, 590596.

P Tyrer , R Mulder (2006). Management of complex and severe personality disorders in community mental health services. Current Opinion in Psychiatry 19, 400404.

S Ullrich , D Deasy , J Smith , B Johnson , M Clarke , N Broughton , J Coid (2008). Detecting personality disorders in the prison population of England and Wales: comparing case identification using the SCID-II Screen and Clinical Interview. Journal of Forensic Psychiatry and Psychology 19, 301322.

MC Zanarini , FR Frankenburg (2001). Attainment and maintenance of reliability of Axis I and Axis II disorders over the course of a longitudinal study. Comprehensive Psychiatry 42, 369374.

MC Zanarini , FR Frankenburg , J Hennen , DB Reich , KR Silk (2006). Prediction of the 10-year course of borderline personality disorder. American Journal of Psychiatry 163, 827832.

MC Zanarini , FR Frankenburg , AA Vujanovic , J Hennen , DB Reich , KR Silk (2004). Axis II comorbidity of borderline personality disorder: description of 6-year course and prediction to time-to-remission. Acta Psychiatrica Scandinavica 110, 416420.

M Zimmerman (1994). Diagnosing personality disorders. A review of issues and research methods. Archives of General Psychiatry 51, 225245.

M Zimmerman , JI Mattia (1999). Axis I diagnostic comorbidity and borderline personality disorder. Comprehensive Psychiatry 40, 245252.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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