Diagnosis and Treatment of Comorbid Borderline Personality Disorder and Substance Use Disorder

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Approximately 1% of the general population meets criteria for borderline personality disorder (BPD) diagnosis. In these individuals, the lifetime prevalence of substance use disorder (SUD) is very high. The patients suffering from both BPD and SUD seem to be a more impaired subpopulation. They present with an earlier onset of SUD, an increased addiction severity, and greater impairment in functioning. There is only a small amount of data available on treatment approaches for co-occurring SUD and BPD. Therefore, we decided to present a typical case of a patient presenting with concurrent BPD and SUD and to review the literature of the different treatment approaches available for these patients. In light of the limited data available, it seems that the pharmacological treatment of alcohol use disorder (AUD), in patients suffering from concurrent BPD and AUD, should be considered early in the therapeutic process as the evidence does not show that it less efficacious in this subgroup. We can also affirm that these patients are likely to respond to structured integrative care, including Dialectical Behavioral Therapy for SUD, evidence-based relapse prevention pharmacotherapy for addiction and 12 steps programs. Deconstructive Dynamic Psychotherapy could also be beneficial, but the results of the studies would need to be replicated. Dual-Focus Schema Therapy appeared to offer limited and inconsistent benefits. In this article, we wanted to convey the need for comprehensive approaches, specifically with patients suffering from BPD and SUD, who tend to be marginalized.

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