Comorbidity in EUPD/BPD and Mental Health

by Yasemin Cakirin Mental Healthon Posted on

In my past couple of blogs I have mentioned comorbidity, but not delved much deeper into it. Today, I’ll be doing exactly that; exploring what comorbidity means and discovering its relevance in EUPD/BPD specifically.

What is Comorbidity?

Comorbidity refers to two or more conditions co-existing within the same individual. For example, someone with depression also being diagnosed with an eating disorder, or anxiety. The rates of comorbidity in mental health are very high, and even more so specifically for EUPD/BPD. Let’s find out why…

Comorbidity in EUPD/BPD

The comorbidity rate for EUPD/BPD is around 85%, making it one of the most comorbid psychiatric conditions. There are multiple explanations that could tie into it such as;

  • Shared Risk Factors

A lot of psychiatric conditions have similar risk factors such as

-Childhood Trauma (Abuse, neglect, emotionally invalidating environment, unstable attachment)
-Neurological differences, specifically in areas related to emotional regulation and impulse control.
-Genetic predisposition

  • The Core of BPD and Common Secondary Conditions

EUPD/BPD is fundamentally a disorder of emotional dysregulation and the difficulty in managing these emotions appropriately increase the risk for secondary conditions such as depression, anxiety and PTSD as well as mood disorders such as MDD (Major Depressive Disorder) with nearly all individuals (approximately 96%) diagnosed with EUPD/BPD also suffering with a Mood Disorder during their lifetime with MDD taking the lead in this category at 71-83% of cases.

Again, another common condition is anxiety – with 88% of patients with EUPD/BPD reporting symptoms qualifying for a diagnosis of an anxiety disorder such as panic attacks or PTSD.

In addition to the above, eating disorders such as restrictive eating and bulimia as well as substance use disorders are commonly noted in EUPD/BPD patients.

Contributing Risk Factors


There are many contributing risk factors included in comorbidity which can happen at any stage in life and increase the possibility or comorbidity with EUPD/BPD. These can include;

  • Emotional Dysregulation

We have discussed how EUPD/BPD can cause severe mood instabilities, which can lead to vulnerability to other mental health conditions.

  • Shared Risk Factors

As described above, genetic predisposition, childhood trauma and a high scoring with ACE’s are common shared risk factors with EUPD/BPD and other mental health conditions.

  • Symptom Overlapping

As discussed in Alice’s story, initial misdiagnosis in EUPD/BPD patients is quite common. This is because so many of the symptoms faced in EUPD/BPD such as emotional dysregulation, self-injury and suicidal ideation, loss of hope and self worth, mood swings and changes in behaviour are common symptoms for other mental health conditions including other personality and mood disorders.

Different symptoms of the conditions can cause additional challenges during diagnosis. For example,

Mood swings in EUPD/BPD can look like Bipolar Disorder,
Self-injury and suicidal ideation can look like MDD,
Impulsivity can look like ADHD.

  • Maladaptive Coping Mechanisms

Maladaptive coping mechanisms such as self-injury, excessive spending, reckless behaviour, unsafe sex, substance misuse can be common with BPD, these can then lead to separate disorders in time.

Misdiagnosis and Challenges in Treatment

For the reasons discussed above, misdiagnosis is very common in EUPD/BPD. This can cause a number of difficulties in treatment. From my own journey, I know that if I was not diagnosed with EUPD that I would not have access to SCM (Structured Clinical Management) and although I have not been misdiagnosed, simply focusing on my other conditions without considering EUPD has seen me wait nearly 20 years for the correct treatment.

Although there is not a specific medication solely for EUPD/BPD, a combination of medications and therapy such as DBT (Dialect Behaviour Therapy) and CBT (Cognitive Behaviour Therapy) alongside trauma focused therapy usually see the best results as SSRI/SNRI’s and mood stabilisers, although used frequently to treat other comorbidities within EUPD/BPD, they do not provide a holistic approach, leaving much untreated.

How Comorbidity Affects Suicide and Self-Injury Rates

EUPD/BPD already has a very high rate of suicide, with every 1 in 10 diagnosed individuals passing by suicide. When this is joined with one or more comorbidities, the risk increases.

Crisis Intervention & Prevention Strategies

  • Therapy: A combination of DBT, CBT, and trauma-focused therapy is most effective in managing co-occurring conditions.
  • Distraction Techniques: Engaging in self-soothing activities, grounding exercises, and mindfulness techniques can reduce impulsive self-harm urges.
  • Crisis Helplines: Immediate access to mental health crisis services and support groups can be lifesaving.

Resources For Further Support

If you or someone you know is struggling, the following resources may be helpful:

Sources