The Comorbid Relationship Between Depression and Borderline Personality Disorder | Guest Post By Kate Harveston

Even though one out of five American adults experienced a mental health disorder within the past year, little remains known about these invisible diseases. Only raising awareness as to the prevalence of such disorders can break the cycle of silence and help people find the help they need. Those lacking chronic mental or physical health issues often envision the as-seen-on-TV method of treatment — the patient goes to the hospital where Dr. House or one of his colleagues breezes by and informs them of the cause of their ailment. In reality, the road to true diagnosis can take months, even years, as many symptoms overlap, as I learned through personal experience. One such comorbid relationship exists between depression and borderline personality disorder.

Clinical Definitions of Depression and Borderline Personality Disorder:

According to the American Psychiatric Association, depression is a mood disorder that disrupts how people feel, think and act. Symptoms of depression include loss of interest in activities formerly enjoyed, loss of energy and fatigue, difficulty concentrating and making decisions, and feelings of guilt or worthlessness. Borderline personality disorder (BPD), on the other hand, consists of unpredictable changes in mood and self-esteem levels but is considered a personality disorder. Those suffering this disorder often demonstrate a pattern of intense yet unstable interpersonal relationships. Many experience trust issues and cannot form the very bonds they crave with others. For a long time, I was being treated for depression because I often exhibited suicidal ideation, which is a characteristic of depression, but also of BPD. It took more than a year for a therapist to identify my condition as BPD.

How Is Borderline Personality Unique?:

An obsession with suicide and a preoccupation with death are trademarks of both depression and BPD. The difference often lies in the interpretation of the cause of suicidal ideation. Those with depression want a way to free themselves from suffering through death and genuinely believe those they love would fare better without them. Those with BPD, conversely, often commit suicide attempts when in the grip of intense rage. Even though those with borderline personality disorder may rail at those they love, inside, they feel guilt over their actions. Some idealize suicide as an act of contrition while others do so to draw attention to that which enrages them. I’ve often felt as if I were letting down my family, my friends, my co-workers — everyone. I felt terrible for flying into destructive rages where I said unforgivable things to those I loved most. I erroneously believed only my death could make up for the hurt I caused. In a way, BPD also shares many characteristics with bipolar disorder. Those who love someone with either may feel as if they never know what to expect from the afflicted person. However, while bipolar disorder typically improves with the right medication, prescriptions usually do little to help those with BPD.

On the Comorbidity of Depression and BPD:

Many people have comorbid diagnoses of both depression and BPD. Sometimes, a single triggering event can cause both disorders. For example, people who grew up in abusive homes often go on to replicate these types of relationships in their adulthood. The impossibility of breaking the cycle causes both rage and despair. Post-traumatic stress disorder can trigger personality changes where the abused person acts histrionically and may even attempt suicide to keep their partner. Unlike mood disorders in which females make up the largest percentage of sufferers, BPD occurs in similar rates between women and men. However, the symptoms vary. Men tend to express their rage through substance abuse and acts of violence, whereas women tend to develop eating disorders. I did both — at times, I rarely ate anything, and at others, I ate like a ravenous bear and then purged. I’ve also struggled with alcoholic tendencies since high school. Alcohol has often been my crutch when I was feeling like I had no other sense of self.

Looking Forward with Courage and Hope:

Since those with personality disorders fail to respond to psychiatric medications, treatment through behavioral therapy works most effectively. I adore my dialectical behavioral therapist, who taught me how to reframe my thoughts in new ways. Folks like me with BPD see the world in movie premier language — things are either spectacular, thrilling and must-see or they’re agonizing, terrifying and devastating. There’s no such thing as shades of gray. Therapy can help those with personality disorders such as BPD put things in perspective. It also teaches us how to see the world through the eyes of another. For those with comorbid depression or bipolar disorder, medications can help. Patients who respond well to antidepressants but who nevertheless struggle with work and home relationships may have undiagnosed BPD.

Reclaiming My Life:

The good news is, with treatment, patients can overcome both mood disorders like depression and personality disorders such as BPD. I am forever grateful for the team who has been helping me, as I’m beginning to feel more peace in life than ever before. If you suspect you suffer from either disorder, please contact a doctor, and know that there is help and hope out there for you.