Living with borderline personality disorder (BPD) can feel overwhelming at times. But for many people, BPD is just one piece of the puzzle. It often shows up alongside other mental health conditions, which can make things feel even more complicated. This is known as co-morbidity, and it’s more common than you might think.
In this article, we’ll explore what co-morbidity means, which mental health conditions commonly occur with BPD, and how to navigate treatment when more than one diagnosis is in the mix. If you’re living with BPD and another condition, you’re not alone.
Table of Contents:
What is co-morbidity?
Co-morbidity (sometimes called dual diagnosis) simply means having two or more conditions at the same time. When it comes to mental health, this might include a mix of mood disorders, anxiety disorders, personality disorders, or even physical health issues.
With BPD, co-morbidity is quite common. In fact, studies suggest that most people with BPD will also meet the criteria for at least one other mental health condition during their lifetime. This overlap can make diagnosis tricky and treatment more complex, but it also offers more insight into a person’s full experience.
Why BPD often comes with other conditions
There are a few reasons why BPD often appears alongside other diagnoses:
- Shared symptoms: Some symptoms of BPD — like intense emotions, mood swings or impulsive behaviour — can also show up in other mental health conditions. This can blur the lines between different diagnoses.
- Early life experiences: BPD is strongly linked with trauma, neglect or unstable relationships in childhood. These experiences can also increase the risk of developing other mental health challenges, like PTSD or anxiety.
- Coping behaviours: People with BPD often use different ways to cope with distress, which can sometimes lead to substance use or eating difficulties. Over time, these coping methods can develop into separate conditions of their own.
Common conditions that occur alongside BPD
Let’s take a look at some of the most common mental health conditions that co-occur with BPD, and how they interact.
Depression
What it is:
Depression is a mood disorder that affects how you feel, think and manage daily life. It often involves deep sadness, lack of motivation and low energy.
How it overlaps with BPD:
People with BPD often experience emotional pain and feelings of emptiness, which can resemble depression. But while BPD mood changes tend to shift quickly (sometimes within hours), depression usually lasts longer and feels more constant.
What to know:
It’s possible to have both BPD and depression. Treatment might involve talking therapies like CBT or DBT, and sometimes medication to help manage mood.
Anxiety disorders
What they are:
This includes generalised anxiety disorder (GAD), panic disorder, social anxiety and phobias. These conditions often involve excessive worry, fear or panic.
How they overlap with BPD:
BPD often comes with a deep fear of abandonment, strong emotional reactions and hyper-awareness of others’ behaviour. These can all feed into feelings of anxiety.
What to know:
Anxiety can make BPD symptoms more intense, and vice versa. Mindfulness and grounding techniques are helpful for both, and therapy can support you in learning to manage anxious thoughts.
Post-traumatic stress disorder (PTSD)
What it is:
PTSD can develop after experiencing or witnessing a traumatic event. Symptoms may include flashbacks, nightmares, hypervigilance and emotional numbing.
How it overlaps with BPD:
Many people with BPD have a history of trauma. In some cases, they may also meet the criteria for PTSD or complex PTSD (C-PTSD), which can develop after long-term trauma.
What to know:
Treating trauma is often a key part of recovery from BPD. Therapies like trauma-focused CBT can be helpful. If trauma is unaddressed, BPD treatment may be less effective.
Bipolar disorder
What it is:
Bipolar disorder involves extreme mood swings between depression and mania or hypomania. These shifts usually last days or weeks.
How it overlaps with BPD:
BPD mood swings are often fast and reactive, changing within hours or even minutes. In bipolar disorder, mood changes are more prolonged and not always triggered by external events.
What to know:
Because both conditions involve mood changes, they’re sometimes confused. Getting the right diagnosis matters, as treatments for bipolar (such as mood stabilisers) may not help with BPD symptoms, and vice versa.
Substance use disorders
What they are:
These involve problematic use of alcohol, drugs or other substances. They can affect judgement, relationships and mental health.
How they overlap with BPD:
Some people with BPD use substances to cope with intense emotions, stress or painful memories. This can lead to a cycle of using and emotional distress.
What to know:
Treatment for both BPD and substance use might involve integrated support, such as DBT programmes designed for dual diagnosis. Breaking the cycle can feel hard, but support is available.
Eating disorders
What they are:
Eating disorders, such as anorexia, bulimia or binge eating disorder, involve unhealthy relationships with food, body image and control.
How they overlap with BPD:
People with BPD may struggle with self-image, impulsivity or emotional regulation, which can contribute to disordered eating behaviours.
What to know:
It’s important to address both the eating disorder and underlying emotional needs. Therapy can help you build self-worth and healthier coping strategies.
Getting the right diagnosis
When symptoms overlap, getting a clear diagnosis can be challenging. You might be told you have one condition at first, only to receive a different diagnosis later on. This can feel confusing or even invalidating, but it’s a common part of the journey.
Mental health professionals use interviews, questionnaires and history-taking to build a full picture. It may take time, but a more accurate diagnosis helps guide the most effective treatment plan.
Don’t be afraid to ask questions or seek a second opinion. You deserve to understand what’s going on and how best to support your mental health.
How co-morbidity affects treatment
When more than one condition is present, treatment needs to be flexible and tailored. Here are some things to keep in mind:
Treatment might take longer
Working on two or more conditions at once can take time. Be patient with yourself. Recovery is a process, and progress can happen in small, meaningful steps.
Therapies may need to be combined
You might benefit from a blend of treatments, such as:
- DBT (dialectical behaviour therapy): A go-to for BPD, this teaches skills to manage emotions, tolerate distress and improve relationships. Find out more about dialectical behaviour therapy.
- CBT (cognitive behavioural therapy): Often used for anxiety, depression and PTSD. Focuses on challenging unhelpful thoughts and behaviours.
- Medication: While there’s no medication specifically for BPD, antidepressants or mood stabilisers may help with co-occurring symptoms.
A supportive team is key
You may need a team of professionals – like a psychiatrist, therapist and GP – working together to support you. Communication between services can make a big difference.
Self-care for BPD and other mental health conditions
Living with BPD and another mental health condition can feel tough, but it’s not a life sentence. With the right support, you can build a life that feels more stable, connected and fulfilling.
Here are a few self-care tips to keep in mind:
- Know your triggers: Keep track of what affects your mood or behaviour. This helps you spot patterns and plan ahead.
- Stick to routines: Regular meals, sleep and movement can support emotional stability.
- Connect with others: Whether it’s friends, family or support groups, connection makes a big difference.
- Be kind to yourself: You are not your diagnosis. It’s okay to have bad days; they don’t undo your progress.
Here are some more self-care tips that could help.
Final thoughts: BPD and other mental health conditions
Co-morbidity with BPD is common, but it doesn’t have to be a barrier to getting better. Understanding how other conditions interact with BPD can help you find the support you need. Whether you’re navigating depression, anxiety, PTSD or another challenge, remember that you’re not alone and recovery is possible.
