Nabel Jana, Bertele Sebastian, Stapel Britta, Scharn Nicole, Kahl Kai G
Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Front Psychiatry. 2025 Mar 25;16:1539611. doi: 10.3389/fpsyt.2025.1539611. eCollection 2025.
Borderline personality disorder (BPD) patients exhibit high rates of co-occurring mental disorders. Though literature reports varying prevalence of substance use disorders (SUD) in BPD, they are frequent with prevalence rates of approximately 45%. This study examines the 12-month prevalence of SUDs in a German sample of BPD patients by semi-structured interviews and compared to medical records.
N=126 BPD patients were included. Twelve-month SUD prevalence was obtained by semi-structured clinical interview (SCID) and compared to reported prevalence in the general population and to diagnoses from medical records.
Mean age of the sample was 37.5 (SD ± 11.5) years and N=61 (48%) patients were female. Compared to the general population, increased 12-month prevalence based on SCID was found for alcohol abuse (22.2%, +7.9-times), alcohol dependence (17.5%, +5.6-times), cannabis abuse (15.1%, +30.2-times), cannabis dependence (19.0%, +31.7-times), sedative abuse (3.2%, +4.6-times) and sedative dependence (3.2% +4.6-times). N=43 (34.1%) patients presented at least one diagnosis of substance abuse and N=43 (34.1%) presented at least one diagnosis of substance dependence. N=51 (40.1%) patients were diagnosed with at least one substance use or dependence disorder. On average, prevalence based on SCID exceeded prevalence obtained from medical records. Particularly, alcohol abuse (3.5-times), cannabis abuse (2.4-times) and dependence (2.2-times), and sedative- and stimulant abuse (both no diagnosis in medical record . 3.2% in SCID) were underrecognized. Furthermore, concordance rates between diagnoses based on medical record and SCID were below 30% for all substances.
Our data confirm high prevalence of SUDs in BPD patients. Of note, medical records underrecognized alcohol abuse and cannabis abuse and dependence. Substance abuse and dependence are primary risk factors of suicidal behaviors and completed suicide. SUDs have been shown to be amenable to psychotherapeutic interventions. Therefore, careful diagnosis of SUD by e.g. expert structured interviews and integration of SUDs in a multimodal treatment plan is recommended.
边缘型人格障碍（BPD）患者共病精神障碍的发生率很高。尽管文献报道BPD患者物质使用障碍（SUD）的患病率各不相同，但这些障碍很常见，患病率约为45%。本研究通过半结构化访谈调查了德国BPD患者样本中SUD的12个月患病率，并与病历进行了比较。
纳入了N = 126名BPD患者。通过半结构化临床访谈（SCID）获得12个月的SUD患病率，并与一般人群中报告的患病率以及病历诊断结果进行比较。
样本的平均年龄为37.5（标准差±11.5）岁，N = 61名（48%）患者为女性。与一般人群相比，基于SCID发现酒精滥用（22.2%，增加7.9倍）、酒精依赖（17.5%，增加5.6倍）、大麻滥用（15.1%，增加30.2倍）、大麻依赖（19.0%，增加31.7倍）、镇静剂滥用（3.2%，增加4.6倍）和镇静剂依赖（3.2%，增加4.6倍）的12个月患病率有所增加。N = 43名（34.1%）患者至少有一项物质滥用诊断，N = 43名（34.1%）患者至少有一项物质依赖诊断。N = 51名（40.1%）患者被诊断患有至少一种物质使用或依赖障碍。平均而言，基于SCID的患病率超过了病历中的患病率。特别是，酒精滥用（3.5倍）、大麻滥用（2.4倍）和依赖（2.2倍），以及镇静剂和兴奋剂滥用（病历中均无诊断，SCID中为3.2%）未得到充分认识。此外，基于病历和SCID的诊断之间的一致性率对于所有物质均低于30%。
我们的数据证实了BPD患者中SUD的高患病率。值得注意的是，病历未充分认识到酒精滥用、大麻滥用和依赖。物质滥用和依赖是自杀行为和自杀完成的主要危险因素。SUD已被证明可通过心理治疗干预。因此，建议通过例如专家结构化访谈仔细诊断SUD，并将SUD纳入多模式治疗计划。
