Borderline personality disorder and its association with bipolar spectrum and binge eating disorder in college students from South India
Introduction
Borderline personality disorder (BPD) is a complex and serious psychiatric disorder affecting approximately 0.7–5.9% of the general population (Swartz et al., 1990; Lenzenweger et al., 2007). It is a devastating mental illness that centers on the inability to manage emotions effectively. The symptoms include: fear of abandonment, impulsivity, rage, bodily self‐harm, suicide, and chaotic relationships. There is a high rate of attempted suicide and approximately 10% of adults with BPD commit suicide (Skodol et al., 2002). The symptoms lead to impairment in psychosocial functioning and high rates of mental health treatment utilization (Bender et al., 2001). It is known that BPD is underdiagnosed in most clinical settings, which can lead to delay in starting appropriate treatment or sometimes, lead to unnecessary treatment.
Personality disorder has its origins in childhood and adolescence, however, diagnosing personality disorder before 18 years is difficult considering evolving nature of the disorder. Recent studies found that borderline personality and mood disorders in youth can be diagnosed with more certainty (Newton-Howes et al., 2015). BPD is recognizable early in life, evolves continuously across the lifespan, and is more plastic than previously believed. BPD or symptoms of borderline personality in young people is associated with high morbidity and potentially poor outcomes. BPD independently predicts current psychopathology, poor general functioning, poor self-care, and poor relationships with family, peers, and significant others (Chanen et al., 2007; Kaess et al., 2012). In a community-based sample of children and adolescents, the prevalence of borderline personality disorder was 11% at age 9–19 years and 22% at 15–25 years (Bernstein et al., 1993). BPD is more common in women than in men (about 70% and 30%, respectively) (Widiger and Weissman, 1991).
Individuals with BPD are also vulnerable to develop eating disorders like binge-eating episodes followed by self-harm demonstrated through induced vomiting or other purging behaviors as well as mood disorders. The most common personality disorder in bulimia nervosa was borderline personality disorder, with a prevalence rate of 28% (Sansone and Sansone, 2011). Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating accompanied by feeling a lack of control and marked distress over one’s eating behaviors. It has been found that BED is a serious condition that impairs health-related quality of life and increases health care costs (Ágh et al., 2015). BED has been linked with several comorbid health conditions, including diabetes, hypertension, stroke, and heart disease, and other psychiatric illnesses such as anxiety and depression (Kessler et al., 2013). Effective treatments for BED have the potential to reduce the burden of BED on patients and the health care system.
Bipolar disorder has its onset in youth; 70% of individuals experience their first symptoms before age 25, with the peak onset at age 17 (Lish et al., 1994). Both in BPD and bipolar disorder, symptoms appear from puberty through to young adulthood. They frequently co-occur, can reinforce one another, and can be difficult to differentiate clinically. Several studies have found subthreshold symptoms prior to onset of syndromal bipolar disorder, which are identified in retrospect (Bechdolf et al., 2012). Delay in the diagnosis of bipolar disorder can lead to neuroprogression, poor psychosocial adjustment and increased rates of hospitalization for episodes, at least in a subset of patients.
There is a paucity of studies that looked at prevalence rates of BPD in Indian population. Pinto et al. (2000) carried out the first study on BPD in India; they found 17% suicide attempters presenting to hospital had borderline personality disorder. The prevalence of such symptoms in nonclinical Indian population is not known. We aimed to study prevalence of borderline personality and its association with binge-eating and bipolar spectrum disorder in college students. The objective was to study the prevalence of borderline personality, binge-eating and bipolar spectrum disorder (BSD) in college students using self-report measures. The second objective was to study the association between BPD with BSD and BED, and their association with socio-demographic variables.
Section snippets
Participants
This was an epidemiological questionnaire based survey conducted from April 2017 to September 2017 in Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka. The study was approved by the Institutional Ethics Committee. Sample consisted of 500 students (250 were medical students and 250 were engineering students). Convenience sampling was used. Estimated sample based on 20% prevalence, 95% confidence interval and 5% precision for infinite sample was 246. Eligibility criteria was
Results
The sample characteristics are summarized in Table 1. The mean age of the sample was 19.9 (SD 1.9) years. There were 52.6% females in the sample. Majority of the sample were from nuclear family (83.6%) and middle socioeconomic status (85.8%). The Cronbach’s α for MSI-BPD and BEDS-7 were 0.802 and 0.887, respectively, which is considered ‘good’, and for MDQ it was 0.771, which is ‘acceptable’ (George and Mallery, 2003). Among the students, the prevalence of BPD using MSI-BPD was 76 (15.2%) with
Discussion
Prevalence of BPD in our study, using MSI-BPD was 15.2% (95% CI 12.3 to 18.6%), which was similar to the study by Chanen et al. (2008). This was much lower than the Zanarini et al. (2003) study that found 69.5% participants meeting the criteria for BPD. The reason for higher prevalence could be because they recruited subjects through advertisements. Also, the mean age of Zanarini et al. (2003) sample was 33.6 (SD 11.1), which was much higher than our sample (mean age 19.9, SD 1.9) and 18.8 (SD
Funding source
The first author received Short Term Studentship (STS) fund in 2018 from Kasturba Medical College (KMC), Manipal, India for carrying out this project.
Acknowledgment
None.
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