Rosh Psychiatry Board Practice Exam

What is the most prevalent comorbidity seen in patients with borderline personality disorder?

1. Autism spectrum disorder

2. Substance use disorder

3. Schizophrenia

4. Major depressive disorder

The correct answer is: Substance use disorder

Substance use disorder is recognized as the most prevalent comorbidity in patients with borderline personality disorder (BPD). This relationship is significant, as the impulsivity and emotional dysregulation often associated with BPD can lead individuals to engage in substance use as a maladaptive coping mechanism. The prevalence of substance use disorders among those with BPD has been noted to be particularly high, with estimates suggesting that around 30-60% of individuals with BPD may also have a substance use disorder at some point in their lives. Furthermore, the presence of substance use disorders in patients with BPD complicates treatment and increases the overall severity of their symptoms. The simultaneous occurrence of both disorders often exacerbates the emotional instability and relationship difficulties that characterize BPD, leading to higher rates of hospitalizations, suicidality, and poorer treatment outcomes. While other comorbidities such as major depressive disorder, schizophrenia, and autism spectrum disorder do exist among those with borderline personality disorder, they are less prevalent compared to substance use disorders. Major depressive disorder is indeed common, but it does not reach the rates seen with substance use. Schizophrenia is relatively uncommon in this population, and autism spectrum disorder is not typically noted as a common comorbidity. Thus