Co-Occurring Antisocial and Borderline Personality Disorders: A Single Syndrome? - Abstract
It has been proposed that antisocial/borderline personality disorder (PD) might, for the purposes of classification, etiology and treatment, be considered as a single syndrome. This paper examines recent evidence relating to the epidemiology, presentation and treatment of patients with antisocial/borderline PD comorbidity. Viewed through the lens of the recently proposed Hierarchical Taxonomy of Psychopathology (HiTOP), antisocial/borderline comorbidity can be seen as due to associations between broad liability factors - internalizing, thought disorder, disinhibited externalizing and antagonistic externalizing - rather than to disorder-specific associations. An affirmative answer to the question of whether antisocial/ borderline comorbidity represents a single syndrome needs to be qualified by a recognition that the syndrome extends beyond the limits of antisocial, borderline and other comorbid PDs; it encompasses other psychiatric disorders such as childhood conduct disorder, intermittent explosive disorder and substance abuse. Results of two recent treatment trials offer hope that patients presenting with antisocial/borderline comorbidity may be treatable, although further treatment trials with seriously violent offenders will be required to justify this initial optimism. It is suggested that treatments should focus on broad liability factors rather than on specific disorders.