Co-Occurring Antisocial and Borderline Personality Disorders: A Single Syndrome?
- 1. Institute of Mental Health, University of Nottingham, UK
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.