Borderline personality disorder may contribute to heart attack among middle-aged adults

Reviewed by Kate Anderton, B.Sc. (Editor)Oct 28 2019

Middle-aged adults who show symptoms of borderline personality disorder may be at greater risk for a heart attack, as they show physical signs of worsening cardiovascular health more than other adults, according to research published by the American Psychological Association.

Although borderline personality disorder is well studied for its relationship to psychological and social impairments, recent research has suggested it may also contribute to physical health risks. Our study suggests that the effects of this disorder on heart health are large enough that clinicians treating patients should recommend monitoring their cardiovascular health.

Whitney Ringwald MSW, MS, of the University of Pittsburgh and lead author of the study

The study was published in Personality Disorders: Theory, Research, and Treatment.

Borderline personality disorder is characterized by intense mood swings, impulsive behaviors, and extreme emotional reactions. Their inability to manage emotions often makes it hard for people with borderline personality disorder to finish school, keep a job, or maintain stable, healthy relationships. According to the National Institute of Mental Health, 1.4% of adults have BPD, but that number does not include those with less severe symptoms, who nevertheless may experience clinically significant impairments, said Aidan Wright, PhD, of the University of Pittsburgh and another author of the study.

"It can be challenging to treat BPD because you are seeking to change a person's longstanding patterns of thinking, feeling and behaving that are very well ingrained," he said. "There are several evidence-based treatment options that can be helpful, so there are many reasons to be optimistic, but treatment may take a long time."

The researchers analyzed health data from 1,295 participants in the University of Pittsburgh Adult Health and Behavior Project. This is a registry of behavioral and biological measurements from non-Hispanic white and African American adults, 30 to 50 years old, recruited between 2001 and 2005 in southwestern Pennsylvania. The researchers looked at self-reported basic personality traits, as well as those reported by up to two of the participants' friends or family members, and self-reported symptoms of depression. By combining several physical health measurements, including blood pressure, body mass index and the levels of insulin, glucose, cholesterol and other compounds in the blood after a 12-hour fast, the researchers established a relative cardiovascular risk score for each participant.

They found a significant association between borderline personality traits and increased cardiovascular risk. The researchers also looked at the potential role of depression, as people with BPD are also often depressed. While borderline personality traits and depression were both significantly associated with cardiovascular risk the effect of borderline traits was independent of depression symptoms.

"We were surprised by the strength of the effect and we found it particularly interesting that our measure of borderline personality pathology had a larger effect, and a unique effect, above and beyond depression in predicting heart disease." said Wright. "There is a large focus on depression in physical health, and these findings suggest there should be an increased focus on personality traits, too."

The researchers said their findings have important implications for primary care doctors and mental health professionals who treat patients with BPD.

"Mental health practitioners may want to screen for cardiovascular risk in their patients with BPD, " said Wright. "When discussing the implications of a personality disorder diagnosis with patients, practitioners may want to emphasize the link with negative health outcomes and possibly suggest exercise and lifestyle changes if indicated. Primary care physicians should attend to personality as a risk factor when monitoring patients for long-term health as well."