Major Depression in Patients With Borderline
Personality Disorder: A Clinical Investigation
Silvio Bellino, MD1, Luca Patria, MD2, Erika Paradiso, MD3, Rossella Di Lorenzo, PhD4,
Caterina Zanon, MD3, Monica Zizza, PhD4, Filippo Bogetto, MD5
Findings from several studies concur that most patients
with borderline personality disorder (BPD) have
comorbid Axis I disorders during their lifetime (1–3).
Comorbiditywithmajor depressive disorder (MDD) is gener-
ally considered the most common, with rates ranging from
53% to 83%. The reasons for this frequent coexistence remain
controversial. Some authors have suggested that MDD and
BPD may be the expression of a common underlying patho-
logical process, while others have objected that these
disorders may simply coexist without sharing any physio-
pathological mechanism (4–8).
! Can J Psychiatry, Vol 50, No 4, March 2005
Objective: Borderline personality disorder (BPD) is characterized by a high frequency of comorbidity
with major depressive disorder (MDD). This study aimed to compare the clinical characteristics of 2
groups of patients with MDD: those with concomitant BPD and those with other concomitant
Methods: We assessed 119 outpatients, using a semistructured interview for demographic and clinical
features, the Structured Clinical Interview for DSM-IV, Hamilton anxiety and depression scales, the
Zung Self-Rating Depression Scale (ZSDS), the Social and Occupational Functioning Assessment
Scale (SOFAS), the Sheehan Disability Scale, and the Revised Childhood Experiences Questionnaire.
We performed a regression analysis, using the number of criteria for BPD as the dependent variable.
Results: Severity of BPD was positively related to the ZSDS score, to self-mutilating behaviours, and
to the occurrence of mood disorders in first-degree relatives; it was negatively related to the SOFAS
score and age at onset of MDD.
Conclusions: Patients with comorbid MDD and BPD present differential characteristics that indicate
a more serio