The complexities of the borderline patient: how much more complex when considering physical health?

Borderline Personality Disorder is associated with a substantially reduced life expectancy, mostly due to physical health conditions that are life-shortening. This clinical review highlights pertinent risk issues for such conditions in Borderline Personality Disorder and suggests ways in which clinicians might address these.

Selective literature review.

People with Borderline Personality Disorder have a reduced life expectancy of some 20 years, attributable largely to physical health maladies, notably cardiovascular. Risk factors include obesity, sedentary lifestyle, poor diet and smoking. Added to these are other physical health problems, including poor sexual health, self-harm, substance use and blood-borne viruses. Chronic pain and opioid and benzodiazepine use are also common in people with Borderline Personality Disorder. Some psychiatric medications commonly used in people with Borderline Personality Disorder - notably certain antipsychotic agents - can add to the metabolic burden. Barriers to care include self-stigma and erratic adherence to medical care, as well as stigma on the part of clinicians, who often do not screen or provide adequate care for the physical health problems suffered by people with Borderline Personality Disorder.

Clinicians need to be aware of the physical health problems in people with Borderline Personality Disorder and ensure appropriate screening and interventions, both preventative and therapeutic, are offered routinely.