Emerging insights into the physical health burden of personality disorders

This review summarizes recent evidence on the physical health burden associated with personality disorders (PDs), focusing on physical comorbidity and multimorbidity, physical symptoms, and premature mortality.

Accumulating evidence indicates that individuals with PDs experience markedly elevated rates of chronic physical illness, multimorbidity, and premature mortality. Large-scale cohort studies demonstrate increased risks of cardiovascular disease, myocardial infarction, stroke, and all-cause mortality emerging early in life. Recent investigations further show that nearly half of individuals with PDs meet criteria for chronic physical multimorbidity. Borderline personality disorder (BPD) appears especially associated with broad somatic burden, including pain-related conditions, accompanied by substantially reduced life expectancy. Dimensional approaches additionally suggest that PD severity and maladaptive domains, particularly Negative Affectivity, are independently linked to greater somatic burden. Current evidence supports multifactorial mechanisms involving maladaptive health behaviors, chronic stress-system dysregulation, systemic inflammation, metabolic changes, and healthcare disparities.

PDs are associated with a substantial yet underrecognized physical health burden. Converging evidence supports a systemic model in which personality pathology contributes to increased somatic (multi)morbidity and premature mortality through interacting behavioral, biological, developmental, and healthcare-related mechanisms. Integrating physical and mental healthcare may help reduce excess morbidity and mortality in this population.