Prevalence of alcohol use disorders in individuals with borderline personality disorder: a meta-analysis and meta-regression study
Keywords:
Alcoholism, Epidemiology, Borderline personality disorder, Alcohol use disorders, Borderline disorder, Borderline, Borderline and alcoholAbstract
BACKGROUND: This review examined the prevalence rate of alcohol use disorders (AUDs)–including heavy episodic drinking, heavy drinking, alcohol abuse, and alcohol dependence–among individuals with borderline personality disorder (BPD).
OBJECTIVES: The primary objective of this meta-analysis and meta-regression study was to investigate the prevalence AUDs associated with BPD.
DESIGN AND SETTING: We searched PubMed, Google Scholar, Virtual Health Library (VHL/BVS), SciELO, LILACS, EMBASE, and PsycINFO for studies, reports, or abstracts published without language restrictions.
METHODS: We searched for reports published from database inception through March 2024. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology guidelines (MOOSE). Based on the extracted data, we performed meta-analyses and meta-regressions.
RESULTS: The final sample included 15 articles with 15,603 individuals aged 18 years or older with BPD. The prevalence of AUDs with BPD was 55.28%, while the prevalence of alcohol dependence (AD) was 44.59%, and alcohol abuse (AA) was 18.84%.
CONCLUSION: Our findings indicate a high prevalence of AUDs among individuals with BPD, underscoring the need for targeted prevention and treatment strategies. Integrated dual-diagnosis approaches addressing both disorders simultaneously are crucial for improving outcomes. This high prevalence has important implications for public health.
Downloads
References
Rehm J, Mathers C, Popova S, et al. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009;373(9682):2223–33. PMID: 19560604; https://doi.org/10.1016/S0140-6736(09)60746-7.
Trull TJ, Freeman LK, Vebares TJ, et al. Borderline personality disorder and substance use disorders: an updated review. Borderline Personal Disord Emot Dysregul. 2018;5:15. PMID: 30250740; https://doi.org/10.1186/s40479-018-0093-9.
Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet. 2019;394(10200):781–92. PMID: 31478502; https://doi.org/10.1016/S0140-6736(19)31775-1.
Livne O, Feinn R, Knox J, et al. Alcohol withdrawal in past-year drinkers with unhealthy alcohol use: prevalence, characteristics, and correlates in a national epidemiologic survey. Alcohol Clin Exp Res. 2022;46(3):422–33. PMID: 35275407; https://doi.org/10.1111/acer.14781.
Sanchez-Roige S, Palmer AA, Clarke TK. Recent efforts to dissect the genetic basis of alcohol use and abuse. Biol Psychiatry. 2020;87(7):609–18. PMID: 31733789; https://doi.org/10.1016/j.biopsych.2019.09.011.
Chapman J, Jamil RT, Fleisher C, Torrico TJ. Borderline personality disorder. 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. PMID: 28613633.
Mendez-Miller M, Naccarato J, Radico JA. Borderline personality disorder. Am Fam Physician. 2022;105(2):156–61. PMID: 35166488.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10(1):89. PMID: 33781348; https://doi.org/10.1186/s13643-021-01626-4.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12. PMID: 10789670; https://doi.org/10.1001/jama.283.15.2008.
Peters MDJ, Godfrey C, McInerney P, et al, editors. JBI Manual for Evidence Synthesis. JBI; 2024. https://doi.org/10.46658/JBIMES-24-09.
Hosmer DW, Lemeshow S, Sturdivant RX. Applied logistic regression. 3rd ed. Hoboken (N.J): Wiley; 2013. 500 p. (Wiley Series in Probability and Statistics).
Harbord RM, Higgins JPT. Meta-regression in stata. The Stata Journal. 2008;8(4):493–519. https://doi.org/10.1177/1536867X0800800403.
Carpenter RW, Trela CJ, Lane SP, et al. Elevated rate of alcohol consumption in borderline personality disorder patients in daily life. Psychopharmacology (Berl). 2017;234(22):3395–406. PMID: 28884321; https://doi.org/10.1007/s00213-017-4727-1.
Carpenter RW, Wood PK, Trull TJ. Comorbidity of borderline personality disorder and lifetime substance use disorders in a nationally representative sample. J Pers Disord. 2016;30(3):336–50. PMID: 25893556; https://doi.org/10.1521/pedi_2015_29_197.
Maraz A, Andó B, Rigó P, et al. The two-faceted nature of impulsivity in patients with borderline personality disorder and substance use disorder. Drug Alcohol Depend. 2016;163:48–54. PMID: 27107850; https://doi.org/10.1016/j.drugalcdep.2016.03.015.
González E, Arias F, Szerman N, et al. Coexistence between personality disorders and substance use disorder. Madrid study about prevalence of dual pathology. Actas Esp Psiquiatr. 2019;47(6):218–28. PMID: 31869422.
Grant BF, Chou SP, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533–45. PMID: 18426259; https://doi.org/10.4088/jcp.v69n0404.
Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich R. Risk factors for suicidal behavior in borderline personality disorder. Am J Psychiatry. 1994;151(9):1316–23. PMID: 8067487; https://doi.org/10.1176/ajp.151.9.1316.
Zanarini MC, Gunderson JG, Frankenburg FR. Axis I phenomenology of borderline personality disorder. Compr Psychiatry. 1989;30(2):149–56. PMID: 2920550; https://doi.org/10.1016/0010-440x(89)90067-9.
Zanarini MC, Frankenburg FR, Weingeroff JL, et al. The course of substance use disorders in patients with borderline personality disorder and Axis II comparison subjects: a 10-year follow-up study. Addiction. 2011;106(2):342–8. Erratum in: Addiction. 2013;108(9):1696. Frankenbur, Frances R [corrected to Frankenburg, Frances R]. PMID: 21083831; https://doi.org/10.1111/j.1360-0443.2010.03176.x.
Zimmerman M, Mattia JI. Axis I diagnostic comorbidity and borderline personality disorder. Compr Psychiatry. 1999;40(4):245–52. PMID: 10428182; https://doi.org/10.1016/s0010-440x(99)90123-2.
Loya JM, Wagner A, Pittman B, Davis MT. Differences in diagnostic rules used to determine borderline personality disorder impact prevalence and associations with clinically relevant variables: findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Personal Disord. 2024;15(1):60–73. PMID: 38206863; https://doi.org/10.1037/per0000643.
Dulit RA, Fyer MR, Haas GL, Sullivan T, Frances AJ. Substance use in borderline personality disorder. Am J Psychiatry. 1990;147(8):1002–7. PMID: 2375433; https://doi.org/10.1176/ajp.147.8.1002.
Picci RL, Vigna-Taglianti F, Oliva F, et al. Personality disorders among patients accessing alcohol detoxification treatment: prevalence and gender differences. Compr Psychiatry. 2012;53(4):355–63. PMID: 21821240; https://doi.org/10.1016/j.comppsych.2011.05.011.
Tadić A, Wagner S, Hoch J, et al. Gender differences in Axis I and Axis II comorbidity in patients with borderline personality disorder. Psychopathology. 2009;42(4):257–63. PMID: 19521142; https://doi.org/10.1159/000224149.
Walter M, Gunderson JG, Zanarini MC, et al. New onsets of substance use disorders in borderline personality disorder over 7 years of follow-ups: findings from the Collaborative Longitudinal Personality Disorders Study. Addiction. 2009;104(1):97–103. PMID: 19133893; https://doi.org/10.1111/j.1360-0443.2008.02413.x.
Poznyak V, Rekve D; Alcohol, Drugs and Addictive Behaviors (ADA), editors. Global status report on alcohol and health 2018 [Internet]. Geneva: World Health Organization (WHO); 2018. 450 p. Available from: https://www.who.int/publications/i/item/9789241565639.
Regional status report on alcohol and health in the Americas 2020 [Internet]. Washington, DC: Pan American Health Organization (PAHO), World Health Organization (WHO), Regional Office for the Americas; 2020. Available from: https://iris.paho.org/handle/10665.2/52705.
Jacob T, Bucholz KK, Sartor CE, Howell DN, Wood PK. Drinking trajectories from adolescence to the mid-forties among alcohol dependent males. J Stud Alcohol. 2005 Nov;66(6):745–55. PMID: 16459936; https://doi.org/10.15288/jsa.2005.66.745.
Gavurova B, Tarhanicova M. Methods for estimating avoidable costs of excessive alcohol consumption. Int J Environ Res Public Health. 2021;18(9):4964. PMID: 34066994; https://doi.org/10.3390/ijerph18094964.
Pozzolo Pedro MO, Pozzolo Pedro M, Martins SS, Castaldelli-Maia JM. Alcohol use disorders in patients with bipolar disorder: a systematic review and meta-analysis. International Review of Psychiatry. 2023;35(5–6):450–60. Available from: https://doi.org/10.1080/09540261.2023.2249548.
Gimeno C, Dorado ML, Roncero C, et al. Treatment of comorbid alcohol dependence and anxiety disorder: review of the scientific evidence and recommendations for treatment. Front Psychiatry. 2017;8:173. PMID: 29018367; https://doi.org/10.3389/fpsyt.2017.00173.
Sansone RA, Sansone LA. Substance use disorders and borderline personality: common bedfellows. Innov Clin Neurosci. 2011;8(9):10–3. PMID: 22010059.
Grant JE, Collins M, Chamberlain SR. Borderline personality disorder in trichotillomania and skin picking disorder: a survey study. BMC Psychol. 2024;12(1):745. PMID: 39696661; https://doi.org/10.1186/s40359-024-02258-8.
Donald F, Arunogiri S, Lubman DI. Substance use and borderline personality disorder: fostering hope in the face of complexity. Australas Psychiatry. 2019;27(6):569–72. PMID: 31512481; https://doi.org/10.1177/1039856219875061.
Helle AC, Sher KJ, Trull TJ. Individual symptoms or categorical diagnoses?: an epidemiological examination of the association between alcohol use, personality disorders, and psychological symptoms. Personal Disord. 2021;12(5):484–90. PMID: 33030953; https://doi.org/10.1037/per0000459.
Boog M, Dugonjic H, Arntz Aet al. Borderline personality disorder with versus without alcohol use disorder: comparing impulsivity and schema modes. J Pers Disord. 2022;36(1):1–18. PMID: 33999655; https://doi.org/10.1521/pedi_2021_35_521.
Rosenström T, Torvik FA, Ystrom E, et al. Prediction of alcohol use disorder using personality disorder traits: a twin study. Addiction. 2018;113(1):15–24. PMID: 28734091; https://doi.org/10.1111/add.13951.
Kaufman EA, Perez J, Lazarus S, Stepp SD, Pedersen SL. Understanding the association between borderline personality disorder and alcohol-related problems: an examination of drinking motives, impulsivity, and affective instability. Personal Disord. 2020 May;11(3):213–21. PMID: 31724410; https://doi.org/10.1037/per0000375.
Kaufman EA, Graves JL, Wallace ML, et al. Associations between physiological and self-reported indices of emotion dysregulation across varying levels of alcohol use among individuals with and without borderline personality disorder. Biol Psychol. 2021;160:108044. PMID: 33571567; https://doi.org/10.1016/j.biopsycho.2021.108044.
Helle AC, Watts AL, Trull TJ, Sher KJ. Alcohol use disorder and antisocial and borderline personality disorders. Alcohol Res. 2019;40(1):arcr.v40.1.05. PMID: 31886107; https://doi.org/10.35946/arcr.v40.1.05.
Patzelt EH, Conway S, Mermin SA, Jurist J, Choi-Kain LW. Enhancing the social network: multimodal treatment for comorbid borderline personality disorder and alcohol use disorder. Am J Psychother. 2025;78(1):55–62. PMID: 39901760; https://doi.org/10.1176/appi.psychotherapy.20230046.
Stepp SD, Trull TJ, Sher KJ. Borderline personality features predict alcohol use problems. J Pers Disord. 2005;19(6):711–22. PMID: 16553564; https://doi.org/10.1521/pedi.2005.19.6.711.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 São Paulo Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
