Psychological Medicine

Original Articles

Borderline personality disorder: health service use and social functioning among a national household population

J. Coida1 c1, M. Yanga1, P. Bebbingtona2, P. Morana3, T. Brughaa4, R. Jenkinsa5, M. Farrella5, N. Singletona6 and S. Ullricha1

a1 Forensic Psychiatry Research Unit, Queen Mary College, University of London, UK

a2 Department of Mental Sciences, University College London, London, UK

a3 Institute of Psychiatry, King's College London, London, UK

a4 Department of Health Sciences, University of Leicester, Leicester, UK

a5 Institute of Psychiatry, London, UK

a6 UK Drug Policy Commission, London, UK


Background It is unclear whether Axis II psychopathology or co-morbid clinical syndromes result in the treatment-seeking behaviour and social impairment of patients with borderline personality disorder (BPD). This study examined the independent associations between social functioning and service use and Axis I and Axis II disorders in persons with BPD in the national household population of Britain.

Method The study was a cross-sectional survey of adults aged 16–74 years in households (n=8397). Data included self-reported consultations with health-care professionals and behavioural problems. Diagnosis was determined by computer-assisted interviews. Analyses included logistic regression adjusting for demography, co-morbid Axis I clinical syndromes and other Axis II disorders.

Results Consultation in the past year was reported by 57.5% of persons with BPD but only 13.4% reported lifetime psychiatric admission. BPD was not independently associated with impaired functioning but was associated with co-morbid psychotic, depressive and anxiety disorders. Only general practitioners (GPs) were consulted for problems independently due to BPD.

Conclusions Functional effects of BPD are mediated through co-morbid clinical syndromes, not Axis II psychopathology. A subgroup do not have co-morbid disorders or seek treatment, and are high functioning.

(Received November 07 2007)

(Revised August 26 2008)

(Accepted November 11 2008)

(Online publication March 02 2009)


c1 Address for correspondence: Professor J. Coid, Forensic Psychiatry Research Unit, St Bartholomew's Hospital, William Harvey House, 61 Bartholomew Close, London EC1A 7BE, UK. (Email: