Subgroups of addicted and nonaddicted borderline outpatients based on symptoms exhibited and comorbid disorders

Delinda Erma Mercer, University of Pennsylvania


This study examined gender differences in addiction, comorbid illnesses and symptoms in chemically dependent borderline outpatients. Subgroups were also identified empirically, using cluster analysis. Finally, the addicted group was compared to a matched, nonaddicted cohort to examine whether differences were borderline or addiction related. Forty-eight borderline outpatients (24 female, 24 male) seeking substance abuse treatment were diagnosed for axis I and II disorders. Subjects also received the Addiction Severity Index and several questions on abuse history were asked directly. All subjects displayed a high prevalence of mood disorders and used primarily alcohol and cocaine. Females exhibited more anxiety disorders, slightly higher psychiatric severity and more histories of sexual abuse. More males exhibited antisocial personality disorder and witnessed domestic violence. Cluster analysis identified two subgroups based on BPD criteria, distinguished by: (1) identity disturbance and frantic efforts to avoid abandonment and (2) affect disregulation and inappropriate expression of anger. These clusters did not differ on axis I disorders, personality disorders, addiction severity, or abuse history. When the complete (male and female) addicted group was compared with a nonaddicted cohort, numerous significant differences were found. Addicted patients exhibited more impulsivity and fewer comorbid personality disorders while nonaddicted patients displayed more inappropriate anger and frantic efforts to avoid abandonment. Gender differences seen in the addicted group were generally absent in the nonaddicted group. Cluster analysis of the combined (addicted and nonaddicted) group identified two groups defined by incidence of self-harming behaviors. Overall, there were fewer gender differences among addicted borderline patients than expected. Thus, there is no reason to suspect that women are more likely to be diagnosed as borderline because they look more "typically borderline" than men. Also, there is no evidence to suggest that gender specific treatment would be particularly useful. The gender differences present appeared to be addiction rather than borderline related. Male and female addicts displayed some differences in symptoms and comorbid illnesses and thus may have different needs in treatment. The most significant differences appear to be between addicted and nonaddicted borderline patients emphasizing the need for thorough assessment of drug abuse/addiction in borderline patients.

Subject Area

Psychotherapy|Mental health

Recommended Citation

Mercer, Delinda Erma, "Subgroups of addicted and nonaddicted borderline outpatients based on symptoms exhibited and comorbid disorders" (1996). Dissertations available from ProQuest. AAI9712975.