There is a growing body of evidence that your mental health and physical health are linked. The American Psychological Association added to this knowledge with a new study that suggests a significant relationship between borderline personality disorder and an increased risk of having a heart attack.
The new research, “Borderline Personality Disorder Traits Associate With Midlife Cardiometabolic Risk,” was published Monday in the journal Personality Disorders: Theory, Research, and Treatment. Researchers investigated the connection between borderline personality disorder (BPD) traits, depression and cardiovascular risk factors. The study’s authors noted that because depression occurs in approximately 83% of people with BPD, it was important to look at how BPD traits specifically impact your heart disease risk. Previous studies on the subject, the authors said, were inconclusive.
Who Was Included in the Study?
BPD is a mental health condition that leads to symptoms such as difficulty regulating your emotions, unstable interpersonal relationships, abandonment fears, impulsive behaviors and always feeling empty, among others. To assess BPD and heart attack risk in this study, researchers looked at previous data from 1,295 participants from the University of Pittsburgh Adult Health and Behavior Project, collected between 2001 and 2005. The average age of those included in the study was 45 years old, and the majority of participants were Caucasian.
Researchers didn’t limit participants to only those who were diagnosed with BPD or had a specific level of severity. Anyone who showed hallmark traits of BPD — as reported by the participant and up to two people who knew the participant — were included. Approximately 88% of those included in the study had data from two informants. The researchers said they wanted to show that BPD traits are important to focus on, even without a full diagnosis.
Depression symptoms were self-reported from the participants. Cardiometabolic risk (CMR), or risk of a heart attack, was measured using a combination of physical health measurements that were combined into a risk score for each participant. These measures included blood pressure, body mass index and insulin, glucose and cholesterol levels taken from a blood test after a 12-hour fast.
What Conclusions Did the Research Find?
After their data analysis, researchers found BPD and depression were associated with an increased risk for cardiovascular issues. Researchers also investigated the risk of heart attacks for BPD traits and depression separately. They found the risk between depression and cardiovascular risk wasn’t significant when they removed BPD traits from the analysis. BPD remained a significant risk factor without depressive traits in the mix.
The study’s authors further suggested “each standard deviation increase in BPD traits” — meaning a statistical jump in the amount or severity of BPD symptoms in this group of middle-aged participants — was equal to the same increase in cardiovascular risk as 9.2 years of aging.
“We were surprised by the strength of the effect and we found it particularly interesting that our measure of borderline personality pathology had a larger effect, and a unique effect, above and beyond depression in predicting heart disease.” study author Aidan Wright, Ph.D., an assistant professor of psychology at the University of Pittsburgh, said in a press release. “There is a large focus on depression in physical health, and these findings suggest there should be an increased focus on personality traits, too.”
What are the Limitations of the Study?
There are a few things to keep in mind regarding the results of this study. First, the study measured heart attack risk, not if or how many of the study participants actually experienced a heart attack or serious cardiovascular issues. Risk doesn’t mean you’re guaranteed to have a heart attack. There are many other factors that contribute to your risk that weren’t factored into the analysis of this study.
Other heart attack risk factors that were not accounted for include secondary heart health risks like poor diet, reduced physical activity or substance use, all of which are also correlated with increased risk for heart attack. According to the study’s authors, hostility, impulsive behavior and difficulty in relationships are also correlated with an increased risk of heart attack, whether these issues are connected to BPD or not.
Additionally, the University of Pittsburgh data used for this study was predominantly collected from white people (83.5% of participants) and the remaining participants were African American. Previous research suggests that heart attack risk is already higher for people of color. For example, African Americans are 30% more likely to die from heart disease compared to Caucasians. Other studies will be needed to better evaluate how BPD impacts heart attack risk among communities of color.
Despite the limitations of this study on borderline personality disorder and heart health risk, it’s still an important finding. It builds on previous knowledge that mental health can have a big impact on your body and it’s important for your health care team to keep an eye on your physical and mental health.
“Although borderline personality disorder is well studied for its relationship to psychological and social impairments, recent research has suggested it may also contribute to physical health risks,” lead author of the study Whitney Ringwald MSW, said in a press release. “Our study suggests that the effects of this disorder on heart health are large enough that clinicians treating patients should recommend monitoring their cardiovascular health.”