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Prevalence of the metabolic syndrome in patients with borderline personality disorder: results from a cross-sectional study

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Abstract

Metabolic syndrome (MetS) is an important risk factor for the development of type-2 diabetes and coronary artery disease. We aimed to compare the MetS prevalence in patients with borderline personality disorder (BPD) with comparison subjects followed in primary care from a similar region. One hundred and thirty-five BPD patients according to DSM-IV diagnostic criteria were compared to 1009 subjects from primary care. We used the American Heart Association/National Heart, Lung and Blood Institute criteria to determine the rate of MetS. The age-standardized prevalence of MetS was more than double in patients with BPD compared to comparison subjects (23.3 vs. 10.6 %, p < 0.05). Regarding individual MetS criteria, hyperglycemia was significantly more prevalent in both genders (p < 0.05). Abdominal obesity (p < 0.05) and hypertriglyceridemia (p < 0.05) were significantly higher only in women with BPD. Within BPD patients, an increased rate of MetS was associated with higher BMI (p = 0.004), age (p = 0.03), treatment with second-generation antipsychotics (quetiapine, olanzapine and clozapine; p = 0.032), dysthymia (p = 0.031), panic disorder (p = 0.032), benzodiazepine dependency (p = 0.015) and binge eating disorder p = 0.02). Our results demonstrate an increased MetS rate, dysregulated glucose and lipid metabolism in patients with BPD. Cardiometabolic monitoring and careful screening for physical health conditions among people with BPD is warranted.

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Abbreviations

BP:

Blood pressure

BDI:

Beck depression inventory

BPD:

Borderline personality disorder

GEMCAS:

German Metabolic and Cardiovascular Risk Project

GL:

Fasting glucose

HDL-C:

High-density lipoprotein BMI: Body mass index

MetS:

Metabolic syndrome

PD:

Personality disorder

SGA:

Second-generation antipsychotics

TG:

Triglyzeride

WC:

Waist circumference

References

  1. Boehm G, Racoosin JA, Laughren TP, Katz R (2004) Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 27:596–601

    Article  Google Scholar 

  2. Carney RM, Blumenthal JA, Freedland KE, Youngblood M, Veith RC, Burg MM, Cornell C, Saab PG, Kaufmann PG, Czajkowski SM, Jaffe AS (2004) Depression and late mortality after myocardial infarction in the enhancing recovery in coronary heart disease (ENRICHD) study. Psychosom Med 66:466–474

    Article  PubMed  Google Scholar 

  3. Cooper SJ (2005) Palatability-dependent appetite and benzodiazepines: new directions from the pharmacology of GABA(A) receptor subtypes. Appetite 44:133–150

    Article  PubMed  CAS  Google Scholar 

  4. Cuppett M, Latin RW (2002) A survey of physical activity levels of certified athletic trainers. J Athl Train 37:281–285

    PubMed  Google Scholar 

  5. De Hert M, Dekker JM, Wood D, Kahl KG, Holt RI, Moller HJ (2009) Cardiovascular disease and diabetes in people with severe mental illness position statement from the European psychiatric association (EPA), supported by the European association for the study of diabetes (EASD) and the European society of cardiology (ESC). Eur Psychiatry 24:412–424

    Article  PubMed  Google Scholar 

  6. De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei DM, Newcomer JW, Uwakwe R, Asai I, Moller HJ, Gautam S, Detraux J, Correll CU (2011) Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 10:138–151

    PubMed  Google Scholar 

  7. De Hert M, Detraux J, van Winkel R, Yu W, Correll CU (2011) Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nat Rev Endocrinol 8:114–126

    Article  PubMed  Google Scholar 

  8. De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Moller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S (2011) Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 10:52–77

    Google Scholar 

  9. de Jonge P, Honig A, van Melle JP, Schene AH, Kuyper AM, Tulner D, Schins A, Ormel J (2007) Nonresponse to treatment for depression following myocardial infarction: association with subsequent cardiac events. Am J Psychiatry 164:1371–1378

    Article  PubMed  Google Scholar 

  10. Eckel RH, Grundy SM, Zimmet PZ (2005) The metabolic syndrome. Lancet 375:181–183

    Article  Google Scholar 

  11. El-Gabalawy R, Katz LY, Sareen J (2010) Comorbidity and associated severity of borderline personality disorder and physical health conditions in a nationally representative sample. Psychosom Med

  12. Fagiolini A, Frank E, Scott JA, Turkin S, Kupfer DJ (2005) Metabolic syndrome in bipolar disorder: findings from the bipolar disorder center for pennsylvanians. Bipolar Disord 7:424–430

    Article  PubMed  Google Scholar 

  13. Fogelholm M (2010) Physical activity, fitness and fatness: relations to mortality, morbidity and disease risk factors. A systematic review. Obes Rev 11:202–221

    Article  PubMed  CAS  Google Scholar 

  14. Ford ES, Giles WH, Dietz WH (2002) Prevalence of the metabolic syndrome among US adults: findings from the third national health and nutrition examination survey. JAMA 287:356–359

    Article  PubMed  Google Scholar 

  15. Frankenburg FR, Zanarini MC (2004) The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization. J Clin Psychiatry 65:1660–1665

    Article  PubMed  Google Scholar 

  16. Friedman M, Rosenman RH (1959) Association of specific overt behavior pattern with blood and cardiovascular findings; blood cholesterol level, blood clotting time, incidence of arcus senilis, and clinical coronary artery disease. J Am Med Assoc 169:1286–1296

    Article  PubMed  CAS  Google Scholar 

  17. Glassman AH, Bigger JT Jr, Gaffney M (2009) Psychiatric characteristics associated with long-term mortality among 361 patients having an acute coronary syndrome and major depression: seven-year follow-up of SADHART participants. Arch Gen Psychiatry 66:1022–1029

    Article  PubMed  Google Scholar 

  18. Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering RP (2004) Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 65:948–958

    Article  PubMed  Google Scholar 

  19. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ (2008) 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 69:533–545

    Article  PubMed  Google Scholar 

  20. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112:2735–2752

    Article  PubMed  Google Scholar 

  21. Haney M, Comer SD, Fischman MW, Foltin RW (1997) Alprazolam increases food intake in humans. Psychopharmacology (Berl) 132:311–314

    Article  CAS  Google Scholar 

  22. Herva A, Rasanen P, Miettunen J, Timonen M, Laksy K, Veijola J, Laitinen J, Ruokonen A, Joukamaa M (2006) Co-occurrence of metabolic syndrome with depression and anxiety in young adults: the Northern Finland 1966 Birth Cohort Study. Psychosom Med 68:213–216

    Article  PubMed  Google Scholar 

  23. Hudson JI, Lalonde JK, Coit CE, Tsuang MT, McElroy SL, Crow SJ, Bulik CM, Hudson MS, Yanovski JA, Rosenthal NR, Pope HG Jr (2010) Longitudinal study of the diagnosis of components of the metabolic syndrome in individuals with binge-eating disorder. Am J Clin Nutr 91:1568–1573

    Article  PubMed  CAS  Google Scholar 

  24. Hybels CF, Pieper CF, Blazer DG, Steffens DC (2008) The course of depressive symptoms in older adults with comorbid major depression and dysthymia. Am J Geriatr Psychiatry 16:300–309

    Article  PubMed  Google Scholar 

  25. Jackson HJ, Burgess PM (2004) Personality disorders in the community: results from the Australian National Survey of Mental Health and Well-being Part III. Relationships between specific type of personality disorder, Axis 1 mental disorders and physical conditions with disability and health consultations. Soc Psychiatry Psychiatr Epidemiol 39:765–776

    PubMed  Google Scholar 

  26. Kahl KG, Bester M, Greggersen W, Rudolf S, Dibbelt L, Stoeckelhuber BM, Gehl HB, Sipos V, Hohagen F, Schweiger U (2005) Visceral fat deposition and insulin sensitivity in depressed women with and without comorbid borderline personality disorder. Psychosom Med 67:407–412

    Article  PubMed  CAS  Google Scholar 

  27. Kahl KG, Bens S, Ziegler K, Rudolf S, Dibbelt L, Kordon A, Schweiger U (2006) Cortisol, the cortisol-dehydroepiandrosterone ratio, and pro-inflammatory cytokines in patients with current major depressive disorder comorbid with borderline personality disorder. Biol Psychiatry 59:667–671

    Article  PubMed  CAS  Google Scholar 

  28. Kahl KG, Bens S, Ziegler K, Rudolf S, Kordon A, Dibbelt L, Schweiger U (2009) Angiogenic factors in patients with current major depressive disorder comorbid with borderline personality disorder. Psychoneuroendocrinology 34:353–357

    Article  PubMed  CAS  Google Scholar 

  29. Kahl KG, Greggersen W, Schweiger U, Cordes J, Balijepalli C, Losch C, Moebus S (2011) Prevalence of the metabolic syndrome in unipolar major depression. Eur Arch Psychiatry Clin Neurosci [epub ahead of print]

  30. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627

    Article  PubMed  Google Scholar 

  31. Kinder LS, Carnethon MR, Palaniappan LP, King AC, Fortmann SP (2004) Depression and the metabolic syndrome in young adults: findings from the Third National Health and Nutrition Examination Survey. Psychosom Med 66:316–322

    Article  PubMed  Google Scholar 

  32. Lee HB, Bienvenu OJ, Cho SJ, Ramsey CM, Bandeen-Roche K, Eaton WW, Nestadt G (2010) Personality disorders and traits as predictors of incident cardiovascular disease: findings from the 23-year follow-up of the Baltimore ECA study. Psychosomatics 51:289–296

    PubMed  Google Scholar 

  33. Lieb K, Rexhausen JE, Kahl KG, Schweiger U, Philipsen A, Hellhammer DH, Bohus M (2004) Increased diurnal salivary cortisol in women with borderline personality disorder. J Psychiatr Res 38:559–565

    Article  PubMed  Google Scholar 

  34. Martinez JM, Garakani A, Kaufmann H, Aaronson CJ, Gorman JM (2010) Heart rate and blood pressure changes during autonomic nervous system challenge in panic disorder patients. Psychosom Med 72:442–449

    Article  PubMed  Google Scholar 

  35. Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M (2011) Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders–a systematic review and meta-analysis. Schizophr Bull [epub ahead of print]

  36. Moebus S, Hanisch JU, Neuhauser M, Aidelsburger P, Wasem J, Jockel KH (2006) Assessing the prevalence of the Metabolic Syndrome according to NCEP ATP III in Germany: feasibility and quality aspects of a two step approach in 1550 randomly selected primary health care practices. Ger Med Sci 4:Doc07

    PubMed  Google Scholar 

  37. Moebus S, Hanisch JU, Aidelsburger P, Bramlage P, Wasem J, Jockel KH (2007) Impact of 4 different definitions used for the assessment of the prevalence of the Metabolic Syndrome in primary healthcare: the German Metabolic and Cardiovascular Risk Project (GEMCAS). Cardiovasc Diabetol 6:22

    Article  PubMed  Google Scholar 

  38. Moran P, Stewart R, Brugha T, Bebbington P, Bhugra D, Jenkins R, Coid JW (2007) Personality disorder and cardiovascular disease: results from a national household survey. J Clin Psychiatry 68:69–74

    Article  PubMed  Google Scholar 

  39. Nabi H, Kivimaki M, Zins M, Elovainio M, Consoli SM, Cordier S, Ducimetiere P, Goldberg M, Singh-Manoux A (2008) Does personality predict mortality? Results from the GAZEL French prospective cohort study. Int J Epidemiol 37:386–396

    Article  PubMed  Google Scholar 

  40. Nakashita Y, Nakamura M, Kitamura A, Kiyama M, Ishikawa Y, Mikami H (2010) Relationships of cigarette smoking and alcohol consumption to metabolic syndrome in Japanese men. J Epidemiol 20:391–397

    Article  PubMed  Google Scholar 

  41. Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roque IFM, Richter B, Mauricio D (2008) Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database Syst Rev CD003054

  42. Patel JK, Buckley PF, Woolson S, Hamer RM, McEvoy JP, Perkins DO, Lieberman JA, Investigators C (2009) Metabolic profiles of second-generation antipsychotics in early psychosis: findings from the CAFE study. Schizophr Res 111:9–16

    Article  PubMed  Google Scholar 

  43. Pfaltz MC, Grossman P, Michael T, Margraf J, Wilhelm FH (2010) Physical activity and respiratory behavior in daily life of patients with panic disorder and healthy controls. Int J Psychophysiol 78:42–49

    Google Scholar 

  44. Purnell JQ, Kahn SE, Samuels MH, Brandon D, Loriaux DL, Brunzell JD (2009) Enhanced cortisol production rates, free cortisol, and 11beta-HSD-1 expression correlate with visceral fat and insulin resistance in men: effect of weight loss. Am J Physiol Endocrinol Metab 296:E351–E357

    Article  PubMed  CAS  Google Scholar 

  45. Rafanelli C, Milaneschi Y, Roncuzzi R, Pancaldi LG (2010) Dysthymia before myocardial infarction as a cardiac risk factor at 2.5-year follow-up. Psychosomatics 51:8–13

    PubMed  Google Scholar 

  46. Raikkonen K, Matthews KA, Kuller LH (2002) The relationship between psychological risk attributes and the metabolic syndrome in healthy women: antecedent or consequence? Metabolism 51:1573–1577

    Article  PubMed  CAS  Google Scholar 

  47. Richter N, Juckel G, Assion HJ (2010) Metabolic syndrome: a follow-up study of acute depressive inpatients. Eur Arch Psychiatry Clin Neurosci 260:41–49

    Article  PubMed  CAS  Google Scholar 

  48. Schweiger U, Greggersen W, Rudolf S, Pusch M, Menzel T, Winn S, Hassfurth J, Fassbinder E, Kahl KG, Oltmanns KM, Hohagen F, Peters A (2008) Disturbed glucose disposal in patients with major depression; application of the glucose clamp technique. Psychosom Med 70:170–176

    Article  PubMed  Google Scholar 

  49. Shaw K, Gennat H, O’Rourke P, Del Mar C (2006) Exercise for overweight or obesity. Cochrane Database Syst Rev CD003817

  50. Simon V, van Winkel R, De Hert M (2009) Are weight gain and metabolic side effects of atypical antipsychotics dose dependent? A literature review. J Clin Psychiatry 70:1041–1050

    Article  PubMed  CAS  Google Scholar 

  51. Skilton MR, Moulin P, Terra JL, Bonnet F (2007) Associations between anxiety, depression, and the metabolic syndrome. Biol Psychiatry 62:1251–1257

    Article  PubMed  CAS  Google Scholar 

  52. Skodol AE, Grilo CM, Pagano ME, Bender DS, Gunderson JG, Shea MT, Yen S, Zanarini MC, McGlashan TH (2005) Effects of personality disorders on functioning and well-being in major depressive disorder. J Psychiatr Pract 11:363–368

    Article  PubMed  Google Scholar 

  53. Skodol AE, Pagano ME, Bender DS, Shea MT, Gunderson JG, Yen S, Stout RL, Morey LC, Sanislow CA, Grilo CM, Zanarini MC, McGlashan TH (2005) Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years. Psychol Med 35:443–451

    Article  PubMed  Google Scholar 

  54. Vancampfort D, De Hert M, Skjerven LH, Gyllensten AL, Parker A, Mulders N, Nyboe L, Spencer F, Probst M (2012) International Organization of Physical Therapy in Mental Health consensus on physical activity within multidisciplinary rehabilitation programmes for minimising cardio-metabolic risk in patients with schizophrenia. Disabil Rehabil 34:1–12

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank J. Ristow, J. Burow, C. Findel and A. Stoll for data collection.

Conflict of interest

Kai G. Kahl received Speaker Honoraries from Eli Lilly, AstraZeneca, Lundbeck and Servier. Helge Frieling receiced Speaker Honoraria from Servier. Christoph U, Correll has been a consultant and/or advisor to or has received honoraria from Actelion, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Cephalon, Eli Lilly, Intra-Cellular Therapeutics; Ortho-McNeill/Janssen/J&J, GSK, Hoffmann-La Roche, Lundbeck, Medicure, Otsuka, Pfizer, Schering-Plough, Sepracor/Sunovion, Supernus, Takeda and Vanda. GEMCAS was supported by an unrestricted educational research grant by Sanofi Aventis Deutschland GmbH, Berlin, Germany.

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Authors and Affiliations

  1. Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Kai G. Kahl & Helge Frieling

  2. Department of Psychiatry and Psychotherapy, Luebeck Medical School, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Wiebke Greggersen & Ulrich Schweiger

  3. Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Bergische Landstraße 2, 40629, Düsseldorf, Germany

    Joachim Cordes

  4. The Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY, 11004, USA

    Christoph U. Correll

  5. Albert Einstein College of Medicine, Bronx, NY, USA

    Christoph U. Correll

  6. Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany

    Chakrapani Balijepalli, Christian Lösch & Susanne Moebus

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  1. Kai G. Kahl
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  2. Wiebke Greggersen
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  3. Ulrich Schweiger
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  4. Joachim Cordes
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  7. Chakrapani Balijepalli
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  8. Christian Lösch
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  9. Susanne Moebus
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Correspondence to Kai G. Kahl.

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Kahl, K.G., Greggersen, W., Schweiger, U. et al. Prevalence of the metabolic syndrome in patients with borderline personality disorder: results from a cross-sectional study. Eur Arch Psychiatry Clin Neurosci 263, 205–213 (2013). https://doi.org/10.1007/s00406-012-0339-2

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  • DOI: https://doi.org/10.1007/s00406-012-0339-2

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