ArticlePsychotherapy and psychosomatics2026
Association of Borderline Personality Disorder with Physical Diseases and Mortality: A 16-Year Population-Based Electronic Health-Record Cohort Study in Hong Kong.
Article in Psychotherapy and psychosomatics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionBorderline personality disorder (BPD) research is scarce. This study quantified risks of physical-diseases and assessed mortality patterns in individuals with BPD.
methodsThis retrospective population-based cohort study investigated individuals with a first-recorded diagnosis of BPD in 2006-2021, utilizing a medical-record database of public healthcare services in Hong Kong. Individuals without mental-disorders attending primary care clinics in the study period served as unexposed comparison (i.e., primary care clinics [PCCs] cohort). We estimated risks of physical-diseases and all-cause and cause-specific mortality using Cox-proportional hazards-regression models, and calculated excess life-years lost (LYLs).
resultsThis analysis included 3,092 patients with BPD and 902,927 individuals in the PCC cohort. BPD was associated with increased risks of a wide-spectrum of physical diseases, with the highest hazards ratio (HR) for epilepsy (7.58 [95% confidence intervals: 5.33-10.79]). HRs for other physical-diseases ranged from 1- to 3-fold higher than the PCC cohort. Individuals with BPD experienced elevated risk of all-cause (5.65 [4.83-6.61]), natural-cause (2.02 [1.56-2.62]) and external-cause mortality (30.35 [23.52-39.17]), with suicide and cardiovascular diseases as the leading contributors. External causes accounted for 40.4% of deaths in BPD, while natural-causes explained 37.3%. The excess LYL for BPD was 13.01 years (9.35-15.52). The association between BPD and physical-diseases generally became statistically nonsignificant among males but remained significantly elevated among females. BPD-associated all-cause mortality risk was higher in females than males. Statistically significant associations between BPD and physical-diseases were predominantly observed in individuals with BPD diagnoses at younger-ages.
conclusionBPD is associated with increased risk of physical-diseases, excess mortality and reduced life expectancy. Suicide-prevention strategies and physical-health monitoring are urgently warranted to reduce physical-health disparities and premature-mortality in BPD.
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