Borderline-Dissociation Comorbidity

TO THE EDITOR: The recent article by James J. Hudziak, M.D., and colleagues (1) reported that female patients with borderline personality disorder had high rates of comorbid Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders. Somatization disorder was emphasized, since patients were evaluated by using both the DSM-III-R criteria for somatization disorder and the criteria for Briquet's syndrome (2), which formed the basis for the DSM-III-R definition of somatization disorder. Not surprisingly, all patients with somatization disorder also met the criteria for Briquet's syndrome.

However, the authors failed to mention possible comorbidity with dissociative disorders. Both borderline personality disorder and dissociative disorders tend to occur in female patients who have experienced severe physical, emotional, or sexual abuse during childhood. Saxe et al. (3) described a high rate of comorbidity with borderline personality disorder in psychiatric inpatients with dissociative disorders. It would therefore have been of considerable interest if Hudziak et al. had evaluated their patients with borderline personality disorder for the presence of dissociative symptoms.

Dissociative disorders are often underrecognized (3), and studies such as that by Hudziak et al. that ignore the range of psychopathology present in patients with borderline personality disorder further contribute to this lack of recognition. Correct diagnosis and appropriate treatment of dissociative disorders have been shown to be effective, both in reducing the high levels of distress experienced by these patients and in achieving substantial savings in social welfare and mental health service expenditure (4).