Individuals with personality disorders (PDs) have a decreased life expectancy compared with the general population in part due to physical illnesses. Many hypotheses have been suggested to explain those physical illnesses such as hormone imbalance, medication, lack of physical activity, and unhealthy diet. However, little is known about the relation between lifestyle and PDs. The purpose of this scoping review is to regroup the available information on this topic. We searched the literature up to February 2021 using four databases and found 21 articles analyzing the relation between lifestyle and PDs in observational studies including 153,081 participants from diverse populations going from general population to adults in psychiatric care. Most studies used measures of lifestyle as control variables or did not use lifestyle variables at all. Moreover, the instruments used to measure lifestyle variables lacked precision at best. Two studies demonstrated a relation between early malnutrition and further development of PDs, but those results may be influenced by confounding variables and cannot indicate a clear link between nutrition and personality disorder. The lack of solid evidence we observed is surprising, considering the multiple benefits individuals with PDs could get from a healthy lifestyle. More studies are needed to thoroughly analyze the impact of lifestyle on PDs and vice versa.
After an exhaustive search of the literature, we were astonished to discover no previous research study investigating the therapeutic effects of physical exercise for adults with borderline personality disorder (BPD). Accordingly, we would like to briefly present a rationale for studying the potential benefits of physical exercise for adults with BPD.BPD is characterized by an instability in self-image, relationships, and emotions (Gunderson et al., 2018). Of these symptoms, emotion dysregulation is among the most commonly targeted symptoms in psychotherapy because it can impact the therapeutic relationship and be associated with a lower quality of life (Gunderson et al., 2018). BPD is highly comorbid with other psychiatric disorders, especially anxiety and depressive disorders (Gunderson et al., 2018), and physical illnesses, most commonly cardiovascular diseases, metabolic syndrome, and diabetes (Doering, 2019). In fact, cardiovascular diseases, along with respiratory and endocrine diseases, account for 32% of deaths among people with cluster B personality disorders which include BPD (Cailhol et al., 2017). However, no study to our knowledge has yet examined the effects of physical exercise in adults with BPD.Physical exercise is an effective intervention to reduce emotion dysregulation and to increase positive affects in healthy adults in an ecological context (Bernstein et al., 2019). More active individuals have reported a quicker return to a neutral or positive affective state after feeling negative affects. Moreover, a single session of physical exercise is effective at increasing positive affects in a short-term in adults with anxiety or depressive disorders (Meyer et al., 2016).In adults with BPD, emotion dysregulation has been linked to a dysfunction in prefrontal cortex and amygdala among other neurobiological structures (Ruocco and Carcone, 2016). Acute effect of physical exercise on those structures has been studied and shows promising results for the emotion regulation in adults with BPD (Schneider et al., 2009). Chronic physical exercise is also an evidence-based intervention to reduce symptom severity in adults with major depressive disorder, generalized anxiety disorder (Ravindran et al., 2016) and schizophrenia (Dauwan et al., 2016). A recent meta-analysis concluded that physical exercise intervention is an efficient way to increase cardiovascular fitness and reduce cardiovascular disease risk in adults with severe mental illness (Vancampfort et al., 2017).Therefore, physical exercise could be tested as an adjunct treatment with adults with BPD to improve emotion regulation, treat comorbid psychiatric symptoms, and reduce cardiovascular disease risk. Future studies need to: i) address the safety of physical intervention in adults with BPD; ii) identify the exercise modalities associated with a good adherence rate, such as preferences and barriers in this population; and iii) evaluate the short-and long-term effects of physical exercise on BPD, its symptoms and its comorbidities.
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