Borderline Personality Traits and Substance Use: Genetic Factors Underlie the Association with Smoking and Ever Use of Cannabis, but Not with High Alcohol Consumption

Abstract

Borderline personality disorder (BPD) and substance use disorders often co-occur. Both disorders are heritable and family studies showed that there are familial factors that increase the risk for BPD as well as substance use/abuse. This is the first study that investigates whether the association of borderline personality traits (BPT) with substance use reflects an underlying genetic vulnerability or nongenetic familial influences. To this end we analyzed data of 5,638 Dutch and Belgian twins aged between 21-50 years from 3,567 families. Significant associations between BPT and high alcohol consumption (r = .192), regular smoking (r = .299), and ever use of cannabis (r = .254) were found. Bivariate genetic analyses showed that the associations of BPT and substance use had different etiologies. For regular smoking and for ever use of cannabis, the correlation with BPT was explained by common genetic factors. Interestingly, for high alcohol consumption and BPT the association was explained by unique environmental factors that influence both traits rather than common genetic factors.The presentation of borderline personality disorder (BPD) with a comorbid substance use disorder (SUD) is common in clinical and population samples (Feske, Tarter, Kirisci, & Pilkonis, 2006; Tomko, Trull, Wood, & Sher, in press;Trull, Sher, Minks-Brown, Durbin, & Burr, 2000;Trull, Jahng, Tomko, Wood, & Sher, 2010). Also, higher rates of alcohol and drug abuse and dependence and a higher rate of new onsets of SUD are found in patients with BPD than in patients with other personality disorders (McGlashan et al., 2000;Walter et al., 2009;Zanarini et al., 2011). In a comprehensive review, Trull et al. (2000) report that almost 60% of the individuals diagnosed with BPD meets criteria for a general category of substance use disorder, almost 50% meets criteria for an alcohol use disorder (abuse or dependence) and almost 40% meets criteria for a drug use disorder (abuse or dependence). The co-occurrence of BPD and SUD is associated with an increased risk for suicide attempts, poorer school performance, a higher level of unemployment, more promiscuity, and more early termination from treatment (Karterud, Arefjord, Andresen, & Pedersen, Miller, Abrams, Dulit, & Fyer, 1993;van den Bosch, Verheul, & van den Brink, 2001).It is well established that genetic factors contribute to the liability for substance use (Agrawal & Lynskey, 2008). Heritability estimates between 36% and 72% were reported for several measures of alcohol use (Grant et al., 2009; Kendler, Myers, Dick, & Pescott, 2010;Sartor et al., 2010;Whitfield et al., 2004). Li, Cheng, Ma, and Swan (2003) conducted a meta-analysis for tobacco use and report a heritability estimate of 59%. A meta-analysis for cannabis initiation estimated the heritability to be 48% for males and 40% for females although the confidence intervals around these estimates for males and females overlapped (Verweij et al., 2010).For BPD and related traits, large scale twin and twin family studies report heritab...

Familial risk and heritability of diagnosed borderline personality disorder: a register study of the Swedish population

“…Thus, the pattern of familial aggregation of BPD across different types of relatives indicates that genetic factors play a significant role in the risk of developing BPD, and explain the familial clustering of the disorder. Previous heritability estimates vary widely [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] and our results represent a substantial improvement in precision, based on our sample size and the number of BPD-diagnosed individuals, as reflected in the narrow confidence intervals for the heritability estimates. Furthermore, our findings indicate that close family members of individuals represent an important high-risk group for developing BPD; and that this is due to genetic, and not environmental, influences.…”

“…This study has several important strengths including utilizing Swedish nationwide register linkages. Previous studies are often limited by small sample sizes [7-10, 13-16, 19, 34, 36] the use of BPD-traits rather than diagnosis [7, 9, 10, 19-24, 28, 29, 31-33, 35-37, 64], and selfrating questionnaires [16,19,[21][22][23][24][25][26][27][28]30] rather than clinical diagnoses, exposing them to risks of low statistical power, selection-and recall bias. This register-based population cohort provided large sample-size, wellidentified biological relatives, extensive follow-up time, and clinical diagnoses.…”

“…Twin and extended twin studies, including relatives of twins, enable exploration of the relative contribution of genetic and environmental factors to familial aggregation [18]. Previous studies investigating the genetic impact of BPD show widely ranging heritability estimates, from 0 to 72% [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Among the population-based studies only seven ascertained case status by clinical interviews [20, 29, 31-33, 35, 37] narrowing down heritability to 32 to 72%.…”

Associations between personality disorders and cannabis use and cannabis use disorder: a population‐based twin study

“…We are unaware of any study that has jointly analysed all ten PDs to identify which PDs are most strongly linked to CU and CUD within a genetic framework. Among the genetic studies linking PDs to CU and CUD, most have focused on single PDs such as Borderline (17), or Antisocial (18). We addressed this gap with two specific aims.…”

ACCENTUATED PERSONALITIES RELATED TO DAILY CIGARETTES SMOKING IN ROMANIAN COLLEGE STUDENTS €“ a CASE-CONTROL STUDY

“…Research literature indicates impulsiveness as shared personality vulnerability for bipolar spectrum status in adult individuals (Alloy et al, 2009). Regular smoking also correlated with borderline personality disorder, that correlation being explained by common genetic factors (Distel et al, 2012). This study showed that nonsmokers were much stronger in X-emotive responses than daily smokers and a statistically significant difference was found in favor of nonsmoker students.…”