16-year HK study: Borderline personality disorder ups risks of physical diseases and mortality

24 Apr 2026
Kanas Chan
Kanas ChanAssociate Editor; MIMS
Kanas Chan
Kanas Chan Associate Editor; MIMS
16-year HK study: Borderline personality disorder ups risks of physical diseases and mortality

Borderline personality disorder (BPD) is associated with higher risks of a wide range of physical diseases and increased mortality from all causes, natural causes, and external causes, according to a 16-year population-based cohort study in Hong Kong.

Using data from the the Hospital Authority’s Clinical Data Analysis and Reporting System (CDARS), a territory-wide electronic health record database, researchers from the University of Hong Kong conducted a retrospective, population-based cohort study in 3,092 patients with a first diagnosis of BPD in 2006–2021 (mean age, 32.2 years; female, 84.4 percent) and 902,927 individuals without mental disorders (mean age, 44.7 years; female, 54.2 percent). [Psychother Psychosom 2026;doi:10.1159/000551534]

“To our knowledge, this population-based study is the first in Asia to evaluate both the risk of physical diseases as well as the all-cause and cause-specific mortality associated with BPD,” highlighted the researchers.

Elevated risks of physical diseases

Compared with absence of mental disorders, BPD was associated with higher risks of a wide range of physical diseases, including:

  • Epilepsy (hazard ratio [HR], 7.58; 95 percent confidence interval [CI], 5.33–10.79);
  • Parkinson’s disease (HR, 6.09; 95 percent CI, 2.72–13.64);
  • Ulcer or chronic gastritis (HR, 3.29; 95 percent CI, 2.32–4.66);
  • Chronic pulmonary disease (HR, 2.30; 95 percent CI, 1.83–2.89);
  • Chronic kidney disease (HR, 2.29; 95 percent CI, 1.54–3.39);
  • Neuropathies (HR, 2.15; 95 percent CI, 1.49–3.10);
  • Stroke (HR, 2.09; 95 percent CI, 1.41–3.09);
  • Anaemia (HR, 1.72; 95 percent CI, 1.37–2.17);
  • Asthma (HR, 1.72; 95 percent CI, 1.37–2.17); and
  • Chronic liver disease (HR, 1.56; 95 percent CI, 1.18–2.07).

“Statistically significant associations between BPD and physical illnesses were mainly found in patients diagnosed at younger ages, indicating a greater burden of physical morbidity among those with earlier-onset BPD,” noted the researchers.

13-year reduction in life expectancy

“In the mortality analysis, patients with BPD had a 5.65-fold increased risk of all-cause mortality [95 percent CI, 4.83–6.61] vs those without any mental disorders, translating to an approximately 13-year reduction in life expectancy,” pointed out the researchers.

Of note, BPD was linked to a 30-fold increase in external-cause mortality (HR, 30.35; 95 percent CI, 23.52–39.17), with the highest risks observed for suicide (HR, 40.75) and accidents (HR, 41.9).

In addition, BPD was associated with a higher risk of natural-cause mortality (HR, 2.02; 95 percent CI, 1.56–2.62) vs no mental disorders. Nervous system diseases (HR, 7.94), cardiovascular diseases (HR, 5.34), and respiratory diseases (HR, 2.73) were the key contributors to natural-cause mortality.

“Overall, the elevated risks of physical diseases and natural-cause mortality may be attributable to poor general health, unhealthy lifestyle behaviours, and significant barriers to accessing and maintaining adequate care for comorbid physical diseases,” explained the researchers.

“From the time of BPD diagnosis, suicide-prevention measures and proactive, integrated physical and mental health monitoring, especially for young patients with BPD, are urgently needed to reduce physical health disparities and premature mortality,” recommended the researchers.