The Weekly Mind Reader: Smoking Trends in Borderline Personality ... - The Journal of Clinical Psychiatry

People with borderline personality disorder (BPD) are 4.1 times more likely to smoke than the average population. This puts them at higher risk for a long list of health problems including cancer, heart disease, stroke, and  lung disease. A new study in The Journal of Clinical Psychiatry examined the influence of recovery on smoking status in this population. 

Methodology and Findings

The study followed 264 patients with BPD over a period of 18 years, collecting and analyzing data at 2-year intervals. Researchers assessed the psychiatric status of the subjects and interviewed them about their smoking histories. 

The findings showed a significant difference in smoking prevalence between those who had recovered and those who had not. At the 6-year follow-up, recovered patients had a 48 percent lower prevalence of smoking compared to non-recovered patients. Furthermore, the study found that the rate of decline in smoking was 68 percent faster among the recovered group compared to those who had not recovered over the course of the study. 

Some distinct patterns emerged. Alcohol abuse or dependence raised the risk of smoking in borderline patients by 22 percent. Having a lower level of education linked to a 28 percent increased chance of smoking. Additionally, using denial as a defense mechanism increased the probability of smoking by a significant eight percent.

The authors offered several theories for why recovery from BPD might help someone kick the habit. 

For one thing, overall cigarette use has steadily declined in the US since the 1940s, in large part due to intense anti-smoking campaigns, targeted quit programs, and higher tobacco prices. People who have recovered from BPD might be more influenced by these changes. For example, they might work in places with smoking bans. 

Recovery also helps people live a healthier lifestyle and enjoy better overall health compared to those who haven't recovered. Previous research indicates that people with BPD exercise less and require more complex healthcare. They are also prone to serious medical conditions.

Furthermore, people with BPD who haven't recovered tend to have worse mental health outcomes. They're more likely to experience dissociation or self-harm, and they tend to struggle with social and work life. This can further erode their physical health and up the risk of early death.

As the researchers noted, these complex factors drive smoking behavior in individuals with BPD. However,  recovery clearly seems to help them give up tobacco. They hope the study's insights can inform targeted interventions and support strategies to help people with BPD quit smoking.

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