BPD and OCD: How These Conditions Interact and Impact Mental Health

Both OCD and BPD can develop in adolescence or early adulthood and can be influenced by genetics and early life experiences. While each disorder is different, their origins may share some commonalities.  

Genetics

OCD and BPD can run in families and are influenced by inherited traits. Studies show that OCD is highly heritable, especially in children and adolescents. Twin studies estimate that the heritability of obsessive-compulsive symptoms is around 50%. Additionally, those with a family history of OCD are 7.2 times more likely to develop the disorder compared to those without a familial connection. 

Similarly, family studies on BPD show that relatives of individuals with BPD are at a significantly higher risk of being diagnosed with the disorder. In fact, full siblings of someone with BPD are 4.7 times more likely to develop the condition, and heritability estimates suggest that about 46% of BPD cases can be attributed to genetics.  

Stress and Trauma

While genetics can play a big role in the development of BPD and OCD, environmental factors, like stressful and traumatic experiences, can also contribute to the onset and severity of these disorders. For many people, life events trigger or worsen symptoms. 

Research shows that stressful life events are a common precursor to OCD. 61.2% of individuals with OCD have experienced stressors, while 34% have gone through traumatic events prior to the onset of their symptoms. These experiences may increase anxiety and reinforce obsessive-compulsive behaviors as a coping mechanism to regain a sense of control. 

For BPD, trauma plays an even bigger part. Studies estimate that between 30% and 90% of people with BPD have a history of childhood abuse or neglect. These rates are significantly higher than those found in other personality disorders.  

The Relationship Between BPD and OCD

BPD and OCD can occur separately on their own, or they can co-occur. In fact, approximately 5% of people with OCD also meet the criteria for BPD. 

Despite their differences, BPD and OCD share certain features, including intrusive thoughts and repetitive behaviors. People with either disorder may struggle with impulsivity, emotional dysregulation, and difficulties in interpersonal relationships; however, these can manifest differently depending on the diagnosis. 

Studies show that OCD patients with co-occurring BPD tend to experience more severe symptoms and greater functional impairment. These individuals often exhibit: 

• Lower education levels
• Higher rates of other psychiatric disorders (e.g., depression and anxiety)
• More interpersonal compulsions, such as excessive reassurance-seeking
• Increased severity of OCD symptoms, aside from symmetry and hoarding
• Greater impulsivity, especially in motor responses and decision-making
• More cognitive compulsions, like excessive mental reviewing and self doubt

Treating Comorbid BPD and OCD

Unfortunately, there is no single treatment that can treat comorbid BPD and OCD; however, a combination of therapy and medication may be most effective. It’s important that treatment balances emotional stabilization with reducing obsessive-compulsive symptoms. 

Types of Therapy for BPD and OCD

Exposure and Response Prevention (ERP) is the gold standard treatment for OCD and helps people gradually face their fears without engaging in compulsions. However, for those with OCD and BPD, ERP alone may not be enough. The intense emotional distress triggered by exposure therapy can provoke anger, which is common in BPD. Because of this, a combination of ERP and therapies specifically for BPD is often more effective.

For BPD symptoms, several evidence-based therapies have been found to be more effective than generic treatments. These include: 

• Dialectical Behavior Therapy (DBT) focuses on emotional regulation, distress tolerance, and reducing self-destructive behaviors.
• Mentalization-Based Therapy (MBT) helps individuals develop a better understanding of their thoughts, emotions, and relationships. This reduces the tendency for black-and-white thinking. 
• Schema Therapy identifies and challenges deep-seated, negative thought patterns that contribute to OCD and BPD symptoms. 

Medications for BPD and OCD

There are no FDA-approved medications specifically for BPD, but various psychiatric medications are prescribed off-label to help manage its symptoms. For OCD, however, medication, like selective serotonin reuptake inhibitors (SSRIs), is a well-established treatment option. 

SSRIs, such as fluoxetine (Prozac) or sertraline (Zoloft), are commonly used to reduce intrusive thoughts and compulsions in OCD. However, for those with both BPD and OCD, SSRIs may not be enough on their own. Since BPD comes with mood swings and emotional dysregulation, treatment may require additional medications, like: 

• Mood stabilizers (e.g., lamotrigine, Lithium)
• Second-generation antipsychotics (e.g., aripiprazole, quetiapine)
• Benzodiazepines* (e.g., clonazepam, lorazepam)

While medications can help reduce the severity of symptoms, they are most effective when combined with therapy. 

*Used cautiously due to their potential for dependence

Manage Your BPD and OCD for a Better Quality of Life

Whether you’re struggling with BPD, OCD, or both, know that recovery and stability are possible. At Cura Behavioral Health, we offer personalized treatment plans that address the unique challenges of co-occurring mental health conditions. To learn more about how we can help you take control of your mental health, reach out today.