borderline personality disorder is a severe and complex psychological disorder characterized by long - term patterns of intense emotions , impulsive and self - destructive behaviors , and chaotic relationships . individuals with borderline personality disorder meet criteria for an average of 3.0 to 3.4 current axis i disorders ( e.g. mood , anxiety , eating , psychotic , and substance use disorders ) and 4.2 to 4.8 lifetime axis i disorders . although emphasis is often placed on the comorbidity between borderline personality disorder and mood disorders , anxiety disorders are equally and highly prevalent , with approximately 75 - 90% of individuals with borderline personality disorder meeting criteria for at least one lifetime anxiety disorder despite the negative prognostic significance of anxiety disorders on borderline personality disorder , there is a paucity of research examining effective treatments for these frequently co - occurring disorders , particularly among severe borderline personality disorder patients . the present review will describe the existing research in this area and make suggestions for future directions . although the high rate of comorbidity between borderline personality disorder and ptsd has received the most theoretical and empirical attention , each of the anxiety disorders has been found to be prevalent among individuals with borderline personality disorder . among borderline personality disorder inpatients , 88% meet criteria for a lifetime anxiety disorder , including ptsd ( 56% ) , panic disorder ( 48% ) , social anxiety disorder ( 46% ) , specific phobia ( 32% ) , obsessive compulsive disorder ( 16% ) , generalized anxiety disorder ( 14% ) , and agoraphobia ( 12% ) . similarly , high rates of current and lifetime anxiety disorders have been found among borderline personality disorder outpatients , treatment - seeking individuals with borderline personality disorder , and community samples of borderline personality disorder individuals . anxiety disorders are more prevalent among borderline personality disorder patients than other clinical populations , and among women than men with borderline personality disorder . anxiety disorders also have a complex and variable course in borderline personality disorder , with high rates of remission ( 77 - 100% ) , recurrence ( 30 - 65% ) , and new onsets ( 15 - 45% ) over 10 years of prospective follow - up . perhaps most critically , anxiety disorders are associated with a heightened risk of suicidal and non - suicidal self - injury among individuals with borderline personality disorder [ 11 - 18 ] and have been found to decrease the likelihood of achieving remission from borderline personality disorder over time . to date , there have been 14 randomized controlled trials ( rcts ) that have examined the effects of borderline personality disorder treatments on anxiety , with all but one of these focused on general anxiety severity as opposed to specific anxiety disorder diagnoses ( table 1 ) . the one study that has evaluated the effects of borderline personality disorder treatment on anxiety disorder diagnoses found that , among suicidal borderline personality disorder women in dialectical behavior therapy , rates of remission from anxiety disorders ranged from 35 - 47% . these remission rates did not differ from those found in the community treatment by experts control condition ( 24 - 54% ) , and were lower than those found for mood , substance , and eating disorders in dialectical behavior therapy ( 64 - 88% ) . the remaining 13 studies have examined general anxiety severity and have found mixed results . at post - treatment and/or follow - up , nine studies found significant decreases in anxiety [ 19 - 28 ] , one study did not find a significant decrease , and three studies did not report pre - post changes [ 30 - 33 ] . additionally , six studies found significant treatment differences in anxiety outcomes [ 19 - 22,26,27,33 ] , whereas seven studies found no differences between treatments [ 23 - 25,28 - 32 ] . although these studies generally indicate that treatment for borderline personality disorder is associated with a significant reduction in anxiety severity , it is unknown if or how these improvements are related to anxiety disorder diagnostic status . of note , several borderline personality disorder treatments that have been examined in rcts have not yet been evaluated in terms of their impact on anxiety outcomes , including schema - focused therapy , systems training for emotional predictability and problem solving , dynamic deconstructive psychotherapy , and general psychiatric management ( see   for a review of these treatments ) . although numerous evidence - based treatments for anxiety disorders are available , borderline personality disorder patients , particularly those with a severe level of disorder , are likely to be excluded from these treatments due to suicidality , self - injurious behavior , and other co - occurring problems that are deemed primary or in need of immediate treatment . as a result , few studies have evaluated the efficacy of anxiety disorder treatments among individuals with borderline personality disorder , and the available research is limited to ptsd treatment studies . results from three rcts of cognitive - behavioral treatments for ptsd indicate that patients with borderline personality disorder or borderline personality characteristics exhibited a comparable rate of improvement as patients without borderline personality disorder or borderline personality characteristics [ 37 - 39 ] . however , borderline personality disorder patients ( 11% ) were less likely than those without borderline personality disorder ( 51% ) to achieve good end - state functioning . importantly , each of these studies excluded patients with acute suicidality as well as one or more other problems common in severe borderline personality disorder ( e.g. substance use disorder , recent self - injury ) . although some research has evaluated the impact of personality disorders on treatment outcome for non - ptsd anxiety disorders , no studies have specifically evaluated the effect of borderline personality disorder . thus , research on the use of anxiety disorder treatments among individuals with borderline personality disorder is limited by the small number of studies available , the exclusion of severe borderline personality disorder patients , and the lack of studies on anxiety disorders other than ptsd . given the paucity of empirical data on the treatment of co - occurring borderline personality disorder and anxiety disorders , recent research has begun to emerge focused on developing and evaluating treatments for this population . to date , this research has focused exclusively on individuals with comorbid borderline personality disorder and ptsd . harned and colleagues have developed a one - year outpatient treatment for suicidal and self - injuring individuals with borderline personality disorder and ptsd that integrates dialectical behavior therapy with a modified version of prolonged exposure therapy for ptsd . to date , this treatment has been evaluated in an open trial ( n  =  13 ) with results indicating that it is feasible and safe to administer , and is associated with large and significant improvements in ptsd ( pre - post d = 1.4  1.7 ; remission rate = 60 - 72% ) , intentional self - injury , and a number of secondary outcomes . pabst and colleagues   conducted a feasibility trial of narrative exposure therapy for women with borderline personality disorder and ptsd ( n  =  10 ) . treatment primarily occurred in an inpatient unit , lasted an average of 14 sessions , and excluded patients who were unwilling to consent to a no - suicide contract , had attempted suicide in the past eight weeks , or had other severe comorbidities . the treatment was associated with significant reductions in ptsd ( g = 0.92 ) and several secondary outcomes . finally , although not intended specifically for borderline personality disorder patients , bohus and colleagues have developed a 12-week residential treatment for women with childhood sexual abuse - related ptsd plus a current diagnosis of major depression , eating disorder , substance use disorder , and/or at least four borderline personality disorder criteria . this treatment combines modified dialectical behavior therapy and trauma - focused cognitive - behavioral approaches   and has been evaluated in an open trial ( n  =  29 )   and an rct ( n  =  74 ) , in which borderline personality disorder patients constituted 24 - 42% of the samples . both studies have shown large and significant reductions in ptsd ( d = 1.2  1.5 ; remission rate  =  35 - 36% ) and a number of secondary outcomes   with one study finding that results were comparable between patients with and without borderline personality disorder . although these treatments have shown promising results , more research is needed to replicate these findings using randomized controlled designs with larger samples of borderline personality disorder patients . given the high rate of co - occurring anxiety disorders among borderline personality disorder patients , as well as the negative impact of these disorders on achieving remission from borderline personality disorder , it is imperative that additional research continues to evaluate how to effectively treat anxiety disorders among individuals with borderline personality disorder . to date , the available research has focused exclusively on evaluating treatments for ptsd among borderline personality disorder patients , and no research has yet evaluated treatments for other types of anxiety disorders in borderline personality disorder . in addition , with the exception of dialectical behavior therapy , the impact of existing borderline personality disorder treatments on specific anxiety disorders has not been examined . as efforts to develop and evaluate treatments for co - occurring borderline personality disorder and anxiety disorders continue , attention should be paid to tailoring these treatments to borderline personality disorder patients with various levels of disorder . for example , it may be the case that existing , brief ( 9 - 12 week ) anxiety disorder treatments can be implemented safely and effectively among borderline personality disorder patients with a mild level of disorder ( e.g. those without suicidal and self - injurious behaviors or severe comorbidities ) . borderline personality disorder patients with a moderate level of disorder ( e.g. low risk non - suicidal self - injury without serious suicidality , significant but non - disabling deficits in interpersonal and emotion regulation skills ) may benefit from longer ( 12 - 16 week ) and/or more intensive ( e.g. residential ) sequential treatments that implement strategies from borderline personality disorder treatments ( e.g. skills training ) prior to targeting anxiety disorders [ 47 - 49 ] . finally , longer - term treatment ( e.g. one year ) that provides integrated treatment for borderline personality disorder and anxiety disorders may be necessary for borderline personality disorder patients with a severe level of disorder ( e.g. recent serious suicidal and/or self - injurious behaviors , severe comorbidities , disabling psychosocial impairment ) . within this general research agenda , several important questions remain to be addressed . first , it will be important to develop empirically - derived criteria for determining when to target anxiety disorders among individuals with borderline personality disorder , particularly in the context of multiple other severe problems . for example , it is not yet clear whether anxiety disorders can be safely and effectively treated among borderline personality disorder patients who are actively engaging in non - suicidal self - injury . it is also possible that these readiness criteria may differ depending on the treatment setting ( e.g. inpatient / residential versus outpatient ) , type of anxiety disorder ( e.g. ptsd versus other diagnoses ) , and/or the relationship of anxiety disorder symptoms to suicidal and self - injurious behaviors . finally , some research has begun to identify common factors underlying borderline personality disorder and anxiety disorders , including a tendency to experience negative emotions combined with efforts to try to alter or avoid these emotions [ 50 - 53 ] . the extant research suggests that borderline personality disorder treatments that address these common factors may be sufficient to facilitate improvements in general anxiety severity . however , additional research is needed to determine whether more targeted anxiety disorder treatment is necessary to achieve full remission from these disorders during treatment for borderline personality disorder .
anxiety disorders are highly prevalent among individuals with borderline personality disorder , with comorbidity rates of up to 90% . 
 anxiety disorders have been found to reduce the likelihood of achieving remission from borderline personality disorder over time and to increase the risk of suicide and self - injury in this population . 
 evidence - based treatments for borderline personality disorder have not sufficiently focused on targeting anxiety disorders , and their effects on these disorders are either limited or unknown . 
 conversely , evidence - based treatments for anxiety disorders typically exclude suicidal , self - injuring , and seriously comorbid patients , thereby limiting their generalizability to individuals with borderline personality disorder . to address these limitations , recent 
 research has begun to emerge focused on developing and evaluating treatments for individuals with co - occurring borderline personality disorder and anxiety disorders , specifically posttraumatic stress disorder ( ptsd ) , with promising initial results . 
 however , there is a need for additional research in this area , particularly studies evaluating the treatment of anxiety disorders among high - risk and complex borderline personality disorder patients .