Background: Borderline personality disorder (BPD) affects about 2% of the American adult
population. It is a very serious psychiatric disorder that places heavy demands on mental
health resources. Behavior dysregulation (impulsivity, self-injurious acts, drinking or
aggressive behavior) is considered one of the main features of BPD and is associated with
significant clinical morbidity. Alcohol abuse is common among patients with BPD, and the
co-morbid rates of alcoholism in BPD patients are estimated to be 30%. It has been
hypothesized that alcohol misuse may be a manifestation of BPD's behavioral dysregulation.
Also, BPD and alcohol dependence (AD) share a common underlying neurobiology. The
co-occurrence of these disorders has been associated with increased rates of alcohol relapse,
impulsive behaviors, greater resistance to treatment, and suicidal behavior. Effective
treatment for patients with BPD and AD would result in markedly reduced health care costs and
a substantial reduction in human distress and suffering. Despite dramatic advances in the
treatment of BPD, to date, no single medication or types of medications have been uniquely
identified as effective in treating BPD. Studies treating patients with co-morbid BPD and AD
are expressly lacking.
Research Design and Methodology: This is an 8-week double-blind outpatient clinical trial of
oral topiramate (250mg) vs placebo in individuals with BPD and AD. The study will be
conducted at the West Haven, CT VA. Thirty men and women with a current diagnosis of BPD and
AD will be enrolled. The State-Trait Anger Expression Inventory (STAEI) will be used to
assess 5 aspects of aggression: state anger, trait anger, anger expressed inwardly, anger
expressed outwardly, and anger control before and during treatment (weeks 0-8). The Timeline
Follow-Back (TLFB) method will be used to document the degree of daily alcohol consumption
before and during treatment (90 days before treatment, and weeks 0 - 8). Emergent side
effects will be assessed using the modified version of the Systematic Assessment for
Treatment Emergent Events (SAFTEE).