Bipolar Disord. 2006 Feb;8(1):1-14.
Affective instability as rapid cycling: theoretical and clinical implications
for borderline personality and bipolar spectrum disorders.
Mackinnon DF, Pies R.
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University
School of Medicine, Baltimore, MD, USA.
Objectives: The Diagnostic and Statistical Manual of Mental Disorders guidelines
provide only a partial solution to the nosology and treatment of bipolar
disorder in that disorders with common symptoms and biological correlates may be
categorized separately because of superficial differences related to behavior,
life history, and temperament. The relationship is explored between extremely
rapid switching forms of bipolar disorder, in which manic and depressive
symptoms are either mixed or switch rapidly, and forms of borderline personality
disorder in which affective lability is a prominent symptom. Methods: A MedLine
search was conducted of articles that focused on rapid cycling in bipolar
disorder, emphasizing recent publications (2001-2004). Results: Studies examined
here suggest a number of points of phenomenological and biological overlap
between the affective lability criterion of borderline personality disorder and
the extremely rapid cycling bipolar disorders. We propose a model for the
development of 'borderline' behaviors on the basis of unstable mood states that
sheds light on how the psychological and somatic interventions may be aimed at
'breaking the cycle' of borderline personality disorder development. A review of
pharmacologic studies suggests that anticonvulsants may have similar stabilizing
effects in both borderline personality disorder and rapid cycling bipolar
disorder. Conclusions: The same mechanism may drive both the rapid mood
switching in some forms of bipolar disorder and the affective instability of
borderline personality disorder and may even be rooted in the same genetic
etiology. While continued clinical investigation of the use of anticonvulsants
in borderline personality disorder is needed, anticonvulsants may be useful in
the treatment of this condition, combined with appropriate psychotherapy.
PMID: 16411976 [PubMed - in process]
----------
J Affect Disord. 2005 Jul;87(1):17-23.
Borderline personality disorder characteristics in young adults with recurrent
mood disorders: a comparison of bipolar and unipolar depression.
Smith DJ, Muir WJ, Blackwood DH.
Division of Psychiatry, School of Molecular and Clinical Medicine, University of
Edinburgh, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF, UK.
daniel.smith@ed.ac.uk
BACKGROUND: In young adults it can be difficult to differentiate between an
early bipolar illness and borderline personality disorder. There are
considerable areas of clinical overlap between cyclothymic temperament,
bipolar-spectrum disorders and borderline characteristics. The aim of this study
was to measure borderline characteristics in young adults during an index
depressive episode and to compare three diagnostic groups: DSM-IV bipolar
affective disorder (BPAD); bipolar spectrum disorder (BSD); and DSM-IV recurrent
major depressive disorder (MDD). METHODS: Eighty-seven young adults with a
current episode of major depression and at least one previous episode of
depression were recruited from consecutive referrals to a psychiatric clinic.
Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID-1)
and recently proposed structured diagnostic criteria for BSD. All patients also
completed the borderline questions from the screening questionnaire of the
International Personality Disorders Examination (IPDE). RESULTS: Diagnostically,
the cohort of 87 patients divided into three groups: 14 with BPAD; 27 with BSD;
and 46 with MDD. None of the subjects fulfilled DSM-IV or ICD-10 diagnostic
criteria for personality disorder and all three groups were well matched in
terms of age, gender distribution, ethnicity, socioeconomic and educational
status, age at onset of illness, and severity of index depressive episode. Both
of the bipolar-depressed groups reported significantly higher median levels of
borderline characteristics than the MDD group (p<0.0001). Three of the
borderline characteristics emerged as potentially useful in differentiating
bipolar depression from unipolar depression: 'I've never threatened suicide or
injured myself on purpose' (sensitivity=0.93; positive predictive value
[PPV]=56.7); 'I have tantrums or angry outbursts' (sensitivity 0.66; PPV=65.6%);
and 'Giving in to some of my urges gets me into trouble' (sensitivity=0.76;
PPV=59.6%). LIMITATIONS: All of the subjects were recruited from a university
health service clinic and as such are unlikely to be representative of patients
from more diverse socio-economic backgrounds. No structured diagnostic
assessment of personality disorder was administered. The diagnostic criteria for
BSD are not yet fully validated. CONCLUSIONS: Young adults with bipolar
depression exhibit significantly higher levels of borderline personality
pathology than those with unipolar depression. Those borderline screening
questions that reflect cyclothymic characteristics or depressive mixed states
may be of practical use to clinicians in helping to differentiate between
bipolar depression and unipolar depression in young adults.
PMID: 15967232 [PubMed - indexed for MEDLINE]
----------
Bipolar Disord. 2005 Apr;7(2):192-7.
Acute treatment outcomes in patients with bipolar I disorder and co-morbid
borderline personality disorder receiving medication and psychotherapy.
Swartz HA, Pilkonis PA, Frank E, Proietti JM, Scott J.
Department of Psychiatry, University of Pittsburgh School of Medicine, Western
Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA. swartzha@upmc.edu
OBJECTIVE: Patients suffering from both bipolar I disorder and borderline
personality disorder (BPD) pose unique treatment challenges. The purpose of this
matched case-control study was to compare acute treatment outcomes of a sample
of patients who met standardized diagnostic criteria for both bipolar I disorder
and BPD (n = 12) to those who met criteria for bipolar I disorder only (n = 58).
METHOD: Subjects meeting criteria for an acute affective episode were treated
with a combination of algorithm-driven pharmacotherapy and weekly psychotherapy
until stabilization (defined as four consecutive weeks with a calculated average
of the 17-item version of the Hamilton Rating Scale for Depression and
Bech-Rafaelsen Mania scale totaling < or = 7). RESULTS: Only three of 12 (25%)
bipolar-BPD patients achieved stabilization, compared with 43 of 58 (74%)
bipolar-only patients. Two of the three bipolar-BPD patients who did stabilize
took over 95 weeks to do so, compared with a median time-to-stabilization of 35
weeks in the bipolar-only group. The bipolar-BPD group received significantly
more atypical mood-stabilizing medications per year than the bipolar-only group
(Z = 4.3, p < 0.0001). Dropout rates in the comorbid group were high.
CONCLUSIONS: This quasi-experimental study suggests that treatment course may be
longer in patients suffering from both bipolar I disorder and BPD. Some patients
improved substantially with pharmacotherapy and psychotherapy, suggesting that
this approach is worthy of further investigation.
PMID: 15762861 [PubMed - indexed for MEDLINE]
----------
Psychosom Med. 2005 Jan-Feb;67(1):1-8.
Psychiatric and medical comorbidities of bipolar disorder.
Krishnan KR.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
(3050A), 4584 Hospital South, Box 3950, Durham, NC 27710, USA.
krish001@mc.duke.edu
OBJECTIVES: This review summarizes the literature on psychiatric and medical
comorbidities in bipolar disorder. The coexistence of other Axis I disorders
with bipolar disorder complicates psychiatric diagnosis and treatment.
Conversely, symptom overlap in DSM-IV diagnoses hinders definition and
recognition of true comorbidity. Psychiatric comorbidity is often associated
with earlier onset of bipolar symptoms, more severe course, poorer treatment
compliance, and worse outcomes related to suicide and other complications.
Medical comorbidity may be exacerbated or caused by pharmacotherapy of bipolar
symptoms. METHODS: Articles were obtained by searching MEDLINE from 1970 to
present with the following search words: bipolar disorder AND, comorbidity,
anxiety disorders, eating disorder, alcohol abuse, substance abuse, ADHD,
personality disorders, borderline personality disorder, medical disorders,
hypothyroidism, obesity, diabetes mellitus, multiple sclerosis, lithium,
valproate, lamotrigine, carbamazepine, atypical antipsychotics. Articles were
prioritized for inclusion based on the following considerations: sample size,
use of standardized diagnostic criteria and validated methods of assessment,
sequencing of disorders, quality of presentation. RESULTS: Although the
literature establishes a strong association between bipolar disorder and
substance abuse, the direction of causality is uncertain. An association is also
seen with anxiety disorders, attention-deficit/hyperactivity disorder, and
eating disorders, as well as cyclothymia and other axis II personality
disorders. Medical disorders accompany bipolar disorder at rates greater than
predicted by chance. However, it is often unclear whether a medical disorder is
truly comorbid, a consequence of treatment, or a combination of both.
CONCLUSION: To ensure prompt, appropriate intervention while avoiding iatrogenic
complications, the clinician must evaluate and monitor patients with bipolar
disorder for the presence and the development of comorbid psychiatric and
medical conditions. Conversely, physicians should have a high index of suspicion
for underlying bipolar disorder when evaluating individuals with other
psychiatric diagnoses (not just unipolar depression) that often coexist with
bipolar disorder, such as alcohol and substance abuse or anxiety disorders.
Anticonvulsants and other mood stabilizers may be especially helpful in treating
bipolar disorder with significant comorbidity.
Publication Types:
Review
PMID: 15673617 [PubMed - in process]
----------
Can J Psychiatry. 2004 Aug;49(8):551-6.
The boundary between borderline personality disorder and bipolar disorder:
current concepts and challenges.
Magill CA.
Department of Psychiatry, McGill University, Montreal, Quebec.
chandra_magill@hotmail.com
OBJECTIVE: The boundary between borderline personality disorder (BPD) and
bipolar disorder (BD) is a controversial subject. Clinically, it can be
difficult to diagnose patients who present with both affective instability and
impulsivity. This paper reviews concepts and challenges related to the overlap
of these disorders. METHODS: A Medline search was conducted, using the key words
borderline personality disorder, bipolar disorder, affective disorder, and
personality disorder. Reference lists from articles generated were also used.
Publications from the last 20 years were considered. RESULTS: Studies
demonstrate a greater cooccurrence between these 2 disorders than between BPD
and other Axis I disorders or between BD and other Axis II disorders. Some
authors suggest that many patients diagnosed with BPD are better described as
having BD, that the bipolar classification is too narrow, or that BPD should be
considered a variant of affective disorders. Others present evidence supporting
BPD as a valid construct. Hypotheses about the relation between the 2 disorders
and suggestions for clinical practice are offered. CONCLUSIONS: There appears to
be sufficient evidence to consider BPD to be a valid diagnosis. Both disorders
apply to heterogeneous populations, and their characteristics require further
clarification. In diagnostically challenging situations, careful consideration
of a patient's longitudinal history is essential. Future research will be
important to ensure that our diagnostic classifications reflect clinically
useful entities.
Publication Types:
Review
PMID: 15453104 [PubMed - indexed for MEDLINE]
----------
Harv Rev Psychiatry. 2004 May-Jun;12(3):140-5.
Comment in:
Harv Rev Psychiatry. 2004 May-Jun;12(3):146-9.
Borderline or bipolar? Distinguishing borderline personality disorder from
bipolar spectrum disorders.
Paris J.
Department of Psychiatry, McGill University, Institute of Community and Family
Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec,
Canada. joel.paris@mcgill.ca
This article addresses the question whether borderline personality disorder
(BPD) can be understood as a variant of bipolar disorder. In the past,
borderline pathology has been seen as a variant of psychosis, depression, or
posttraumatic stress disorder, but there are important differences between all
of these conditions and BPD. The proposal that BPD falls within the bipolar
spectrum depends on the assumption that affective instability develops through
the same mechanism in both diagnostic categories. There are major differences in
phenomenology, family history, longitudinal course, and treatment response
between BPD and bipolar disorder, and the findings of comorbidity studies are
equivocal. Thus, existing evidence is insufficient to support the concept that
BPD falls in the bipolar spectrum.
Publication Types:
Review
PMID: 15371068 [PubMed - indexed for MEDLINE]
----------
Harv Rev Psychiatry. 2004 May-Jun;12(3):133-9.
Comment in:
Harv Rev Psychiatry. 2004 May-Jun;12(3):146-9.
Is borderline personality disorder part of the bipolar spectrum?
Smith DJ, Muir WJ, Blackwood DH.
Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital,
Edinburgh, Scotland. daniel.smith@ed.ac.uk
In recent years, advances in the areas of both bipolar and borderline
personality disorders have generated considerable interest in the clinical
interface between these two conditions. Developments in the study of the
neurobiology of borderline personality disorder suggest that many patients with
this diagnosis have etiological features in common with those diagnosed with
bipolar disorders. This claim is supported by new insights into the
phenomenology of both disorders and by evidence that mood stabilizers are
efficacious in the pharmacological management of borderline patients. This area
of research is an important one because of the considerable morbidity and public
health costs associated with borderline personality disorder. Since borderline
patients can be so challenging to care for, it may be that a reframing of the
disorder as belonging to the broad clinical spectrum of bipolar disorders holds
benefits for patients and clinicians alike.
Publication Types:
Review
PMID: 15371067 [PubMed - indexed for MEDLINE]
---------
J Affect Disord. 2004 Apr;79(1-3):297-303.
Borderline personality disorder in patients with bipolar disorder and response
to lamotrigine.
Preston GA, Marchant BK, Reimherr FW, Strong RE, Hedges DW.
Department of Psychiatry, Mood Disorders Clinic, University of Utah School of
Medicine, Salt Lake City, UT, USA. prestong@intra.nimh.nih.gov
BACKGROUND: Recent reports suggesting lamotrigine as an effective treatment in
bipolar disorder, and perhaps borderline personality disorder, a common comorbid
personality disorder in bipolar patients, led us to retrospectively examine
patients from two bipolar studies to investigate this pattern of comorbidity,
and to determine whether lamotrigine effected the dimensions of borderline
personality. Methods: Fifteen months following entry into either study, we
retrospectively assessed DSM-IV dimensions of borderline personality disorder
pre- and post-treatment with lamotrigine in 35 bipolar patients. RESULTS: Forty
percent met criteria for borderline personality disorder; this subgroup had a
more frequent history of substance abuse and childhood symptoms of attention
deficit hyperactivity disorder (ADHD). Dimensions of borderline personality
improved significantly with treatment in both patient groups, and corresponded
with response of bipolar symptoms. Six (43%) comorbid bipolar patients endorsed
three or fewer criteria of borderline personality during treatment with
lamotrigine. There was a trend for comorbid bipolar patients to require a second
psychoactive medication in addition to lamotrigine during extended treatment.
LIMITATIONS: Criteria for borderline personality and improvement were assessed
retrospectively in an open manner. CONCLUSIONS: Dimensions of borderline
personality disorder may respond to lamotrigine in comorbid bipolar patients;
controlled studies appear warranted. Bipolar studies should assess and specify
the number of patients with personality disorders in the trial.
PMID: 15023511 [PubMed - indexed for MEDLINE]
----------
J Clin Psychiatry. 2004 Jan;65(1):104-9.
Olanzapine versus placebo in the treatment of borderline personality disorder.
Bogenschutz MP, George Nurnberg H.
Department of Psychiatry, University of New Mexico School of Medicine,
Albuquerque, NM 87131, USA. mbogenschutz@salud.unm.edu
BACKGROUND: Atypical antipsychotics are increasingly used in clinical practice
in the management of borderline personality disorder (BPD), and a small but
growing body of literature supports their efficacy. Here, we report the results
of a double-blind, placebo-controlled study of olanzapine as a treatment for
BPD. METHOD: Forty BPD patients (25 female, 15 male) were randomly assigned in
equal numbers to olanzapine and placebo. Diagnoses were made using the
Structured Clinical Interview for DSM-IV Axis II Personality Disorders and the
Mini-International Neuropsychiatric Interview. Patients with schizophrenia,
bipolar disorder, or current major depression were excluded. Olanzapine dosage
was flexible, and the dose range was 2.5 to 20 mg/day, with most patients
receiving 5 to 10 mg/day. No concomitant psychotropic medications were allowed.
Patients were assessed at baseline and at 2, 4, 8, and 12 weeks. The primary
outcome was change in the total score for the 9 BPD criteria on a 1-to-7 Likert
scale, the Clinical Global Impressions scale modified for borderline personality
disorder (CGI-BPD), using an analysis of covariance model including baseline
score as covariate. Data were collected from July 2000 to April 2002. RESULTS:
Olanzapine was found to be significantly (p <.05) superior to placebo on the
CGI-BPD at endpoint, with separation occurring as early as 4 weeks. Similar
results were found for the single-item Clinical Global Impressions scale. Weight
gain was significantly (p =.027) greater in the olanzapine group. CONCLUSIONS:
This study supports the efficacy of olanzapine for symptoms of BPD in a mixed
sample of women and men. Further studies with olanzapine and other atypical
antipsychotics are needed.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 14744178 [PubMed - indexed for MEDLINE]
----------
Zh Nevrol Psikhiatr Im S S Korsakova. 2004;104(8):18-23.
[Affective phases in dynamics of personality disorders (on a model of borderline
personality disorder)]
[Article in Russian]
Smulevich AB, Dubnitskaia EB, Koliutskaia EV.
Affective phases developing in personality disorder (index-sample--98 patients)
were compared to those in cyclothymia (85 patients--control group). A preference
of phase dynamics in the group of abnormalities relating to ICD-10 item
"Borderline personality disorder" was confirmed. In line with a concept
considering personality disorders as clinical syndromes, patients of the
index-group have personality disorders with the signs of psychopathological
diathesis determined by vulnerability to affective disorders. Affective phases
are interpreted not only as an expression of a specific type of personality
disorders dynamics but as an emergence of affective pathology, which is
alternative to endogenous one both by modus of constitutional predisposition and
clinical parameters (egosyntonic moderating of the phase, domination of negative
affectivity in its structure, amphitymic duality of pathologically altered
affect).
PMID: 15554137 [PubMed - indexed for MEDLINE]
----------
Int J Neuropsychopharmacol. 2003 Jun;6(2):139-44.
Bipolar comorbidity: from diagnostic dilemmas to therapeutic challenge.
Sasson Y, Chopra M, Harrari E, Amitai K, Zohar J.
Chaim Sheba Medical Centre, Division of Psychiatry, Tel Hashomer, Israel.
Comorbidity in bipolar disorder is the rule rather than the exception more than
60% of bipolar patients have a comorbid diagnosis and is associated with a mixed
affective or dysphoric state; high rates of suicidality; less favourable
response to lithium and poorer overall outcome. There is convincing evidence
that rates of substance use and anxiety disorders are higher among patients with
bipolar disorder compared to their rates in the general population. The
interaction between anxiety disorders and substance use goes both ways: patients
with bipolar disorder have a higher rate of substance use and anxiety disorder,
and vice versa. Bipolar disorder is also associated with borderline personality
disorder and ADHD, and to a lesser extent with weight gain. As more than 40% of
bipolar patients have anxiety disorder, it is indicated that while diagnosing
bipolar patients, systematic enquiry about different anxiety disorders is called
for. This also presents a therapeutic challenge, since agents that effectively
treat anxiety disorders are associated with the risk of induced mania.
Therefore, the treating psychiatrist needs to carefully evaluate the potential
benefit of treating the anxiety against the potential cost of inducing a manic
episode. A possible solution would be to use, when possible, a
non-pharmacological intervention, such as a cognitivebehavioural approach.
Alternately, it is suggested that the clinician attempts to ensure that the
patient receives adequate treatment with mood stabilizers before slowly and
carefully attempting the addition of anti-anxiety compounds with a relatively
lower risk of mania induction (e.g. SSRIs compared to TCAs).
PMID: 12890307 [PubMed - indexed for MEDLINE]
----------
J Affect Disord 2003 Jan;73(1-2):49-57
Bipolar II with and without cyclothymic temperament: "dark" and "sunny"
expressions of soft bipolarity.
Akiskal HS, Hantouche EG, Allilaire JF.
International Mood Center, UCSD Department of Psychiatry, 9500 Gilman Drive, La
Jolla, 92093-0603, San Diego, CA, USA
BACKGROUND: In the present report deriving from the French national multi-site
EPIDEP study, we focus on the characteristics of Bipolar II (BP-II), divided on
the basis of cyclothymic temperament (CT). In our companion article (, this
issue), we found that this temperament in its self-rated version correlated
significantly with hypomanic behavior of a risk-taking nature. Our aim in the
present analyses is to further test the hypothesis that such patients-assigned
to CT on the basis of clinical interview-represent a more "unstable" variant of
BP-II. METHODS: From a total major depressive population of 537 psychiatric
patients, 493 were re-examined on average a month later; after excluding 256
DSM-IV MDD and 41 with history of mania, the remaining 196 were placed in the
BP-II spectrum. As mounting international evidence indicates that hypomania
associated with antidepressants belongs to this spectrum, such association per
se did not constitute a ground for exclusion. CT was assessed by clinicians
using a semi-structured interview based on in its French version; as two files
did not contain full interview data on CT, the critical clinical variable in the
present analyses, this left us with an analysis sample of 194 BP-II.
Socio-demographic, psychometric, clinical, familial and historical parameters
were compared between BP-II subdivided by CT. Psychometric measures included
self-rated CT and hypomania scales, as well as Hamilton and Rosenthal scales for
depression. RESULTS: BP-II cases categorically assigned to CT (n=74) versus
those without CT (n=120), were differentiated as follows: (1) younger age at
onset (P=0.005) and age at seeking help (P=0.05); (2) higher scores on HAM-D
(P=0.03) and Rosenthal (atypical depressive) scale (P=0.007); (3) longer delay
between onset of illness and recognition of bipolarity (P=0.0002); (4) higher
rate of psychiatric comorbidity (P=0.04); (5) different profiles on axis II
(i.e., more histrionic, passive-aggressive and less obsessive-compulsive
personality disorders). Family history for depressive and bipolar disorders did
not significantly distinguish the two groups; however, chronic affective
syndromes were significantly higher in BP-II with CT. Finally, cyclothymic BP-II
scored significantly much higher on irritable-risk-taking than "classic"
driven-euphoric items of hypomania. CONCLUSION: Depressions arising from a
cyclothymic temperament-even when meeting full criteria for hypomania-are likely
to be misdiagnosed as personality disorders. Their high familial load for
affective disorders (including that for bipolar disorder) validate the bipolar
nature of these "cyclothymic depressions." Our data support their inclusion as a
more "unstable" variant of BP-II, which we have elsewhere termed "BP-II 1/2."
These patients can best be characterized as the "darker" expression of the more
prototypical "sunny" BP-II phenotype. Coupled with the data from our companion
paper (, this issue), the present findings indicate that screening for
cyclothymia in major depressive patients represents a viable approach for
detecting a bipolar subtype that could otherwise be mistaken for an erratic
personality disorder. Overall, our findings support recent international
consensus in favoring the diagnosis of cyclothymic and bipolar II disorders over
erratic and borderline personality disorders when criteria for both sets of
disorders are concurrently met.
PMID: 12507737 [PubMed - in process]
----------
Psychiatr Clin North Am 2002 Dec;25(4):713-37
The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive,
impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions.
Perugi G, Akiskal HS.
Institute of Behavioral Sciences G. De Lisio, Viale Monzone 3, 54031 Carrara,
Italy. g.perugi@psico.med.unipi.it
The bipolar II spectrum represents the most common phenotype of bipolarity.
Numerous studies indicate that in clinical settings this soft spectrum might be
as common--if not more common than--major depressive disorders. The proportion
of depressive patients who can be classified as bipolar II further increases if
the 4-day threshold for hypomania proposed by the DSM-IV is reconsidered. The
modal duration of hypomanic episodes is 2 days; highly recurrent brief hypomania
is as short as 1 day, and when complicated by major depression, it should be
classified as a variant of bipolar II. Another variant of the bipolar II pattern
is represented by major depressive episodes superimposed on cyclothymic or
hyperthymic temperamental characteristics. The literature is unanimous in
supporting the idea that depressed patients who experience hypomania during
antidepressant treatment belong to the bipolar II spectrum. So-called alcohol-
or substance-induced mood disorders may have much in common with bipolar II
spectrum disorders, in particular when mood swings outlast detoxification.
Finally, many patients within the bipolar II spectrum, especially when
recurrence is high and the interepisodic period is not free of affective
manifestations, may meet criteria for personality disorders. This is
particularly true for cyclothymic bipolar II patients, who are often
misclassified as borderline personality disorder because of their extreme mood
instability. Subthreshold mood lability of a cyclothymic nature seems to be the
common thread that links the soft bipolar spectrum. The authors submit this to
represent the endophenotype likely to be informative in genetic investigations.
Mood lability can be considered the core characteristics of the bipolar II
spectrum, and it has been validated prospectively as a sensitive and specific
predictor of bipolar II outcome in major depressives. In a more hypothetical
vein, cyclothymic-anxious-sensitive temperamental disposition might represent
the mediating underlying characteristic in the complex pattern of anxiety, mood,
and impulsive disorders that bipolar II spectrum patients display throughout
much of their lifetimes. The foregoing conclusions, based on clinical experience
and the research literature, challenge several conventions in the formal
classificatory system (i.e., ICD-10 and DSM-IV). The authors submit that the
enlargement of classical bipolar II disorders to include a spectrum of
conditions subsumed by a cyclothymic-anxious-sensitive disposition, with mood
reactivity and interpersonal sensitivity, and ranging from mood, anxiety,
impulse control, and eating disorders, will greatly enhance clinical practice
and research endeavors. Prospective studies with the requisite methodologic
sophistication are needed to clarify further the relationship of the putative
temperamental and developmental variables to the complex syndromic patterns
described herein. The authors believe that viewing these constructs as related
entities with a common temperamental diathesis will make patients in this realm
more accessible to pharmacologic and psychological approaches geared to their
common temperamental attributes. The authors submit that the use of the term
"spectrum" is distinct from a simple continuum of subthreshold and threshold
cases. The underlying temperamental dimensions postulated by the authors define
the disposition for soft bipolarity and its variation and dysregulation in
anxious disorders and dyscontrol in appetitive, mental, and behavioral
disorders, much beyond affective disorders in the narrow sense.
Publication Types:
Review
Review, Tutorial
PMID: 12462857 [PubMed - indexed for MEDLINE]
----------
Suicide Life Threat Behav 2002 Summer;32(2):167-75
Situational determinants of inpatient self-harm.
Nijman HL, a Campo JM.
De Kijvelanden forensic psychiatric hospital, Poortugaal, The Netherlands.
volkoren@wxs.nl
Auto-aggressive individuals have a higher likelihood of engaging in
interpersonal violence, and vice versa. It is unclear, however, whether ward
circumstances are involved in determining whether aggression-prone patients will
engage in auto-aggressive or outwardly directed aggressive behavior. The current
study focuses on the situational antecedents of self-harming behavior and
outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly
aggressive behavior were monitored on a locked 20-bed psychiatric admissions
ward for 3.5 years with the Staff Observation Aggression Scale-Revised (SOAS-R).
A map of the ward was attached to each SOAS-R form, enabling staff members to
specify locations of aggressive incidents. Time of onset, location, and
provoking factors of auto-aggressive incidents were compared to those connected
to aggression against others or objects. Of a total of 774 aggressive incidents,
154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly
more prevalent during the evening (i.e., 50% compared to 32%), and reached its
highest level between 8 and 9 P.M. (17% compared to 7%). The majority of
self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed
aggression was particularly common in the day-rooms (24%), the staff office
(19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking
factors of auto-aggressive behavior are less often of an interactional nature
compared to outwardly directed aggression. The results suggest that a lack of
stimulation and interaction with others increases the risk of self-injurious
behavior. Practical and testable measures to prevent self-harm are proposed.
PMID: 12079033 [PubMed - indexed for MEDLINE]
----------
Can J Psychiatry 2002 Mar;47(2):195-6
Borderline personality disorder comorbidity in early- and late-onset bipolar II
disorder.
Benazzi F.
Publication Types:
Letter
PMID: 11926084 [PubMed - indexed for MEDLINE]
----------
J Clin Psychiatry 2002 May;63(5):442-6
Divalproex sodium treatment of women with borderline personality disorder and
bipolar II disorder: a double-blind placebo-controlled pilot study.
Frankenburg FR, Zanarini MC.
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA
02478, USA. ffrankenburg@mclean.harvard.edu
BACKGROUND: The intent of this study was to compare the efficacy and safety of
divalproex sodium and placebo in the treatment of women with borderline
personality disorder and comorbid bipolar II disorder. METHOD: We conducted a
placebo-controlled double-blind study of divalproex sodium in 30 female subjects
aged 18 to 40 years who met Revised Diagnostic Interview for Borderlines and
DSM-IV criteria for borderline personality disorder and DSM-IV criteria for
bipolar II disorder. Subjects were randomly assigned to divalproex sodium or
placebo in a 2:1 manner. Treatment duration was 6 months. Primary outcome
measures were changes on the interpersonal sensitivity, anger/hostility, and
depression scales of the Symptom Checklist 90 (SCL-90) as well as the total
score of the modified Overt Aggression Scale (MOAS). RESULTS: Twenty subjects
were randomly assigned to divalproex sodium; 10 subjects to placebo. Using a
last-observation-carried-forward paradigm and controlling for baseline severity,
divalproex sodium proved to be superior to placebo in diminishing interpersonal
sensitivity and anger/hostility as measured by the SCL-90 as well as overall
aggression as measured by the MOAS. Adverse effects were infrequent. CONCLUSION:
The results of this study suggest that divalproex sodium may be a safe and
effective agent in the treatment of women with criteria-defined borderline
personality disorder and comorbid bipolar II disorder, significantly decreasing
their irritability and anger, the tempestuousness of their relationships, and
their impulsive aggressiveness.
PMID: 12019669
----------
Can J Psychiatry 2002 Mar;47(2):195-6
Borderline personality disorder comorbidity in early- and late-onset bipolar II
disorder.
Benazzi F.
Publication Types:
Letter
PMID: 11926084
----------
J Affect Disord 2001 Dec;67(1-3):221-8
Do patients with borderline personality disorder belong to the bipolar spectrum?
Deltito J, Martin L, Riefkohl J, Austria B, Kissilenko A, Corless C Morse P.
Anxiety and Mood Disorders Program, The New York Hospital-Cornell Medical
Center, Westchester Division, USA. deltito@aol.com
BACKGROUND: This report examines clinical indicators for bipolarity in a cohort
of patients suffering from Borderline Personality Disorder (BPD). METHODS: The
study was conducted in the Cornell-Westchester Hospital, famed for its expertise
in BPD. To avoid biasing our sample, we excluded all BPD patients who were
active patients in our anxiety and mood disorders program. Through the use of
both open clinical interviews and standardized diagnostic interviews (SCID),
borderline patients were examined for evidence of bipolarity by five indicators:
history of spontaneous mania, history of spontaneous hypomania, bipolar
temperaments, pharmacologic response typical of bipolar disorder, and a positive
bipolar family history. RESULTS: Depending on the level of bipolar disorder from
the most rigorous (mania) to the most 'soft' (bipolar family history), between
13 and 81% of borderline patients showed signs of bipolarity. Based on what the
emerging literature supports as rigorously defined bipolar spectrum (bipolar I
and II), we submit that at least 44% of BPD belong to this spectrum; adding
hypomanic switches during antidepressant pharmacotherapy, the rate of bipolarity
in BPD reaches 69%. As expected from this formulation, most responded negatively
to antidepressants (e.g. hostility and agitation) and positively to mood
stabilizers. LIMITATIONS: Small sample size and retrospective gathering of data
on treatment response. CCONCLUSION: Patients with BPD more often than not
exhibit clinically ascertainable evidence for bipolarity and may benefit from
known treatments for Bipolar Spectrum Disorders. Large scale, systematic
treatment studies with mood stabilizers are indicated.
PMID: 11869772
----------
J Psychiatr Res 2001 Nov-Dec;35(6):307-12
Affective instability and impulsivity in borderline personality and bipolar II
disorders: similarities and differences.
Henry C, Mitropoulou V, New AS, Koenigsberg HW, Silverman J, Siever LJ.
Service Universitaire de Psychiatrie, Centre Hospitalier Charles Perrens, 121
rue de la Bechade, 33076, Bordeaux, France.
OBJECTIVES: many studies have reported a high degree of comorbidity between mood
disorders, among which are bipolar disorders, and borderline personality
disorder and some studies have suggested that these disorders are co-transmitted
in families. However, few studies have compared personality traits between these
disorders to determine whether there is a dimensional overlap between the two
diagnoses. The aim of this study was to compare impulsivity, affective lability
and intensity in patients with borderline personality and bipolar II disorder
and in subjects with neither of these diagnoses. METHODS: patients with
borderline personality but without bipolar disorder (n=29), patients with
bipolar II disorder without borderline personality but with other personality
disorders (n=14), patients with both borderline personality and bipolar II
disorder (n=12), and patients with neither borderline personality nor bipolar
disorder but other personality disorders (OPD; n=93) were assessed using the
Affective Lability Scale (ALS), the Affect Intensity Measure (AIM), the
Buss-Durkee Hostility Inventory (BDHI) and the Barratt Impulsiveness Scale
(BIS-7B). RESULTS: borderline personality patients had significantly higher ALS
total scores (P<0.05) and bipolar II patients tended to have higher ALS scores
than patients with OPD (P<0.06). On one of the ALS subscales, the borderline
patients displayed significant higher affective lability between euthymia and
anger (P<0.002), whereas patients with bipolar II disorder displayed affective
lability between euthymia and depression (P<0.04), or elation (P<0.01) or
between depression and elation (P<0.01). A significant interaction between
borderline personality and bipolar II disorder was observed for lability between
anxiety and depression (P<0.01) with the ALS. High scores for impulsiveness
(BISTOT, P<0.001) and hostility (BDHI, P<0.05) were obtained for borderline
personality patients only and no significant interactions between diagnoses were
observed. Only borderline personality patients tended to have higher affective
intensity (AIM, P<0.07). CONCLUSIONS: borderline personality disorder and
bipolar II disorder appear to involve affective lability, which may account for
the efficacy of mood stabilizers treatments in both disorders. However, our
results suggest that borderline personality disorder cannot be viewed as an
attenuated group of affective disorders.
PMID: 11684137
----------
Encephale 2001 Mar-Apr;27(2):120-7
[Symptoms of DSM IV borderline personality disorder in a nonclinical population
of adolescents: study of a series of 35 patients]
[Article in French]
Chabrol H, Chouicha K, Montovany A, Callahan S.
Centre d'Etude et de Recherche en Psychopathologie, Universite de Toulouse-Le
Mirail, 5, allee Antonio Machado, 31058 Toulouse.
1,363 high school students were solicited to complete a personality disorder
questionnaire and were encouraged to continue in the study by signing up for
interviews with Master's level psychology students. 107 students (7.8%, 34
males, 73 females, mean age = 16.7 +/- 1.8) manifested themselves for the
interview and were assessed by using structured diagnostic interviews for
borderline personality disorder and major depressive disorder (DIB-R, Revised
Diagnostic Interview for Borderlines; MINI, Mini International Neuropsychiatric
Interview). The interviews were audiotaped. Interrater reliability was
determined by independent ratings of 12 borderline subjects and 12
non-borderline subjects (kappa: 0.795). The distribution of the 107 subjects
based on the number of DSM IV borderline personality disorder criteria indicated
a gradual dispersion suggesting a continuum from normality to borderline
personality disorder: 8% of the subjects met none of the criteria; 16% met one
criterion; 17% met two; 12.5%, three; 13.7%, four; 8.4%, five; 5.6%, six; 9.3%,
seven; 4.6%, eight; 4.6%, nine. Thirty-five of these 107 subjects (32.7%, 6
males, 29 females, mean age = 16.7 +/- 1.7) received a diagnosis of borderline
personality disorder according to DSM IV criteria. The most frequent symptoms
were paranoid ideation or dissociative symptoms (97.1%), affective instability
(88.6%), inappropriate, intense anger (85.6%), suicidal gestures or
automutilation (82.9%), followed by frantic efforts to avoid abandonment (77%),
impulsivity (65.7%), unstable and intense relationships (62.9%), identity
disturbance (60%), and emptiness (57.1%). The comparison between borderline and
non-borderline subjects showed that all borderline personality disorder criteria
discriminated significantly between the two groups. The high incidence of
paranoid ideation (97.1%) and dissociative experiences (65.7%) in the borderline
group suggests the pertinence of criterion 9 in the diagnosis of borderline
personality disorder in adolescents. Two criteria of schizotypal personality
disorder were also frequent in this group: 68.6% of the borderline group
reported odd beliefs or magical thinking, in particular beliefs in clairvoyance
or telepathy and 88.6% reported unusual perceptual experiences, in particular
sensing the presence of a force or person and bodily illusions. Moreover, 31.4%
of the borderline group reported transient "quasi" psychotic experiences, mainly
"quasi" visual hallucinations. Auditory hallucinations or delusional ideas were
not observed. This symptomatology suggests a "quasi" psychotic dimension of
adolescent borderline personality disorder. Affective instability was the next
most frequent symptom which was usually marked by a cyclothymic appearance.
Comorbidity with major depressive disorder was high: 85.7% of the borderline
subjects had a concurrent diagnosis of major depression versus 45.8% of the
non-borderline subjects. Thus, major depression is more frequent than most of
the borderline personality disorder criteria, with the exception of the already
noted paranoid ideation and affective instability. Hypomanic symptoms were
frequent in the borderline group (65.7%) as well as in the non-borderline group
(38.8%). This symptomatology suggests that adolescent borderline personality
disorder is linked to an attenuated bipolar spectrum characterised by major
depressive episodes and soft signs of bipolarity. However, hypomanic symptoms,
which were quite frequent in non-borderline subjects, might also be due to a
mechanism of defence, i.e. the denial of depression. Comorbidity with anxiety
disorders appeared also to be high: anxiety symptoms were found in 91.4% of the
borderline subjects who reported symptoms of generalised anxiety disorder, panic
disorder, and somatoform disorders. The overall clinical appearance of these
borderline adolescents not referred for treatment seemed to be quite similar to
that of borderline adolescents in clinical samples. This study shows that
adolescent borderline personality disorder in non-clinical population is a
serious disorder characterised by the importance of mental suffering and
behavioural disturbances the disorganising power of which may fix the
developmental process in a pathological pathway. Adolescent borderline
personality disorder appears in this study to be strongly associated with major
depressive disorder and at-risk behaviours linked to impulsivity, affective
instability, and suicidal ideation. However, this study found an absence of
precise cut-off between borderline and non-borderline subjects. Two factors
might have contributed to the appearance of a continuum. First, some degree of
impulsivity and instability in affectivity, self-images and interpersonal
relationships is part of normal adolescence. (ABSTRACT TRUNCATED)
PMID: 11407263
----------
Bipolar Disord 2000 Sep;2(3 Pt 2):281-93
Bipolar disorder during adolescence and young adulthood in a community sample.
Lewinsohn PM, Klein DN, Seeley JR.
Oregon Reserch Institute, Eugene, 97403-1983, USA. pete@ori.org
OBJECTIVES: To compare the incidence and prevalence of bipolar disorder (BD)
between adolescence and young adulthood; to explore the stability and
consequences of adolescent BD in young adulthood; to determine the rate of
switching from major depressive disorder (MDD) to BD; and to evaluate the
significance of subsyndromal BD (SUB). METHODS: A large, randomly selected
community sample (n = 1,507) received diagnostic assessments twice during
adolescence, and a stratified subset (n = 893) was assessed again at 24 years of
age. In addition, direct interviews were conducted with all available
first-degree relatives. Five mutually exclusive groups, based on diagnoses in
adolescence, were compared: BD (n = 17), SUB (n = 48), MDD (n = 275), disruptive
behavior disorder (n = 49), and no-disorder (ND) controls (n = 307). RESULTS:
Lifetime prevalence of BD was approximately 1% during adolescence and 2%, during
young adulthood. Lifetime prevalence for SUB was approximately 5%. Less than 1%,
of adolescents with MDD 'switched' to BD by age 24. Adolescents with BD had an
elevated incidence of BD from 19 to 23 years, while adolescents with SUB
exhibited elevated rates of MDD and anxiety disorders in young adulthood. BD and
SUB groups both had elevated rates of antisocial symptoms and borderline
personality symptoms. Compared to the ND group, adolescents with BD and SUB both
showed significant impairment in psychosocial functioning and had higher
mental-health treatment utilization at age 24 years of age. The relatives of
adolescents with BD and SUB had elevated rates of MDD and anxiety disorders. The
relatives of SUB probands had elevated BD, while the relatives of BD had
elevated rates of SUB and borderline symptoms. CONCLUSIONS: Adolescent BD showed
significant continuity across developmental periods and was associated with
adverse outcomes during young adulthood. Adolescent SUB was also associated with
adverse outcomes in young adulthood, but was not associated with an increased
incidence of BD. Due to high rates of comorbidity with other disorders,
definitive conclusions regarding the specific clinical significance of SUB must
await studies with larger numbers of 'pure' SUB cases.
PMID: 11249806
----------
Am J Psychiatry 2001 Feb;158(2):295-302
Treatment utilization by patients with personality disorders.
Bender DS, Dolan RT, Skodol AE, Sanislow CA, Dyck IR, McGlashan TH, Shea MT,
Zanarini MC, Oldham JM, Gunderson JG.
Department of Psychiatry and Human Behavior, Brown University, Providence, RI,
USA. benderd@pi.cpmc.columbia.edu
OBJECTIVE: Utilization of mental health treatment was compared in patients with
personality disorders and patients with major depressive disorder without
personality disorder. METHOD: Semistructured interviews were used to assess
diagnosis and treatment history of 664 patients in four representative
personality disorder groups-schizotypal, borderline, avoidant, and
obsessive-compulsive-and in a comparison group of patients with major depressive
disorder. RESULTS: Patients with personality disorders had more extensive
histories of psychiatric outpatient, inpatient, and psychopharmacologic
treatment than patients with major depressive disorder. Compared to the
depression group, patients with borderline personality disorder were
significantly more likely to have received every type of psychosocial treatment
except self-help groups, and patients with obsessive-compulsive personality
disorder reported greater utilization of individual psychotherapy. Patients with
borderline personality disorder were also more likely to have used antianxiety,
antidepressant, and mood stabilizer medications, and those with borderline or
schizotypal personality disorder had a greater likelihood of having received
antipsychotic medications. Patients with borderline personality disorder had
received greater amounts of treatment, except for family/couples therapy and
self-help, than the depressed patients and patients with other personality
disorders. CONCLUSIONS: These results underscore the importance of considering
personality disorders in diagnosis and treatment of psychiatric patients.
Borderline and schizotypal personality disorder are associated with extensive
use of mental health resources, and other, less severe personality disorders may
not be addressed sufficiently in treatment planning. More work is needed to
determine whether patients with personality disorders are receiving adequate and
appropriate mental health treatments.
PMID: 11156814
----------
J Abnorm Psychol 2000 May;109(2):222-6
A longitudinal study of high scorers on the hypomanic personality scale.
Kwapil TR, Miller MB, Zinser MC, Chapman LJ, Chapman J, Eckblad M.
Department of Psychology, University of Wisconsin-Madison, USA.
t_kwapil@uncg.edu
Former college students (n = 36) identified by high scores on the Hypomanic
Personality Scale (HYP; Eckblad & Chapman, 1986) were compared with control
participants (n = 31) at a 13-year follow-up assessment. As hypothesized, the
HYP group reported more bipolar disorders and major depressive episodes than the
control group. The HYP group also exceeded the control group on the severity of
psychotic-like experiences, symptoms of borderline personality disorder, and
rates of substance use disorders. HYP group members with elevated scores on the
Impulsive-Nonconformity Scale (Chapman et al., 1984) experienced greater rates
of bipolar mood disorders, poorer overall adjustment, and higher rates of arrest
than the remaining HYP or control participants.
PMID: 10895560
----------
Compr Psychiatry 2000 Mar-Apr;41(2):106-10
Borderline personality disorder and bipolar II disorder in private practice
depressed outpatients.
Benazzi F.
Department of Psychiatry, Public Hospital Morgagni, Forli, Italy.
Bipolar II disorder (BDII) may be confused with borderline personality disorder
(BPD) when it is cyclothymic between episodes. The aim of the present study was
to determine the prevalence of BPD and to test whether BDII can be distinguished
from BPD without difficulty in private practice mood disorder outpatients.
Private practice was chosen because it is often the first or second line of
treatment of mood disorders in Italy, and many "soft" patients can be found in
this setting. Among 63 consecutive unipolar and 50 bipolar II major depressive
episode (MDE) outpatients interviewed with the Structured Clinical Interviews
for DSM-IV axis I/II disorders (SCIDs), the prevalence of BPD was 6.1% and was
significantly higher in BDII patients (12% v. 1.5%). Overall, the rate of BPD
diagnosis was very low. BDII was distinguished from BPD without difficulty by
DSM-IV criteria. The results suggest that there may be a subgroup of BDII
patients with a relatively stable course between episodes (or at least not so
unstable as to suggest a BPD diagnosis or comorbidity) and a low comorbidity
with BPD, in a setting closer to community patients than university settings.
The "usual" BDII patient can be distinguished from the BPD patient.
PMID: 10741888
----------
Compr Psychiatry 1999 Jul-Aug;40(4):245-52
Axis I diagnostic comorbidity and borderline personality disorder.
Zimmerman M, Mattia JI.
Department of Psychiatry and Human Behavior, Brown University School of
Medicine, Rhode Island Hospital, Providence, USA.
Borderline personality disorder (PD) has been the most studied PD. Research has
examined the relationship between borderline PD and most axis I diagnostic
classes such as eating disorders, mood disorders, and substance use disorders.
However, there is little information regarding the relationship of borderline PD
and overall comorbidity with all classes of axis I disorders assessed
simultaneously. In the present study, 409 patients were evaluated with
semistructured diagnostic interviews for axis I and axis II disorders. Patients
with a diagnosis of borderline PD versus those who did not receive the diagnosis
were assigned significantly more current axis I diagnoses (3.4 v 2.0).
Borderline PD patients were twice as likely to receive a diagnosis of three or
more current axis I disorders (69.5% v 31.1%) and nearly four times as likely to
have a diagnosis of four or more disorders 147.5% v 13.7%). In comparison to
nonborderline PD patients, borderline PD patients more frequently received a
diagnosis of current major depressive disorder (MDD), bipolar I and II disorder,
panic disorder with agoraphobia, social and specific phobia, posttraumatic
stress disorder (PTSD), obsessive-compulsive disorder (OCD), eating disorder
NOS, and any somatoform disorder. Similar results were observed for lifetime
diagnoses. Overall, borderline PD patients were more likely to have multiple
axis I disorders than nonborderline PD patients, and the differences between the
two groups were present across mood, anxiety, substance use, eating, and
somatoform disorder categories. These findings highlight the importance of
performing thorough evaluations of axis I pathology in patients with borderline
PD in order not to overlook syndromes that are potentially treatment-responsive.
PMID: 10428182
----------
J Nerv Ment Dis 1999 May;187(5):313-5
Borderline personality disorder and bipolar mood disorder: two distinct
disorders or a continuum?
Atre-Vaidya N, Hussain SM.
Department of Psychiatry and Behavioral Sciences, Finch University of Health
Sciences/The Chicago Medical School, North Chicago, Illinois 60064, USA.
PMID: 10348089
----------
J Affect Disord 1998 Dec;51(3):333-43
Lamotrigine as a promising approach to borderline personality: an open case
series without concurrent DSM-IV major mood disorder.
Pinto OC, Akiskal HS.
International Mood Center, University of California at San Diego, La Jolla
92093-0603, USA.
BACKGROUND: Borderline personality disorder (BPD) has long defined definitive
treatment. Such failure is reflected in repeated suicidal crises, often
associated with dysphoric symptoms of a chronic fluctuating nature, whose labile
intermittent character does suggest a subthreshold bipolar depressive mixed
state. For all these reasons, we hypothesized that the anticonvulsant
lamotrigine, touted to be a mood stabilizer with antidepressant properties,
might be uniquely beneficial for these patients. METHODS: From a base rate of
about 300 patients in a community mental health center, we identified eight
patients meeting seven or more of the DSM-IV criteria for BPD without concurrent
major mood disorders. All patients presented with history of severe suicidal
behavior, hostile depression and/or labile moods, stimulant and alcohol abuse,
as well as multiple unprotected sexual encounters; one patient was actually HIV
positive. All had failed previous trials with different antidepressants and mood
stabilizers. All current medications were gradually withdrawn--and when
necessary--patients kept on a low dose of a conventional neuroleptics for a few
weeks, while lamotrigine was being gradually introduced in 25-mg weekly
increments until the patient responded (up to 300 mg/day maximum). RESULTS:
Consistent with previous work by us and others, bipolar family history could be
documented in three of eight BPD patients, and worsening on antidepressants in
four of eight, providing indirect support to our conceptualization of BPD as a
bipolar variant. One patient developed a rash on 25 mg and was dropped from the
lamotrigine trial, while another patient was noncompliant. Three who failed
lamotrigine, subsequently responded, respectively, to sertraline,
lithium-thioridazine combination, and valproate. The remaining three patients
showed a robust response to lamotrigine, ranging from 75 to 300 mg/day: their
functioning jumped from a mean baseline DSM-IV GAF score in the 40's to the 80's
during 3-4 months. Among all responders impulsive sexual, drug-taking and
suicidal behaviors disappeared and no longer met the criteria for BPD. At an
average follow-up of 1 year, they no longer meet criteria for BPD. LIMITATIONS:
Open uncontrolled results on a small number of patients in a tertiary care
center may not generalize to BPD patients at large. CONCLUSIONS: Overall, the
BPD response to pharmacotherapy in the present case series was 75%. The fact
that five of six pharmacotherapy responders required mood stabilizers, argues
against the prevalent view that the depressions of borderline patients belong to
unipolarity. Of BPD patients who completed the trial, 50% achieved sustained
remission from their personality disorder with lamotrigine monotherapy. The
dramatic nature of the response in patients refractory to all previous
medication trials and maintenance of a robust response over 1 year, argue
against a placebo effect. Controlled systematic investigation of lamotrigine in
BPD is indicated.
PMID: 10333987
----------
J Am Acad Child Adolesc Psychiatry 1999 Jan;38(1):56-63
Natural course of adolescent major depressive disorder: I. Continuity into young
adulthood.
Lewinsohn PM, Rohde P, Klein DN, Seeley JR.
Oregon Research Institute, Eugene 97403-1983, USA.
OBJECTIVE: To examine the course of adolescent major depressive disorder (MDD)
by comparing rates of mood and non-mood disorders between age 19 and 24 years in
participants with a history of adolescent MDD versus participants with
adolescent adjustment disorder with depressed mood, nonaffective disorder, and
no disorder. METHOD: Participants from a large community sample who had been
interviewed twice during adolescence completed a third interview assessing Axis
I psychopathology and antisocial and borderline personality disorders after
their 24th birthday: 261 participants with MDD, 73 with adjustment disorder, 133
with nonaffective disorder, and 272 with no disorder through age 18. RESULTS:
MDD in young adulthood was significantly more common in the adolescent MDD group
than the nonaffective and no disorder groups (average annual rate of MDD = 9.0%,
5.6%, and 3.7%, respectively). Adolescents with MDD also had a high rate of
nonaffective disorders in young adulthood (annual nonaffective disorder rate =
6.6%) but did not differ from adolescents with nonaffective disorder (7.2%).
Prevalence rates of dysthymia and bipolar disorder were low (< 1%). Adolescents
with adjustment disorder exhibited similar rates of MDD and nonaffective
disorders in young adulthood as adolescents with MDD. CONCLUSIONS: This study
documents the significant continuity of MDD from adolescence to young adulthood.
Public health implications of the findings are discussed.
PMID: 9893417
----------
J Nerv Ment Dis 1999 May;187(5):313-5
Borderline personality disorder and bipolar mood disorder: two distinct
disorders or a continuum?
Atre-Vaidya N, Hussain SM
Department of Psychiatry and Behavioral Sciences, Finch University of Health
Sciences/The Chicago Medical School, North Chicago, Illinois 60064, USA.
PMID: 10348089, UI: 99275845
----------
J Nerv Ment Dis 1998 Oct;186(10):616-22
Comorbid mood disorders as modifiers of treatment response among inpatients
with borderline personality disorder.
Goodman G, Hull JW, Clarkin JF, Yeomans FE
Department of Psychiatry, Cornell University Medical College, White Plains, New
York 10605, USA.
Structured clinical interviews of 63 female inpatients diagnosed with
borderline personality disorder were used to study the relations of comorbid
mood disorders to treatment response. Diagnostic information was gathered using
the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II)
and the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P).
Information about psychotic symptoms was also based upon responses to the
SCID-P. Treatment response was assessed through weekly ratings on the Symptom
Checklist-90-Revised over 25 weeks of hospitalization. Initial depression but
not initial or previous bipolar disorder was found to predict treatment course.
Initial psychotic symptoms were also found to predict treatment course among
patients with initial bipolar disorder and tended to modify the trajectory of
symptoms over time among patients with initial depression. Possible
explanations for these findings are explored and discussed.
----------
Compr Psychiatry 1998 Mar-Apr;39(2):72-4
Comorbidity of personality disorders with bipolar mood disorders.
Ucok A, Karaveli D, Kundakci T, Yazici O
Department of Psychiatry, Istanbul Medical Faculty, Turkey.
The aim of the study was to assess the prevalence of personality disorders in a
group of outpatients with bipolar I disorder. The Structured Clinical Interview
for DSM-III-R Personality Disorders (SCID-II) was administered to 90 bipolar
outpatients who met the DSM-III-R criteria and 58 control subjects. Of the
patients and controls, 47.7% and 15.5%, respectively, had at least one
personality disorder. At least one personality disorder in clusters A, B, and C
and obsessive-compulsive, paranoid, histrionic, and borderline personality
disorders were significantly more prevalent in bipolars. Suicide attempts were
more frequent in patients with a history of personality disorder.
----------
Ned Tijdschr Geneeskd 1997 Mar 1;141(9):409-12
[Borderline or bipolar disorder after all]?
[Article in Dutch]
Knoppert-van der Klein EA, Hoogduin CA, Nolen WA, Kolling P
Psychiatrisch Ziekenhuis Endegeest, afd. Jelgersmapolikliniek, Oegstgeest.
In two women aged 35 and 21 years, the initial diagnosis 'borderline
personality disorder' was changed to 'bipolar disorder'. These disorders are
separate entities with different therapy, but may resemble each other very
much. It may be necessary to use heteroanamnesis and family anamnesis and to
follow the patient for some time in order to establish whether there are mood
disorders.
----------
J Clin Psychopharmacol 1996 Apr;16(2 Suppl 1):4S-14S
The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV.
Akiskal HS
International Mood Clinic, University of California at San Diego, La Jolla,
USA.
Based on the author's work and that of collaborators, as well as other
contemporaneous research, this article reaffirms the existence of a broad
bipolar spectrum between the extremes of psychotic manic-depressive illness and
strictly defined unipolar depression. The alternation of mania and melancholia
beginning in the juvenile years is one of the most classic descriptions in
clinical medicine that has come to us from Greco-Roman times. French alienists
in the middle of the nineteenth century and Kraepelin at the turn of that
century formalized it into manic-depressive psychosis. In the pre-DSM-III era
during the 1960s and 1970s, North American psychiatrists rarely diagnosed the
psychotic forms of the disease; now, there is greater recognition that most
excited psychoses with a biphasic course, including many with schizo-affective
features, belong to the bipolar spectrum. Current data also support Kraepelin's
delineation of mixed states, which frequently take on psychotic proportions.
However, full syndromal intertwining of depressive and manic states into
dysphoric or mixed mania--as emphasized in DSM-IV--is relatively uncommon;
depressive symptoms in the midst of mania are more representative of mixed
states. DSM-IV also does not formally recognize hypomanic symptomatology that
intrudes into major depressive episodes and gives rise to agitated depressive
and/or anxious, dysphoric, restless depressions with flight of ideas. Many of
these mixed depressive states arise within the setting of an attenuated bipolar
spectrum characterized by major depressive episodes and soft signs of
bipolarity. DSM-IV conventions are most explicit for the bipolar II subtype
with major depressive and clear-cut spontaneous hypomanic episodes;
temperamental cyclothymia and hyperthymia receive insufficient recognition as
potential factors that could lead to switching from depression to bipolar I
disorder and, in vulnerable subjects, to predominantly depressive cycling. In
the main, rapid-cycling and mixed states are distinct. Nonetheless, there exist
ultrarapid-cycling forms where morose, labile moods with irritable, mixed
features constitute patients' habitual self and, for that reason, are often
mistaken for "borderline" personality disorder. Clearly, more formal research
needs to be conducted in this temperamental interface between more classic
bipolar and unipolar disorders. The clinical stakes, however, are such that a
narrow concept of bipolar disorder would deprive many patients with lifelong
temperamental dysregulation and depressive episodes of the benefits of
mood-regulating agents.
----------
Encephale 1995 Mar;21 Spec No 2:47-9
[Pathologic personality, temperament and treatment].
[Article in French]
Akiskal HS
The relationships between affective disorders and personality disorders remain
controversial. The inefficacy of therapeutics in depressed subjects with a
personality disorder is often due to an inadequate therapeutic. A few clinical
arguments and experimental data corroborate the hypothesis of a commun
substratum for affective disorders and personality disorders. A few studies
demonstrate an efficacy in specific cases of lithium, neuroleptics and
antidepressants (particularly MAOI) in borderline subjects with an affective
disorder. We may too use pragmatic psychotherapies targeted on specific
problems of each patient.
----------
J Abnorm Psychol 1994 Nov;103(4):610-24
Social perceptions and borderline personality disorder: the relation to mood
disorders.
Benjamin LS, Wonderlich SA
Department of Psychology, University of Utah.
We used the Structural Analysis of Social Behavior (SASB) to compare the social
perceptions of borderline, unipolar, and bipolar-depressed inpatients. As
predicted, borderline subjects differed from bipolar-depressed and unipolar
subjects in their social perceptions. Borderline subjects viewed their
relationships to their mother, hospital staff, and other patients as more
hostile and autonomous than did mood disordered subjects. The results are
discussed in terms of an integrative theory of borderline personality that
considers the psychobiology of interpersonal relationships and attachment
disruptions.
----------
Can J Psychiatry 1994 Jun;39(5):315
Re: Misdiagnosis of bipolar affective disorder as personality disorder.
Paris J
Comments:
Comment on: Can J Psychiatry 1993 Nov;38(9):587-9
Comment in: Can J Psychiatry 1995 Mar;40(2):109-10
----------
Acta Psychiatr Scand Suppl 1994;379:45-9
The borderline syndromes of depression, mania and schizophrenia: the coaxial or
temperamental approach.
Bech P
Department of Psychiatry, Frederiksborg General Hospital, Hillerod, Denmark.
When analyzing the diagnostic position of "neurosis", Akiskal found it
clinically meaningless because it lacks sufficient phenomenological
characterization. In contrast, Tyrer found it meaningful because it explains
the heterogeneity of neurotic symptoms. The diagnostic position of "borderline"
has been treated analogically by Akiskal and Tyrer. Thus, Tyrer uses the term
borderline in a very broad and general sense, while Akiskal again has found it
without sufficient phenomenological characterization. Hence, the DSM-III
concept of borderline personality disorder includes the temperament borders of
affective disorders (melancholic, choleric and sanguine). A closer look at the
Tyrer concept of neurosis places it within the melancholic temperament. The
choleric temperament covers cyclothymia and the sanguine temperament the
subclinical manifestations of mania. The term borderline personality disorders
should, then, be restricted to cover the phlegmatic temperament or mild degrees
of the schizophrenic spectrum disorders, which is in accordance with ICD-10.
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Acta Psychiatr Scand Suppl 1994;379:32-7
The temperamental borders of affective disorders.
Akiskal HS
Department of Psychiatry, University of California at San Diego, La Jolla
92093-0603.
Depending on the population studied, anywhere from half to two-thirds of
DSM-III borderline disorders seem to represent subaffective expressions,
principally on the border of bipolar disorder. "Borderland" may actually be a
better characterization of this large temperamentally unstable terrain with a
population prevalence of 4-6% (as compared with 1% for classical bipolar
disorder). The temperaments include the dysthymic, irritable, and cyclothymic
types which, respectively, coexist with "double depressive", mixed bipolar, and
bipolar II disorders; others conform to an anxious-sensitive temperament in
continuum with hysteroid dysphoric and atypical depressive disorders.
Borderline "stable instability" in these patients appears secondary to
affective temperamental dysregulation, which has exacerbated into a protracted
emotional storm during a difficult maturational phase in the biography of a
given patient.
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Am J Psychiatry 1992 Nov;149(11):1473-83
Contested boundaries of bipolar disorder and the limits of categorical
diagnosis in psychiatry.
Blacker D, Tsuang MT
Program in Psychiatric Epidemiology, Harvard School of Public Health, Boston,
MA.
The authors' primary objective is to outline the phenomenology, importance, and
available data on issues concerning the boundaries between bipolar disorder and
diagnoses such as schizophrenia, unipolar depression, and personality
disorders. In addition, by illuminating the many difficulties with the
boundaries of one of psychiatry's more robust diagnoses, they hope to awaken in
the reader a healthy skepticism about current psychiatric nosology. For a topic
of this scope, a literature review must be selective. For each boundary area, a
mixture of classic and recent papers covering a range of validating criteria is
included whenever possible. Good summary data are cited when available, as are
a selection of relevant theoretical papers. The review indicates that current
diagnostic criteria for bipolar disorder are generally reasonable, but there
are many problem areas, most of which cannot be solved by changes in criteria.
Notable among these are 1) the possibility of future manic episodes in unipolar
disorder, 2) schizoaffective disorder, bipolar type, and 3) borderline
personality disorder with prominent mood swings. The disputes concerning the
boundaries of bipolar disorder illustrate the limitations of categorical
diagnosis which result from the implementation of diagnostic criteria, the
criteria themselves, the fundamental nosologic process, and the phenomena
themselves. If these limitations are to be extended, it may be necessary to
explore alternative ways of defining psychiatric diagnoses for different
settings in research and clinical practice.
Comments:
Comment in: Am J Psychiatry 1993 Oct;150(10):1568-9
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Encephale 1992 Jan;18 Spec No 1:78-82
[Clinical study of 5 families with bipolar disorder].
[Article in French]
Amadeo S, Abbar M, Fourcade ML, Scharbach H, Selin D, Bretome A, Madec A,
Castelnau D, Besancon G
Service de Psychiatrie Adulte, Hopital Saint-Jacques, CHRU, Nantes.
Five pedigrees of bipolar patients with at least two bipolar subjects on two
generations have been identified in psychiatric departments of Nantes,
Montpellier and Challans for linkage studies. In each pedigree, it was found
one or more patients suffering from other conditions, like Borderline
personality, Anorexia-bulimia, Mental retardation with dysmorphia, and Panic
disorders. Mood disorders spectrum and therapeutic implications are discussed.
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J Psychiatr Res 1992 Jan;26(1):1-16
Mood and global functioning in borderline personality disorder: individual
regression models for longitudinal measurements.
Hoke LA, Lavori PW, Perry JC
Beth Israel Hospital, Department of Psychiatry, Boston, MA 02215.
This report addresses the need for prospective studies of personality
disorders, as well as some of the difficulties encountered in longitudinal
studies when missing data occur due to subject attrition and variable follow-up
intervals. Various statistical methods for handling repeated measurements data
are reviewed. Many of these methods are quite complex and require expert
statistical skills. A simpler way to handle multivariate data using
single-number summary scores is proposed as an alternative which is efficient
and more readily understood by professionals in many disciplines. Findings are
presented from a prospective study of borderline personality disorder which
utilized repeated observations over time. Individual regression models were
applied to each subject's repeated measurements to obtain a summary of his or
her trend on measures of mood and global functioning. The individual
regressions produced separate statistics, slopes summarizing rates of change
and intercepts which estimated initial levels of functioning. These summaries
were then used in group analyses. Findings indicated that subjects showed mild
to moderate impairment in mood and moderate impairment in overall functioning.
The individual slopes indicated that little overall change was observed during
the 5-year period after initial assessment. Neither presence of borderline
diagnosis (definite vs. trait vs. no borderline diagnosis) nor gender predicted
initial levels of functioning or rates of change. Further examination of other
predictors which may influence longterm outcome, such as history of childhood
trauma or presence of schizotypal personality features, is suggested. It is
concluded that prospective studies are essential in establishing the validity
of personality disorders and in understanding individual variation in outcomes.
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J Affect Disord 1991 Apr;21(4):265-72
Morbidity risk for mood disorders in the families of borderline patients.
Gasperini M, Battaglia M, Scherillo P, Sciuto G, Diaferia G, Bellodi L
Department of Neuropsychiatric Sciences, School of Medicine, University of
Milan, Italy.
We analyzed the familial morbidity risk for mood disorders (MR) and the
presence of a family history of alcoholism in a group of 58 patients with
DSM-III borderline personality disorder (PD). The MR in the families of
borderline subjects was not significantly different from that found in a
control group of affective patients with other cluster II PD, or without PD.
The MR in the families of borderline subjects who had never developed an
affective episode was not significantly different from that found in the
families of borderline PD with a history of mood disorders. Borderline subjects
with mood disorders had higher rates of alcoholism in their families, mainly
among parents. Our results support the hypothesis that borderline PD, even in
absence of the codiagnosis of a mood disorder in the subject, may be a
predictor of higher familial liability to mood disorders, although it may be
more informative for the familial clustering of specific subgroups than for
mood disorders as a whole.
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J Clin Psychiatry 1990 Aug;51(8):335-9
The prevalence of cyclothymia in borderline personality disorder.
Levitt AJ, Joffe RT, Ennis J, MacDonald C, Kutcher SP
University of Toronto, Ontario, Canada.
Sixty patients with personality disorders were evaluated by several different
diagnostic instruments to determine the prevalence of cyclothymia in borderline
personality disorder (BPD) and in other personality disorders (OPD).
Cyclothymia occurred more frequently in BPD than in OPD, regardless of which
diagnostic system was used. In contrast, the prevalence of major, minor, and
intermittent depression, hypomania, and bipolar disorder was not significantly
different in BPD as compared with OPD. Cyclothymic borderlines and
noncyclothymic borderlines could not be distinguished on behavioral or
functional measures. These results have implications for the diagnostic
validity of both BPD and cyclothymia.
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J Am Acad Child Adolesc Psychiatry 1990 May;29(3):355-8
Adolescent bipolar illness and personality disorder.
Kutcher SP, Marton P, Korenblum M
Department of Psychiatry, Sunnybrook Medical Centre, University of Toronto,
Ontario, Canada.
The relationship between adolescent bipolar illness and personality disorder
has not been explored. Studies of adult bipolars suggest a bipolar
illness/borderline personality disorder (BPD) association. Twenty euthymic
bipolar teens were assessed using the Personality Disorders Examination.
Thirty-five percent met DSM-III-R criteria for at least one personality
disorder. Three of the 20 (15%) had a borderline personality disorder
diagnosis. The bipolar illness with personality disorder group differed
significantly from the bipolar illness without personality disorder group in
terms of increased lithium unresponsiveness (p less than 0.05) and neuroleptic
treatment at time of personality assessment (p less than 0.01), but not in
terms of age, sex, age of illness onset, serum lithium level, rapid cycling,
substance abuse history, alcohol abuse history, or number of suicide attempts.
Issues regarding the study of personality disorder in adolescent bipolars are
discussed.
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J Affect Disord 1990 Apr;18(4):267-73
Sleep patterns in borderline personality disorder.
Benson KL, King R, Gordon D, Silva JA, Zarcone VP Jr
Department of Psychiatry, VA Medical Center, Palo Alto, CA 94304.
Sleep patterns of borderline patients with and without a history of affective
disorder were compared to each other and to normal reference data. The three
groups could not be distinguished in terms of REM latency because a wide spread
of values was seen within each group. Borderlines were different from normal
controls in other aspects of sleep architecture; they had less total sleep,
more stage 1 sleep, and less stage 4 sleep. If one assumes that REM latency is
a biological marker for mood disorder, then our results do not support the
hypothesis that borderline personality disorder is a variant of affective
illness. However, other data suggest that REM latency should not be used to
validate the presence of affective illness.
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Psychiatr J Univ Ott 1990 Mar;15(1):22-7
Associated diagnoses (comorbidity) in patients with borderline personality
disorder.
Prasad RB, Val ER, Lahmeyer HW, Gaviria M, Rodgers P, Weiler M, Altman E
University of Illinois Medical Center, Illinois.
The authors administered the Diagnostic Interview Schedule to 21 patients with
borderline personality disorder. The patients met criteria for various other
DSM-III diagnoses, meeting exclusion criteria in some cases, and not in other
cases. Frequency distribution of each diagnosis and the diagnoses of each
individual patient, are presented. Affective disorder was the most common
diagnosis (85%). Of these, 62% had primary major depression, and 23% had
secondary depression. Other diagnoses include bipolar disorder, dysthymia,
panic, agoraphobia, alcohol and Drug abuse, somatization disorder, and many
others. The authors conclude that while borderline disorder may be a
sub-affective disorder, a specific diagnostic profile for this disorder that
accounts for the presence of other Axis I and Axis II syndromes has yet to be
delineated.
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Am J Psychiatry 1986 Aug;143(8):1068-9
The overlap of affective and borderline disorders.
Fein S
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Am J Psychiatry 1985 Jul;142(7):855-8
Comparison of three systems for diagnosing borderline personality disorder.
Nelson HF, Tennen H, Tasman A, Borton M, Kubeck M, Stone M
The authors assessed three systems for diagnosing borderline personality
disorder: DSM-III, the checklist criteria of Spitzer et al., and the Diagnostic
Interview for Borderline Patients. In an inpatient sample of 51 patients, 43
(84%) met the criteria of at least one of these systems; analyses were carried
out on 28 of these patients. Twelve (43%) of these 28 patients met criteria for
all three systems, seven (25%) for two systems, and nine (32%) for only one
system. Kernberg's structural criteria showed reasonable overlap with the other
diagnostic criteria. Affective disorders were prominent across diagnostic
measures in this sample of borderline patients.
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J Clin Psychiatry 1985 Feb;46(2):41-8
Borderline: an adjective in search of a noun.
Akiskal HS, Chen SE, Davis GC, Puzantian VR, Kashgarian M, Bolinger JM
Outpatients diagnosed as borderline (N = 100) were prospectively followed for
6-36 months and examined from phenomenologic developmental, and family history
perspectives. At index evaluation, 66 met criteria for recurrent depressive,
dysthymic, cyclothymic, or bipolar II disorders, and 16 for those of
schizotypal personality. Other subgroups included sociopathic, somatization,
panic-agoraphobic, attention deficit, epileptic, and identify disorders.
Compared with nonborderline personality controls, borderlines had a
significantly elevated risk for major affective but not for schizophrenic
breakdowns during follow-up. Prominent substance abuse history, tempestuous
biographies, and unstable early home environment were common to all diagnostic
subgroups. In family history, borderlines were most like bipolar controls, and
differed significantly from schizophrenic, unipolar, and personality controls.
It is concluded that, despite considerable overlap with subaffective disorders,
the current adjectival use of this rubric does not identify a specific
psychopathologic syndrome.
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Am J Psychiatry 1985 Jan;142(1):15-21
Depression in borderline personality disorder: lifetime prevalence at interview
and longitudinal course of symptoms.
Perry JC
The author compared a group of patients with borderline personality disorder
with groups of subjects with antisocial personality and bipolar II illness. The
lifetime prevalence at interview of DSM-III major depression was high in all
groups. Chronic depression demonstrated a specific relationship to borderline
psychopathology. Prospectively, borderline psychopathology predicted high
levels of depressive and anxiety symptoms. This relationship was reversed for
depressive symptoms in patients with antisocial personality disorder,
suggesting that when borderline and antisocial personality disorders occur
together, some features may arise that differentiate patients with both
disorders from those with either disorder alone.
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Arch Gen Psychiatry 1983 Dec;40(12):1319-23
The borderline syndrome. II. Is it a variant of schizophrenia or affective
disorder?
McGlashan TH
Recent studies question whether the borderline syndrome represents two
entities: borderline schizophrenia (or schizotypal personality) as a variant of
schizophrenia and borderline personality disorder as a variant of primary
affective disorder. Relevant data are presented from the long-term follow-up of
patients at the Chestnut Lodge, Rockville, Md, receiving systematic diagnoses
by the retrospective application of diagnostic criteria. Studied were (1)
diagnostic overlap at index admission, (2) diagnostic change over follow-up
period, and (3) comparative long-term functional outcome between borderline
samples and other diagnostic groups. Findings supported the hypothesis that
schizotypal personality (as defined by DSM-III) is a variant of schizophrenia
but borderline personality disorder (as defined by the DSM-III and Gunderson et
al criteria) is not. An affiliation of borderline personality disorder with
primary affective disorder is suggested although not conclusive.
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Schizophr Bull 1980;6(4):549-51
The borderline syndrome and affective disorders: a comment on the Wolf-man.
Abrahamson D
The famous Wolf-Man case described by Freud is re-examined. Evidence of a
recurrent affective disorder, which appears to have been neglected in previous
assessments, is presented. The evidence is derived from the patient's own
memoirs, comments by therapists and others, and from the family history. A plea
is made for a multidimensional conceptualization of this and other complex and
influential cases. Is this true? The bullsh*t and your question connection? There is not a thing clinically valid or reliable about any of this so therefor there can be no conclusive answer that is based on any valid and reliable science. Report It
Learn how to read this and understand what you are reading, this is the way that it goes the most of the time and then they say they know it. Report It
WOW! That's the longest question I have ever seen on here. lol.....anyways, Absolutely. Check your source. No one here is going to a. read it all and b. know for sure.
If your source is a respected psychological journal or academic, then yes, it's probably a fairly reliable study. If not, then you need to be wary. It doesn't mean it isn't true, it just means you need to do a little more research to see if any other studies have the same findings. The more you can find, the more you can trust the article.
Also, it is very true that Borderline personality disorder is ofter misdiagnosed originally as Bipolar disorder or co-morbid with it. There are some similarities in symptoms. Borderline Personality Disorder can be misdiagnosed for a Bi-polar patient.This often occurs in the case of a rapid cycling of a Bi Polar. Because of the "moodiness" of the individual. Borderline's often have this "I hate your guts so I need you to love me" mentality that can confuse loved ones. With a Rapid Cycling Bi-polar you may have someone who has the emotions of anger and hate in the morning towards someone but by afternoon they are loving and wanting to be loved. Have I confused you more?
You see a Borderline will honestly still have the feeling of hate and still want the love.....The bi-polar will feel hate for a period of time and then want to love and be loved after that. It isn't a confused state with the Bi-polar patient. |
