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The borderlines of bipolar affective disorder

Published online by Cambridge University Press:  13 June 2014

Sharyn Byrne  and
Anne Jeffers
Sharyn Byrne*
Affiliation:
NUI Galway, Ireland
Anne Jeffers
Affiliation:
East Galway Mental, Health Services, Loughrea Day Hospital, Barrack Street, Loughrea, Co Galway, Ireland
*
*Correspondence E-mail: [email protected]
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Abstract

This paper provides an overview of the major studies of bipolar affective disorder (BAD) and borderline personality disorder (BPD), and assesses whether the disorders might be better understood as variants of the same basic disorder. There is a shortage of research that delineates the features of both disorders within their representative samples. As a consequence the symptomatic overlap of the disorders, detected by categorical assessment instruments, is often misconstrued as an indication of the disorders' high rates of comorbidity (up to 81%).

In paying particular attention to features of both disorders, eg. affective instability and impulsivity, the paper provides evidence that BPD attenuates bipolar disorder along the spectrum of affective disorders, from non-classical bipolar presentation through to severe BAD with borderline features. The paper cites clinical, research and pharmacologic support of the contention that BPD, rather than representing a distinct disorder, is merely an attenuation of Axis I disorders, most especially bipolar affective disorder. Borderline personality is evident across the bipolar spectrum and exacerbates symptomatology and leads to poorer recovery prognosis.

Keywords

Borderline personality disorderBipolar affective spectrum disorderSymptom overlap
Type
Review
Information
Irish Journal of Psychological Medicine , Volume 26 , Issue 4 , December 2009 , pp. 202 - 205
Copyright
Copyright © Cambridge University Press 2009

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References

1.Gunderson, JG, Kolb, JE, Austin, V. The diagnostic interview of borderline patients. Am J Psychiatry 1981; 38: 896–903.Google Scholar
2.Nigg, JT, Goldsmith, HH. Genetics of personality disorders: perspectives from personality and psychopathology research. Psychological Bull 1994; 115: 346–380, cited in Smith et al (2004)CrossRefGoogle ScholarPubMed
3.Livesley, WJ. Conceptual and Taxonomic Issues. In Livesley, WJ (Ed), Handbook of Personality Disorders. New York: Guilford Press, 2001: 3–38.Google Scholar
4.Sanislow, CA, Grilo, GM, Morey, LCet al.Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: findings from the collaborative longitudinal personality disorders study. Am J Psychiatry 2002; 159: 284–290.CrossRefGoogle Scholar
5.Links, PS, Heslegrave, R, van Reekum, R. Prospective follow-up study of borderline personality disorders: prognosis, prediction of outcome, and axis II comorbidity. Can J Psychiatry 1998; 43: 265–270.CrossRefGoogle ScholarPubMed
6.Zanarini, MC, Frankenburg, FR, Dubo, EDet al.Axis I Comorbidity of Borderline Personality Disorder. Am J Psychiatry 1998; 155: 1733–1739.CrossRefGoogle ScholarPubMed
7.Fyer, MR, Frances, AJ, Sullivan, T, Hurt, SW, Clarkin, J. Comorbidity of borderline personality disorder. Arch Gen Psychiatry 1988; 45(4): 348–352.CrossRefGoogle ScholarPubMed
8.Tyrer, SP. Borderline Personality Disorder: a Motley Diagnosis in Need of Reform. Lancet 1999; 354(9196): 2095–2098.CrossRefGoogle ScholarPubMed
9.Zanarini, MC, Frankenburg, FR, Vujanovic, AA, Hennen, J, Reich, DB, Silk, KR. Axis II comorbidity of borderline personality disorder: description of 6-year course and prediction to time-to-remission. Acta Psyohiatr Scand 2004; 110: 416–420.CrossRefGoogle ScholarPubMed
10.Rossi, A, Marinangeli, G, Butti, Get al.Personality disorders in bipolar and depressive disorders. J Affect Dis 2001; 65: 3–8.CrossRefGoogle ScholarPubMed
11.Garno, JL, Goldberg, JF, Ramirez, PM, Ritzier, BA. Bipolar disorder with comorbid cluster B personality features: impact on suicidality. J Clin Psychiatry 2005; 66(3): 339–345.CrossRefGoogle ScholarPubMed
12.Preston, GA, Marchant, BK, Reimherr, FW, Strong, RE, Hedges, DW. Borderline personality disorder in patients with bipolar disorders and response to lamotrigine. J Affect Dis 2003; 79(1-3): 297–303.CrossRefGoogle Scholar
13.Brieger, P, Ehrt, U, Marneros, A. Frequency of comorbid personality disorders in bipolar and unipolar affective disorders. Compr Psychiatry 2003; 44(1): 28–34.CrossRefGoogle ScholarPubMed
14.Henry, C, Mitropoulou, V, New, AS, Koenigsberg, HW, Silverman, J, Siever, LJ. Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. J Psychiatr Res 2001; 35(6): 307–312.CrossRefGoogle ScholarPubMed
15.Skodol, AE, Oldham, JM, Gallagher, PE. Axis II comorbidity of substance use disorders among patients referred for treatment of personality disorders. Am J Psychiatry 1999; 156: 733–738.CrossRefGoogle ScholarPubMed
16.Grilo, CM, Walker, ML, Becker, DF, Edell, WS, McGlashan, TH. Personality Disorders in Adolescents with Major Depression, Substance Use Disorders, and Coexisting Major Depression and Substance Use Disorders. J Consult Clin Psychol 1997; 65(2): 328–332.CrossRefGoogle ScholarPubMed
17.Pepper, CM, Klein, DN, Anderson, RL, Riso, LP, Ouimette, PC, Lizardi, H. DSM-III-R axis II comorbidity in dysthymia and major depression. Am J Psychiatry 1995; 152(2): 239–247.Google ScholarPubMed
18.Akiskal, HS, Chen, SE, Davis, GCet al.Borderline: an adjective in search of a noun. J Clin Psychiatry 1985; 46(2), 41–48.Google ScholarPubMed
19.Ruocco, AC. Reevaluating the distinction between Axis I and Axis II disorders: the case of borderline personality disorder. J Clin Psychol 2005; 61 (12): 1509–1523.CrossRefGoogle ScholarPubMed
20.Akiskal, HS. Demystifying borderline personality: critique of the concept and unorthodox reflections on its natural kinship with the bipolar spectrum. Acta Psychiat Scand 2004; 110(6): 401–410.Google ScholarPubMed
21.Zimmerman, M, Mattia, JI. Aix I diagnostic comorbidity and borderline personality disorder. Compr Psychiatry 1999; 40(4): 245–252.CrossRefGoogle Scholar
22.Smith, DJ, Muir, WJ, Blackwood, DH. Is borderline personality disorder part of the bipolar spectrum? Harvard Rev Psychiat 2004; 12(3): 133–139.CrossRefGoogle ScholarPubMed
23.Miller, FT, Abrams, T, Dulit, R, Fyer, M. Psychotic symptoms in patients with borderline personality disorder and concurrent axis I disorder. Hosp Comm Psychiatry 1993; 44(1): 59–61.Google ScholarPubMed
24.Paris, J. Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders. Harvard Rev Psychiat 2004; 12(3): 140–145.CrossRefGoogle ScholarPubMed
25.Akiskal, HS. The bipolar spectrum – the shaping of a new paradigm in psychiatry. Curr Psychiatry Rep 2002; 4: 1–3CrossRefGoogle ScholarPubMed
26.Akiskal, HS. The temperamental borders of affective disorders. Acta Psychiat Scand 1994; Supplement: 379: 32–37CrossRefGoogle ScholarPubMed
27.Magill, CA. The boundary between borderline personality disorder and bipolar disorder: current concepts and challenges. Can J Psychiatry 2004; 49(8): 551–556.CrossRefGoogle ScholarPubMed
28.Bolton, S, Gunderson, JG. Distinguishing borderline personality disorder from bipolar disorder: differential diagnosis and implications. Am J Psychiatry 1996; 153: 1202–1207.Google ScholarPubMed
29.Tyrer, SP, Brittlebank, AD. Misdiagnosis of bipolar affective disorder as personality disorder. Can J Psychiatry 1993; 38(9): 587–589.CrossRefGoogle ScholarPubMed
30.Akiskal, HS. The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J Clin Psychopharmacol 1996; 16(Suppl 1): 4S–14S.CrossRefGoogle ScholarPubMed
31.Ghaemi, SN, Ko, JY, Goodwin, FK. Case's Disease and beyond: misdiagnosis, antidepressant use and a proposed definition for bipolar spectrum disorders. Can J Psychiatry 2002; 47: 125–134.CrossRefGoogle Scholar
32.Deltito, J, Martin, L, Riefkohl, J, et al.Do patients with borderline personality disorder belong to the bipolar spectrum? J Affect Dis 2001; 67(1-3): 221–228.CrossRefGoogle Scholar
33.Zanarini, MC, Wiliiams, AA, Lewis, REet al.Reported Pathological Childhood Experiences Associated with the Development of Borderline Personality Disorder. Am J Psychiatry 1997; 154: 1101–1106.Google ScholarPubMed
34.Leverich, GS, Altshuler, LL, Fyer, MAet al.Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network. J Clin Psychiatry 2003; 64(5): 506–515.CrossRefGoogle ScholarPubMed
35.Shea, MT, Stout, RL, Yen, Set al.Associations in the course of personality disorders and Axis I disorders overtime. J Abnormal Psychol 2004; 113: 499–508.CrossRefGoogle Scholar
36.Akiskal, HS. Subaffective disorders: dysthymic, cyclothymic and bipolar II disorders in the “borderline” realm. Psychiatr Clin North Am 1981; 4(1): 25–46.CrossRefGoogle ScholarPubMed
37.Birnbaum, R. Borderline, bipolar, or both? Harvard Rev Psychiat 2004; 12: 146–149.CrossRefGoogle ScholarPubMed
38.Kaplan, . 2000. www.healthrising.com/stories/biaxis.htmlGoogle Scholar
39.Bajaj, P, Tyrer, P. Personality Disorder in Bipolar Patients. Curr Opin Psychiatry 2005; 18(1): 27–31.Google Scholar
40.Kay, JH, Altshuler, LL, Ventura, J, Mintz, J. Prevalence of axis II comorbidity in bipolar patients with and without alcohol use disorders. Ann Clin Psychol 1999; 11(4): 187–195.CrossRefGoogle ScholarPubMed
41.Haslam, N. Categorical versus dimensional models of mental disorder: the taxometric evidence. Aus NZ J Psychiatry 2003; 37: 696–704.CrossRefGoogle ScholarPubMed
42.Schiavone, P, Dorz, S, Conforti, D, Scarso, C, Borgherini, G. Comorbidity of DSM-IV Personality Disorders in unipolar and bipolar affective disorders: a comparative study. Psychological Rep 2004; 95(1): 121–128.Google ScholarPubMed
43.Dolan-Sewell, RT, Krueger, RF, Shea, MT. Co-occurrence with syndrome disorders. In: Livesley, WJ Ed. Handbook of Personality Disorders. New York: Guilford Press, 2001: 84–104.Google Scholar
44.Tondo, L, Baldessarini, RJ, Hennen, J, Floris, G. Lithium maintenance treatment of depression and mania in bipolar I and bipolar II disorders. Am J Psychiatry 1998; 155: 638–645.CrossRefGoogle ScholarPubMed
45.Soloff, PH, Lynch, KG, Kelly, TM, Malone, KM, Mann, JJ. Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study. Am J Psychiatry 2000; 157(4): 601–608.CrossRefGoogle ScholarPubMed
46.Cheng, AT, Mann, AH, Chan, KA. Personality disorder and suicide: A case-control study. Br J Psychiatry 1997; 170: 144–446.CrossRefGoogle ScholarPubMed
47.Baldessarini, RJ, Tondo, L, Hennen, J. Lithium Treatment and Suicide Risk in Major Affective Disorders: Update and New Findings. J Clin Psychiatry 1999; 64(Suppl 5): 44–52.Google Scholar
48.Sanislow, CA, McGlashan, TH. Treatment outcome of personality disorders. Can J Psychiatry 1998; 43: 237–250.CrossRefGoogle ScholarPubMed
49.Hertzberg, MA, Butterfield, MI, Feldman, MEet al.A preliminary study of Lamotrigine for the treatment of posttraumatic stress disorder. Biol Psychiatry 1999; 45: 1226–1229.CrossRefGoogle ScholarPubMed
50.Pinto, O, Akiskal, HS. Lamotrigine as a promising approach to borderline personality: a report of a case series without major mood disorders. J Affect Dis 1998; 51: 333–343.CrossRefGoogle Scholar
51.Benazzi, F. Borderline personality disorder comorbidity in early- and late onset bipolar II disorder. Can J of Psychiatry 2002; 47(2): 195–196.Google ScholarPubMed
52.Dunayevich, E, Sax, KW, Keck, PEet al.Twelve-month outcome in bipolar patients with and without personality disorders. J Clin Psychiatry 2000; 61(2): 134–139.CrossRefGoogle ScholarPubMed
53.Gaviria, M, Flaherty, J, Val, E. A comparison of bipolar patients with and without a borderline personality disorder. Psychiatr J Univ Ott 1982; 7(3): 190–195.Google ScholarPubMed
54.George, EL, Miklowitz, DJ, Richards, JA, Simoneau, TL, Taylor, DO. The comorbidity of bipolar disorder and Axis II personality disorders: prevalence and clinical correlates. Bipolar Dis 2002; April 5(2): 115–122.CrossRefGoogle Scholar
55.Hawton, K, Houston, K, Haw, C, Townsend, E, Harriss, L. Comorbidity of axis I and axis II in patients who attempted suicide. Am J Psychiatry 2003; 160(8): 1494–1500.CrossRefGoogle Scholar
56.Ucok, A, Karaveli, D, Kundakci, T, Yazici, O. Comorbidity of personality disorders with bipolar mood disorders. Compr Psychiatry 1998; 39(2): 72–74.CrossRefGoogle ScholarPubMed
57.Skodol, AE, Gunderson, JG, Pfohl, B, Widiger, TA, Livesley, WJ, Siever, LJ. The borderline diagnosis I: psychopathology, comorbidity and personality structure. Biol Psychiatry 2002; 15: 936–950.CrossRefGoogle Scholar
58.Tyrer, P. Personality Disorder: A new respect for an old acquaintance. Br J Psychiatry 2001; 179: 81–84.CrossRefGoogle Scholar
59.Blacker, D, Tsuang, M. Contested boundaries of bipolar disorder and the limits of categorical diagnosis in psychiatry. Am J Psychiatry 1992; 149: 1473–1483.Google ScholarPubMed
60.First, MB. 2002. DSM-V website: www.dsm5.org/whitepapers.cfmGoogle Scholar
61.White, CN, Gunderson, JG, Zanarini, MC, Hudson, JI. Family studies of borderline personality disorder: a review. Harv Rev Psychiatry 2003; 11: 8–19.Google ScholarPubMed
62.Kutcher, SP, Martin, P, Korenblum, M. Adolescent bipolar illness and personality disorder. J Am Acad Child Adol Psychiatry 1990; 29(3): 355–358.CrossRefGoogle ScholarPubMed
63.Feiner, NF. Borderline personality and bipolar disorder. Am J Psychiatry 1997; 154(8): 1175–6; author reply 1176-1177.Google ScholarPubMed