Should borderline personality disorder be placed on the bipolar spectrum?
DOI:
https://doi.org/10.47611/jsrhs.v12i2.4301Keywords:
Bipolar disorder and borderline personality disorder, bipolar spectrum, bipolar disorder misdiagnosis, borderline personality disorder misdiagnosisAbstract
Bipolar disorder (BD) is a mood disorder characterized by changes in activity levels, mood, and energy. These categories can range from elation during manic episodes to depression during depressive episodes. BD affects 2-3% of the population. Borderline personality disorder (BPD) is the diagnostic label assigned to individuals who struggle with unstable personal relationships, hypersensitivity to rejection, or an unstable self-image. 1.6% of the general population has this disorder and 20 percent of those in the psychiatric population have BD. Given that BD and BPD share features, such as rapid mood swings, impulsive actions, and suicidal behavior it is sometimes difficult for practitioners to readily and accurately differentiate between these two disorders. These issues with diagnosis have led to the idea BPD should belong on the spectrum of bipolar disorders. The current paper compares the disorders, including their clinical presentation and symptoms, the effect of genetic and environmental factors on the development of these disorders, and treatments for each disorder. The aforementioned topics represent factors underlying the resolution to the question of whether BPD belongs on the bipolar spectrum. Answering this question would allow researchers and clinicians to better understand the relationship between these disorders and the best treatments for BPD and BD.
Downloads
References or Bibliography
Adler G & Buie D. (1979) Aloneness and borderline psychopathology: The possible relevance of child developmental issues. Int J Psychoanal 60:8%-96
Afifi, T. O., Mather, A., Boman, J., Fleisher, W., Enns, M. W., MacMillan, H., & Sareen, J. (2011). Childhood adversity and personality disorders: Results from a nationally representative population-based study. Journal of Psychiatric Research, 45(6), 814–822. doi:10.1016/j.jpsychires.2010.11.008.
Alvidrez, J., & Azocar, F. (1999). Distressed women’s clinic patients: General Hospital Psychiatry, 21(5), 340–347. doi:10.1016/s0163-8343(99)00038-9
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Anderson, I. M., Haddad, P. M., & Scott, J. (2012). Bipolar disorder. BMJ, 345(dec27 3), e8508–e8508. doi:10.1136/bmj.e8508
Ayano, G., Demelash, S., yohannes, Z. et al. (2021) Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia. Ann Gen Psychiatry 20, 10. https://doi.org/10.1186/s12991-021-00333-7
Berzoff, J., Flanagan, L. M., & Hertz, P. (Eds.). (2011). Inside out and outside in (3rd ed.). Rowman & Littlefield.
Bondurant, H., Greenfield, B., & Tse, S. M. (2004). Construct validity of the adolescent borderline personality disorder: a review. The Canadian child and adolescent psychiatry review = La revue canadienne de psychiatrie de l'enfant et de l'adolescent, 13(3), 53–57.
Bridley, A., & Daffin Jr, L.W. (2020). Abnormal Psychology (2nd ed.). Washington State University.
Brohan, E., Slade, M., Clement, S. et al. (2010). Experiences of mental illness stigma, prejudice and discrimination: a review of measures. BMC Health Serv Res 10, 80. https://doi.org/10.1186/1472-6963-10-80
Bücker, J., Kozicky, J., Torres, I. J., Kauer-Sant’anna, M., Silveira, L. E., Bond, D. J., … Yatham, L. N. (2013). The impact of childhood trauma on cognitive functioning in patients recently recovered from a first manic episode: Data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM). Journal of Affective Disorders, 148(2-3), 424–430. doi:10.1016/j.jad.2012.11.022
Cade JFJ. (1949). Lithium salts in the treatment of psychotic excitement. Med J Aust; 36: 349–52.
Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar Disorder. New England Journal of Medicine, 383(1), 58–66. doi:10.1056/nejmra1906193
Chapman, J., Jamil, R.T., & Fleisher, C. (2022, May 2). Borderline Personality Disorder. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK430883/#:~:text=Surveys%20have%20estimated%20the%20prevalence,in%20the%20inpatient%20psychiatric%20population.
Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017). What Works in the Treatment of Borderline Personality Disorder. Current Behavioral Neuroscience Reports, 4(1), 21–30. doi:10.1007/s40473-017-0103-z
Cipriani A, Barbui C, Salanti G, et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. Lancet 2011; 378: 1306–15.
Craddock, N., & Jones, I. (1999). Genetics of bipolar disorder. Journal of Medical Genetics, 36(8), 585–594. doi:10.1136/jmg.36.8.585
Craddock, N., & Sklar, P. (2013). Genetics of bipolar disorder. The Lancet, 381 (9878), 1654-1662. doi: 10.1016/s0140-6736 (13) 60855-7
Etain, B., Mathieu, F., Henry, C., Raust, A., Roy, I., Germain, A., … Bellivier, F. (2010). Preferential association between childhood emotional abuse and bipolar disorder. Journal of Traumatic Stress, n/a–n/a. doi:10.1002/jts.20532
Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672–1682. doi:10.1016/s0140-6736(13)60857-0
Gijsman, H. J., Geddes, J. R., Rendell, J. M., Nolen, W. A., & Goodwin, G. M. (2004). Antidepressants for Bipolar Depression: A Systematic Review of Randomized, Controlled Trials. American Journal of Psychiatry, 161(9), 1537–1547. doi:10.1176/appi.ajp.161.9.1537
Goodwin, F.K., & Jamison, K.R. (2007). Manic-Depressive Illness: Bipolar Disorder and Recurrent Despression, Volume 2. Oxford Uiversity Press.
Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561–1572. doi:10.1016/s0140-6736(15)00241-x
Gunderson, J. G., Daversa, M. T., Grilo, C. M., McGlashan, T. H., Zanarini, M. C., Shea, M. C., … & Stout, R. L. (2006). Predictors of 2-year outcome for patients with borderline personality disorder. American Journal of Psychiatry, 163, 822–826.
Gunderson, J. G., Herpertz, S. C., Skodol, A. E., Torgersen, S., & Zanarini, M. C. (2018). Borderline personality disorder. Nature Reviews Disease Primers, 4, 18029. doi:10.1038/nrdp.2018.29
Jain, A., & Mitra, P. (2022, May 1). Bipolar Affective Disorder. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK558998/
Kendall, T., Burbeck, R., & Bateman, A. (2010). Pharmacotherapy for borderline personality disorder: NICE guideline. British Journal of Psychiatry, 196(2), 158-159. doi:10.1192/bjp.196.2.158
Kendler, K. S. (2006). Reflections on the Relationship Between Psychiatric Genetics and Psychiatric Nosology. American Journal of Psychiatry, 163(7), 1138–1146. doi:10.1176/ajp.2006.163.7.1138
Kernberg 0: Borderline Conditions and Pathological Narcissism. New York, Jason Aronson, 1975
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617. doi:10.1001/archpsyc.62.6.617
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes M, Eshleman, S., Wittchen, H. U., Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry, 51, 8-19.
Klatzkin, R. R., Mechlin, B., Bunevicius, R., & Girdler, S. S. (2007). Race and histories of mood disorders modulate experimental pain tolerance in women. The journal of pain, 8(11), 861–868. https://doi.org/10.1016/j.jpain.2007.06.001
Konkel L. (2015). Racial and Ethnic Disparities in Research Studies: The Challenge of Creating More Diverse Cohorts. Environmental health perspectives, 123(12), A297–A302. https://doi.org/10.1289/ehp.123-A297
Lingardi, V., & McWilliams, N. (2017). Psychodynamic Diagnostic Manual (2nd ed.). Guilford Press.
Link, B.G., Struening, E., Cullen, F.T., Shrout, P.E., Dohrenwend, B.P., 1989. A modified labeling theory approach to mental disorders - an empirical assessment. Am. Social. Rev. 54(3), 400-423.
Links, P. S., Steiner, M., & Huxley, G. (1988). The Occurrence of Borderline Personality Disorder in the Families of Borderline Patients. Journal of Personality Disorders, 2(1), 14–20. doi:10.1521/pedi.1988.2.1.14
Loranger, A. W. (1985). Family History of Alcoholism in Borderline Personality Disorder. Archives of General Psychiatry, 42(2), 153. doi:10.1001/archpsyc.1985.0179025
Masterson J: Treatment of the Borderline Adolescent: A Developmental Approach. New York, Wiley, 1972
McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet 2012; 379: 721–28.
Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … Swendsen, J. (2010). Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. doi:10.1016/j.jaac.2010.05.017
Najt, P., Perez, J., Sanches, M., Peluso, M., Glahn, D., & Soares, J. (2007). Impulsivity and bipolar disorder. European Neuropsychopharmacology, 17(5), 313–320. doi:10.1016/j.euroneuro.2006.10.002
Nall, M. (2019, April 23). Antidepressants and Bipolar Disorder. Healthline. https://www.healthline.com/health/bipolar-disorder/antidepressants
Nehls, N., 1998. Borderline personality disorder: gender stereotypes, stigma, and limited system of care. Issues ment. Health nurs. 19(2), 97-112.
Palmer, B.A., Pahwa, M., Geske, J.R., Kung, S., & Singh, B. (2021). Self-report screening instruments differentiate bipolar disorder and borderline personality disorder. Brain Behav, 11(7), 1-8. doi: 10.1002/brb3.2201
Paris, J., & Black, D. W. (2015). Borderline Personality Disorder and Bipolar Disorder. The Journal of Nervous and Mental Disease, 203(1), 3–7. doi:10.1097/nmd.0000000000000225
Paris, J., Gunderson, J., & Weinberg, I. (2007). The interface between borderline personality disorder and bipolar spectrum disorders. Comprehensive Psychiatry, 48(2), 145–154. doi:10.1016/j.comppsych.2006.10.0
Pope, H.G., Jr., Jones, J.M., Hudson, J.I., Cohen, B.M., & Gunderson, J.G. (1983). The validity of DSM-III borderline personality disorder: A phenomenologic, family history, treatment, response, and long term follow up study. Archives of General Psychiatry. 40. 23-30.
Sanches, M. (2019). The Limits between Bipolar Disorder and Borderline Personality Disorder: A Review of the Evidence. Diseases, 7(3), 49. doi:10.3390/diseases7030049
Saunders, K. E. A., Bilderbeck, A. C., Price, J., & Goodwin, G. M. (2015). Distinguishing bipolar disorder from borderline personality disorder: A study of current clinical practice. European Psychiatry, 30(8), 965–974. doi:10.1016/j.eurpsy.2015.09.007
Schulz. P. M., Schulz, S. C, Goldberg, i* S. C, Ettigi, P., Resnick, R. J., & Friedel, R. O. (1986). Diagnoses of the relatives of schizotypal outpatients. Journal of Nervous and Mental Disease, 174, 457463
Silverman, J., Pinkham, L., Horvath, T., Coccaro, E., Klar, H., Schear, S., et al. (1991). Affective and impulsive personality disorder traits in the relatives of patients with borderline personality disorder. American Journal of Psychiatry. 48. 1378-1385.
Sirey, J.A., Bruce, M.L., Alexopoulos, G.S., Perlick, D.A., Raue, P., Friedman, S.J., Meyers, B.S., 2001. Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. Am. J. Psychiatry 158 (3), 479e481. http://dx.doi.org/10.1176/appi.ajp.158.3.479.
Swartz, M., Blazer, D., George, L., & Winfield, I. (1990). Estimating the prevalence of borderline personality disorder in the community. Journal of Personality Disorders, 4(3), 257-272. doi:https://doi.org/10.1521/pedi.1990.4.3.257
Thomé, E. S., Dargél, A. A., Migliavacca, F. M., Potter, W. A., Jappur, D. M. C., Kapczinski, F., & Ceresér, K. M. (2011). Stigma experiences in bipolar patients: the impact upon functioning. Journal of Psychiatric and Mental Health Nursing, 19(8), 665–671. doi:10.1111/j.1365-2850.2011.01849.x
Torgersen, S., Lygren, S., Øien, P. A., Skre, I., Onstad, S., Edvardsen, J., … Kringlen, E. (2000). A twin study of personality disorders. Comprehensive Psychiatry, 41(6), 416–425. doi:10.1053/comp.2000.16560
Van Meter, A. R., Youngstrom, E. A., & Findling, R. L. (2012). Cyclothymic disorder: A critical review. Clinical Psychology Review, 32(4), 229–243. doi:10.1016/j.cpr.2012.02.001
Vázquez, G. H., Kapczinski, F., Magalhaes, P. V., Córdoba, R., Lopez Jaramillo, C., Rosa, A. R., … Tohen, M. (2011). Stigma and functioning in patients with bipolar disorder. Journal of Affective Disorders, 130(1-2), 323–327. doi:10.1016/j.jad.2010.10.012
Vöhringer, P. A., Barroilhet, S. A., Alvear, K., Medina, S., Espinosa, C., Alexandrovich, K., … Ghaemi, S. N. (2016). The International Mood Network (IMN) Nosology Project: differentiating borderline personality from bipolar illness. Acta Psychiatrica Scandinavica, 134(6), 504–510. doi:10.1111/acps.12643
Wahl, O.F., 1999. Mental health consumers experience of stigma. Schizophr. Bull. 25(3), 467-478.
Watson S, Gallagher P, Dougall D, et al. Childhood trauma in bipolar disorder. Aust N Z J Psychiatry 2014; 48: 564–570.
Widiger, T. A., & Weissman, M. M. (2006). Epidemiology of Borderline Personality Disorder, Pychiatric Services, 42(10). doi: https://doi.org/10.1176/ps.42.10.1015
Wilstrand, C., Lindgren, B.M., Gilje, F., & Olofsson, B. (2007). Being burdened and balancing boundaries: a qualitative study of nurses’ experiences caring for patients who self-harm. Journal of Psychiatric and Mental Health Nursing, 14(1). doi:10.1111/j.1365-2850.2007.01045.x
Witt, S. H., Kleindienst, N., Frank, J., Treutlein, J., Mühleisen, T., Degenhardt, F., … Bohus, M. (2014). Analysis of genome-wide significant bipolar disorder genes in borderline personality disorder. Psychiatric Genetics, 24(6), 262–265. doi:10.1097/ypg.0000000000000060
Wright, E.R., Gronfein, W.P., Owens, T.J., 2000. Deinstitutionalization, social rejection, and the self-esteem of former mental patients. J. Health Soc. Behav. 41 (1), 68e90. http://dx.doi.org/10.2307/2676361.
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Beaulieu, S., Alda, M., … Berk, M. (2012). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disorders, 15(1), 1–44. doi:10.1111/bdi.12025
Zanarini, M. C. (2000). Childhood Experiences Associated with the Development of Borderline Personality Disorder. Psychiatric Clinics of North America, 23(1), 89–101. doi:10.1016/s0193-953x(05)70145-3
Zanarini, M.C., Gunderson J.G., Marino, M.F., Schwartz E.O., Frankenburg, F.R. (1988). DSM-III Disorders in the Families of Borderline Outpatients. Journal of Personality Disorders, 2(4), 292-302. doi:10.1521/pedi.1988.2.4.292
Zimmerman, M., Morgan, T.A. Problematic Boundaries in the Diagnosis of Bipolar Disorder: The Interface with Borderline Personality Disorder. Curr Psychiatry Rep 15, 422 (2013). https://doi.org/10.1007/s11920-013-0422-z
Published
How to Cite
Issue
Section
Copyright (c) 2023 Sreemayee Krishna
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright holder(s) granted JSR a perpetual, non-exclusive license to distriute & display this article.
