Beyond the Categorical Distinction Between Borderline Personality Disorder and Bipolar II Disorder Through the Identification of Personality Traits Profiles

Juana Villarroel,Paul A Vöhringer,Sonia Jerez,Valeria Salinas,Cristián Montes,Hernán Silva,Luisa Herrera,Maria Leonor Bustamante

doi:10.3389/fpsyt.2020.00552

Abstract

BackgroundThe relationship between borderline personality disorder (BPD) and type-II bipolar disorder (BDII) is not clearly understood. Nevertheless, in clinical practice and research, most efforts focus on establishing a categorical distinction between the two. We propose using personality traits as a more informative strategy to describe them.MethodsFive-Factor Model personality traits were measured in 73 individuals with either BPD or BDII. Latent class cluster analysis was applied to the sample.ResultsA three-cluster model resulted the best fit to the data, where all clusters had high neuroticism and low extraversion scores but differed widely on the other traits. The clusters’ boundaries did not match the categorical diagnosis.ConclusionsOur sample showed significant heterogeneity on personality traits, which can have a relevant effect on the outcome of each disorder and that was not captured by the categorical diagnosis. Thus, we advocate for a multivariate approach as a better way to understand the relationship between BPD and BDII.

Highlights

The distinction between borderline personality disorder (BPD) and bipolar disorder (BD) has been traditionally considered a major challenge for clinicians and researchers alike [1]
We studied a sample of patients with either BPD or BDII using Latent Class Cluster Analysis (LCA)
The sample was composed of 73 patients, 43 with BPD 30 with BDII. 71% of the sample were female

Summary

Introduction

The distinction between borderline personality disorder (BPD) and bipolar disorder (BD) has been traditionally considered a major challenge for clinicians and researchers alike [1]. The majority of the studies agree that both disorders coexist much more frequently than expected by chance, in an average 1/5 of the patients, whether this is due to misdiagnosis or to a common underlying biology is not clear [4] Difficult it is to establish a categorical distinction, this is the key element used to select the best treatment. In the case of comorbidity, the effect one disorder on the other appears to be asymmetrical, as it has been observed that the presence of BPD worsens the outcome of BDII but not vice versa; the reasons for this asymmetry are not clear [4] This is a prime example of the long-standing challenges faced by psychiatric nosology as a discipline focused in defining valid disease entities with solid neurobiological correlates and reliable diagnostic tools.

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