Abstract
Systematic reviews suggest comorbid borderline personality disorder is present in approximately 20% of individuals who have bipolar disorder, but current diagnostic systems demonstrate a move towards dimensional rather than categorical approaches to classifying personality pathology. We aimed to examine the presence and severity of borderline personality traits in bipolar I and bipolar II disorder, and to explore associations between the presence/severity of borderline personality traits and clinical outcomes in bipolar disorder. Borderline personality traits were measured in 1447 individuals with DSM-IV bipolar disorder (1008 bipolar I disorder and 439 bipolar II disorder) using the Borderline Evaluation of Severity over Time (BEST) questionnaire. Lifetime clinical outcomes were assessed via Schedules for Clinical Assessment in Neuropsychiatry (SCAN) semi-structured interview and clinical case notes. Borderline personality traits were common in both bipolar disorder groups, with 86.2% participants reporting at least one trait. These included traits that overlap with (eg mood instability) and those that are distinct from the symptoms of bipolar disorder (eg fear of abandonment). Borderline personality traits were significantly more frequent and more severe in bipolar II disorder compared to bipolar I disorder. More severe borderline traits, and even the presence of a single borderline personality trait, were significantly associated with younger age of bipolar disorder onset and higher prevalence of lifetime alcohol misuse in both bipolar disorder groups. The presence of comorbid borderline personality traits should be considered in the management of all patients with bipolar disorder irrespective of whether criteria for a categorical borderline personality disorder diagnosis are met.
Highlights
| INTRODUCTIONBipolar disorder is a common psychiatric disorder that affects at least 1% of the population. It has one of the highest mortality rates of any psychiatric disorder
After adjustment for demographic and clinical differences between the diagnostic groups, and for current mood state (BDI and Altman Mania Scale (AMS) score), both higher Borderline Evaluation of Severity over Time (BEST) total score and the presence of nine of the twelve BEST items remained individually significantly associated with a diagnosis of bipolar II disorder (Table 2)
Even when we considered those having only one borderline trait there was still a significant relationship with younger bipolar disorder onset and alcohol misuse, so the association was not driven by participants having comorbid borderline personality disorder
Summary
Bipolar disorder is a common psychiatric disorder that affects at least 1% of the population. It has one of the highest mortality rates of any psychiatric disorder. Borderline personality disorder is a pervasive disorder which shares some symptom similarities with bipolar disorder.5 Despite these similarities in presentation, there is evidence which suggests that the two disorders have different aetiologies, distinct neuropsychological processes 7,8 and different prognoses.. Systematic reviews suggest comorbid borderline personality disorder is present in approximately 20% of individuals who have bipolar disorder, with higher rates in bipolar II disorder compared with bipolar I disorder.. The diagnosis of borderline personality disorder is a categorical one made if five or more of nine possible personality traits are present, many authors have noted that a categorical system may not be optimal for diagnosing personality disorder.. We sought to explore the presence, severity and impact of borderline personality traits in a large cohort of individuals who have bipolar disorder
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