Abstract
BackgroundAlthough bipolar disorder (BD) and borderline personality disorder (BPD) share clinical characteristics and frequently co-occur, their interrelationship is controversial. Especially, the differentiation of rapid cycling BD and BPD can be troublesome. This study investigates the relationship between borderline personality features (BPF) and prospective illness course in patients with BD, and explores the effects of current mood state on self-reported BPF profiles.MethodsThe study included 375 patients who participated in the former Stanley Foundation Bipolar Network. All patients met DSM-IV criteria for bipolar-I disorder (n = 294), bipolar-II disorder (n = 72) or bipolar disorder NOS (n = 9). BPF were assessed with the self-rated Personality Diagnostic Questionnaire. Illness course was based on 1-year clinician rated prospective daily mood ratings with the life chart methodology. Regression analyses were used to estimate the relationships among these variables.ResultsAlthough correlations were weak, results showed that having more BPF at baseline is associated with a higher episode frequency during subsequent 1-year follow-up. Of the nine BPF, affective instability, impulsivity, and self-mutilation/suicidality showed a relationship to full-duration as well as brief episode frequency. In contrast all other BPF were not related to episode frequency.ConclusionsHaving more BPF was associated with an unfavorable illness course of BD. Affective instability, impulsivity, and self-mutilation/suicidality are associated with both rapid cycling BD and BPD. Still, many core features of BPD show no relationship to rapid cycling BD and can help in the differential diagnosis.
Highlights
Bipolar disorder (BD) and borderline personality disorder (BPD) share clinical characteristics and frequently co-occur, their interrelationship is controversial
Aims of the study To gain further insight in the association between rapid cycling bipolar disorder (BD) and BPD, we investigated the prevalence of the nine borderline personality features (BPF) in relationship to prospectively assessed mood episode frequency in outpatients with BD
Current mood state had no influence on BPF sumscore measured by PDQ-4+ (χ2(3) = 5.533, p = .1378)
Summary
Bipolar disorder (BD) and borderline personality disorder (BPD) share clinical characteristics and frequently co-occur, their interrelationship is controversial. Bipolar mood disorder (BD) and borderline personality disorder (BPD) are severe psychiatric disorders characterized by a chronic and recurrent illness course Both disorders have a considerable impact on daily functioning and quality of life and necessitate long-term treatment in Riemann et al Int J Bipolar Disord (2017) 5:31 in patients with BPD ranging from 5.6 to 16.1% (median 9.2%) in eight studies (Pope et al 1983; McGlashan 1986; Links et al 1988; Alnæs and Torgersen 1991; Hudziak et al 1996; Zimmerman and Mattia 1999; Deltito et al 2001; McGlashan et al 2000), and a prevalence of bipolar II disorder (BD-II) ranging from 8 to 19% (median 10.7%) in six studies (Links et al 1988; Zimmerman and Mattia 1999; Deltito et al 2001; McGlashan et al 2000; Zanarini et al 1998; Akiskal 1992). They found that 0.5–30% (median 10.7%) of BD-I patients in 12 studies met criteria for BPD (George et al 2003; Alnæs and Torgersen 1991; Gaviria et al 1982; Koenigsberg et al 2002; Jackson et al 1991; Pica et al 1990; O’Connell et al 1991; Turley et al 1992; Ucok et al 1998; Vieta et al 2001; Rossi et al 2001; Brieger et al 2003), as well as 12–23% (median 16%) of BD-II patients in three studies (Peselow et al 1995; Vieta et al 1999; Benazzi 2000). Paris et al (2007) concluded that nearly 20% of the patients diagnosed with either BD or BPD met criteria for the other diagnosis.
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