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Flow chart of diagnostic classification systems.
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Background:
The status and differentiation of comorbid borderline personality disorder and bipolar disorder is worthy of clarification.
Aims:
To determine whether comorbid borderline personality disorder and bipolar disorder are interdependent or independent conditions.
Method:
We interviewed patients diagnosed with either a borderline persona...
Context in source publication
Context 1
... both the self-report measure and diagnostic interview and received a DSM bipolar disorder and/or a DSM borderline personality disorder diagnosis from the assessing clinician. Of the 137 receiving a DSM-IV bipolar disorder diagnosis (alone or comorbid), 11 (8%) met bipolar I and 126 (92%) met bipolar II disorder criteria. As illustrated in Fig. 1, rates of comorbid assignment were highest (28%) in relation to DSM diagnoses and 13% for those receiving a bipolar disorder clinical strict diagnosis and 14% for those receiving a bipolar disorder clinical extended diagnosis. Although 53 participants were assigned a borderline personality disorder diagnosis across the two diagnostic ...
Citations
... Explanations for the comorbidity between bipolar and borderline include that they share common underlying genetic risks factors [34,35], have similar symptoms [30], and that the same variables are used to validate them [36]. Some scholars argue that borderline should be reclassified as a type of bipolar [37,38] although most concur that they are distinct disorders [29,[39][40][41][42]44]. Given their similarities, distinguishing between bipolar and borderline in clinical practice is challenging, and is influenced by clinician bias [43]. ...
... These findings are consistent with other recent published comparisons of people with bipolar, borderline, or both. Specifically, other studies have also found that people with both disorders vs. bipolar have lower income [33], are less likely to be married [66], have a higher incidence of ACES [33,40,59], more co-morbidity with other psychiatric disorders [30,33,59,66,67], more episodes of depression [59,67], and greater suicidality [30,40,59,66,67]. Studies that compared people with both to those with borderline found fewer differences [40,59,67], whereas we tended to find smaller differences, suggesting that meeting criteria for borderline personality disorder, with or without bipolar, is distinctly undesirable above and beyond its symptoms. ...
... These findings are consistent with other recent published comparisons of people with bipolar, borderline, or both. Specifically, other studies have also found that people with both disorders vs. bipolar have lower income [33], are less likely to be married [66], have a higher incidence of ACES [33,40,59], more co-morbidity with other psychiatric disorders [30,33,59,66,67], more episodes of depression [59,67], and greater suicidality [30,40,59,66,67]. Studies that compared people with both to those with borderline found fewer differences [40,59,67], whereas we tended to find smaller differences, suggesting that meeting criteria for borderline personality disorder, with or without bipolar, is distinctly undesirable above and beyond its symptoms. ...
PurposeBipolar and borderline personality disorders share similar features, are challenging to differentiate and sometimes co-occur in the same individual. This paper compares people with bipolar, borderline, both or neither, analyzing sociodemographic characteristics, lifetime exposure to stressors, and emotional, social, and physical wellbeing to illuminate differences in life experiences associated with expressing symptoms consistent with bipolar, borderline, or both.Methods
Data were analyzed from the 2012–13 National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III), N = 36,309. Survey participants were classified as bipolar (N = 488, 1.3%), borderline (N = 1758, 4.8%), both (N = 388, 1.1%), or neither (N = 33,675, 92.8%). Differences between these groups regarding demographics, adverse childhood experiences, recent stressors, lifetime trauma, psychiatric co-morbidities, and emotional, social, and physical wellbeing were assessed with the adjusted Wald F test.ResultsPeople with bipolar were more likely to also have borderline (44.3%) than the reverse (18.1%). People with both disorders were least advantaged socioeconomically, most exposed to stressors and traumas across the life course, and had the worst wellbeing emotionally, socially, and physically. Differences between people with both disorders vs. borderline only were smaller than between people with borderline vs. bipolar, although bipolar disorder was associated with considerable hardship relative to having neither disorder.Conclusion
Borderline personality disorder alone or in combination with bipolar is associated with worse economic, social, and health outcomes than bipolar alone. Borderline can resolve with evidence-based treatment, and it is critical to correctly differentiate between the two conditions, so people with borderline and/or bipolar have the optimum chance for recovery.
... We previously applied ML to differentiate individuals with 'pure' BP or BPD (Bayes et al., 2021). Using datasets previously described (Bayes et al., 2016a(Bayes et al., , 2016bBayes and Parker, 2019;Parker et al., 2016), we examined participant observations pertaining to emotion regulation strategies, their parenting during childhood, as well as personality constructs held as over-represented in those with a BPD conditionachieving machine learning classificatory accuracy of 87.8% for BP, 57.7% for BPD, and an overall accuracy of 73.9% (Bayes et al., 2021). ...
Comorbid bipolar disorder (BP) and borderline personality disorder (BPD) presents a diagnostic challenge in its differentiation from each condition individually. We aimed to use a machine learning (ML) approach to differentiate comorbid BP/BPD from both BP and BPD. Participants were assigned DSM diagnoses and compared on self-report measures examining personality, emotion regulation strategies and perceived parental experiences during childhood. 82 participants were assigned as BP, 52 as BPD and 53 as comorbid BP/BPD. ML-derived diagnoses had an accuracy of 79.6% in classifying BP/BPD vs. BP, and 61.7% in classifying BP/BPD vs. BPD. Stress-related paranoid ideation and other core borderline personality items were important in distinguishing BP/BPD vs. BP, whereas deficits in emotion regulation strategies were important in distinguishing BP/BPD vs. BPD. Impulsivity and anger were important across both analyses. We identified clinical variables more distinctive in comorbid BP/BPD, with superior accuracy in distinguishing from BP, and with lower accuracy compared to BPD alone. Such an additive model should assist in sharpening clinical decision making, with future machine learning examination of larger datasets likely to further improve diagnostic accuracy.
... We defined BPF as the presence of two or more symptoms of BPD, as measured using clinician judgement, standardized questionnaires, or semi-structured interviews (Table 1). Notably, because BPD symptoms largely overlap with other psychiatric disorders (e.g., bipolar II disorder), its pragmatic diagnosis has been largely debated Fornaro et al. 2016;Parker et al. 2016;Kulkarni 2017;Fitzpatrick et al. 2020;Palmer et al. 2021). In addition, BPD is often comorbid with other disorders (i.e., bipolar disorder, PTSD, anxiety). ...
... Additionally, studies that conceptualized BPF as only a few features, such as Nagel et al. (2021), call into question whether the perinatal populations displayed borderline pathology specifically, or other psychiatric conditions with intersecting symptoms. Indeed, diagnostic considerations around BPD have led to numerous debates around the overlapping entities of the condition and others, such as complex PTSD (C-PTSD), bipolar disorder (BD), and other personality disorders Fornaro et al. 2016;Parker et al. 2016;Kulkarni 2017;Fitzpatrick et al. 2020;Palmer et al. 2021). For instance, a 2016 review investigating the prevalence of comorbid BPD and BD found that the two had substantial rates of comorbidity and did not necessarily represent distinct diagnostic categories; however, the authors also noted that both disorders were often diagnosed in the absence of the other (Fornaro et al. 2016). ...
Borderline personality disorder (BPD) is a psychiatric disorder marked by severe affective instability and poor interpersonal functioning. Existing literature has highlighted that individuals with BPD are at greater risk for a wide range of adverse physiological and psychosocial outcomes in the perinatal period compared to perinatal individuals without BPD. However, to date, no systematic review has addressed the prevalence of BPD and borderline personality features (BPF) in pregnant and postpartum individuals. A systematic review and meta-analysis was conducted by searching three databases (PubMed, PsycINFO, and Embase) on April 6th, 2021. Research articles and conference abstracts that evaluated BPF or BPD in pregnant, postpartum, or mixed perinatal populations were included. Sixteen publications were included in the systematic review (n = 14 research articles, n = 2 conference abstracts), seven of which were included in the meta-analysis. Among non-clinical samples, prevalence rates of BPF during pregnancy ranged from 6.9 to 26.7%, while rates of BPD across the perinatal period ranged from 0.7 to 1.7%. Among clinical samples, rates of BPF and BPD across the perinatal period spanned 9.7–34% and 2.0–35.2%, respectively. Results from the meta-analysis revealed that the pooled prevalence rate of BPD in clinical samples during the perinatal period is 14.0% (95% CI [7.0, 22.0]). Among clinical perinatal samples, there is a high prevalence of borderline personality pathology. This review highlights the need for appropriate validated screening methods to identify and treat BPD in the perinatal population.
... In prior studies by our group, we have sought to differentiate BP from BPD across multiple domains, including family history, developmental antecedents, clinical symptoms and illness correlates (Bayes et al., 2016a); as well as using a self-report measure of cognitive and behavioral borderline features (Bayes and Parker, 2019). Further studies utilising validated scales compared BP vs. BPD vs. co-occurring BP/BPD on emotion regulation strategies (Bayes et al., 2016b); and remembered parental behaviors during childhood (Parker et al., 2016). Strong differentiation was achieved in distinguishing BP vs. BPD with an accuracy of 92-95%, with history of childhood sexual abuse (CSA), childhood depersonalisation, personality variables capturing sensitivity to criticism and relationship difficulties, as well as an absence of a BP family history being the strongest predictors (Bayes et al., 2016a). ...
... The current study seeks to use a machine learning approach for participants in our previously reported samples (Bayes et al., 2016a;2016b;Bayes and Parker, 2019;Parker et al., 2016) to determine variables (both as part of rules or individually) that best distinguish those individuals with BP as against BPD, excluding those comorbid for both conditions. ...
Background: Differentiation of bipolar disorder (BP) from borderline personality disorder (BPD) is a common diagnostic dilemma. We undertook a machine learning (ML) approach to distinguish the conditions.
Methods: Participants meeting DSM criteria for BP or BPD were compared on measures examining cognitive and behavioral BPD constructs, emotion regulation strategies, and parental behaviors during childhood. Two analyses used continuous and dichotomised data, with ML-allocated diagnoses compared to DSM.
Results: 82 participants met DSM criteria for BP and 52 for BPD. Accuracy of ML classification was 84.1% - 87.8% for BP, 50% - 57.7% for BPD, with overall accuracy of 73.1% - 73.9%. Importance of items differed between the analyses with the overall most important items including identity difficulties, relationship problems, female gender, feeling suicidal after a relationship breakdown and age.
Limitations: Participants were volunteers, preponderance of bipolar II (BP II) participants, comorbidity of BP and BPD not examined, and small BPD sample contributed to the relatively low classification accuracies for this group
Conclusions: Study findings may assist distinguishing BP and BPD based on differences in cognitive and behavioral domains, emotion regulation strategies and parental behaviors. Future studies using larger datasets could further improve predictive accuracy and assist in differential diagnosis.
... While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders (Parker, Bayes, McClure, Del Moral, & Stevenson, 2016). Frias et al. (2016) recently reviewed the literature on the clinical impact of one disorder on the other. ...
... Our results are consistent with prior studies which have found that bipolar/BPD patients, compared to patients with bipolar disorder without BPD, make more suicide attempts (Carpiniello, Lai, Pirarba, Sardu, & Pinna, 2011;Galfalvy et al., 2006;Joyce et al., 2010;Neves, Malloy-Diniz, & Correa, 2009;Parker et al., 2016;Perugi et al., 2013;Richard-Lepouriel et al., 2019;Zeng et al., 2015), are more frequently hospitalized (Neves et al., 2009;Parker et al., 2016), have more comorbid anxiety and substance use disorders (McDermid et al., 2015;Neves et al., 2009;Perugi et al., 2013;Richard-Lepouriel et al., 2019), lower ratings on the GAF (Carpiniello et al., 2011), greater childhood adversity (Goldberg & Garno, 2009;McDermid et al., 2015;Parker et al., 2016;Richard-Lepouriel et al., 2019), and more mood disorder episodes (McDermid et al., 2015;Neves et al., 2009;Perugi et al., 2013). ...
... Our results are consistent with prior studies which have found that bipolar/BPD patients, compared to patients with bipolar disorder without BPD, make more suicide attempts (Carpiniello, Lai, Pirarba, Sardu, & Pinna, 2011;Galfalvy et al., 2006;Joyce et al., 2010;Neves, Malloy-Diniz, & Correa, 2009;Parker et al., 2016;Perugi et al., 2013;Richard-Lepouriel et al., 2019;Zeng et al., 2015), are more frequently hospitalized (Neves et al., 2009;Parker et al., 2016), have more comorbid anxiety and substance use disorders (McDermid et al., 2015;Neves et al., 2009;Perugi et al., 2013;Richard-Lepouriel et al., 2019), lower ratings on the GAF (Carpiniello et al., 2011), greater childhood adversity (Goldberg & Garno, 2009;McDermid et al., 2015;Parker et al., 2016;Richard-Lepouriel et al., 2019), and more mood disorder episodes (McDermid et al., 2015;Neves et al., 2009;Perugi et al., 2013). ...
Background
Bipolar disorder and borderline personality disorder (BPD) are each significant public health problems. It has been frequently noted that distinguishing BPD from bipolar disorder is challenging. Consequently, reviews and commentaries have focused on differential diagnosis and identifying clinical features to distinguish the two disorders. While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compare psychiatric outpatients with both BPD and bipolar disorder to patients with BPD without bipolar disorder and patients with bipolar disorder without BPD.
Methods
Psychiatric outpatients presenting for treatment were evaluated with semi-structured interviews. The focus of the current study is the 517 patients with both BPD and bipolar disorder ( n = 59), BPD without bipolar disorder ( n = 330), and bipolar disorder without BPD ( n = 128).
Results
Compared to patients with bipolar disorder, the patients with bipolar disorder and BPD had more comorbid disorders, psychopathology in their first-degree relatives, childhood trauma, suicidality, hospitalizations, time unemployed, and likelihood of receiving disability payments. The added presence of bipolar disorder in patients with BPD was associated with more posttraumatic stress disorder in the patients as well as their family, more bipolar disorder and substance use disorders in their relatives, more childhood trauma, unemployment, disability, suicide attempts, and hospitalizations.
Conclusions
Patients with both bipolar disorder and BPD have more severe psychosocial morbidity than patients with only one of these disorders.
... BPD has been shown to be a risk factor for developing BP (though not the reverse) [87] with McDermid finding BPD was a strong predictor of incident BP II [86]. Parker et al. [90], in a study of BPD and predominant BP II individuals, found that, irrespective of whether BPD occurs alone or comorbid with BP, individuals were more likely to have experienced childhood sexual abuse or other developmental trauma, report depersonalization in childhood, to have experienced deficient parenting, exhibit DSH and return higher borderline personality profile scores-thus explaining why some features viewed as specific to those with BPD are reported by those with a BP condition. Overall, while the literature suggests that the majority of those with BPD are not comorbid for BP II (and vice versa), their co-occurrence is not rare and likely contributes to the clinical differential diagnostic dilemma (which is generally a binary one of choosing between the two options rather than allowing that both may be present). ...
... Overall, the literature supports a diagnostic model whereby BP II and BPD exist as independent conditions [49] while acknowledging they can also co-exist in some individuals [90]. However, an over-reliance on the dominant psychiatric diagnostic paradigm, which focusses on polythetic symptombased criteria, may obscure accurate differential diagnosis due to shared features. ...
... For example, a large head-to-head comparison study of individuals with BPD or BP [49] found key differences across diagnostic validators, which favoured a BPD diagnosis-namely a history of childhood sexual abuse, depersonalization in childhood, personality features related to relationship difficulties and sensitivity to criticism and an absence of a family history of BP disorder-which yielded high diagnostic accuracy of between 92 and 95%. The related study by Parker et al. [90] extended these findings and demonstrated that, irrespective of whether the borderline condition occurred on its own or was comorbid with BP, the developmental antecedents, personality profile and deliberate self-harm rates were the same-thus arguing for the co-occurrence of two independent conditions. Such an independence model also argues for the following approach to clinical assessment [97]: firstly, assessing whether a BP II condition is present or absent-with a weighting of features specific to BP disorder; and, secondly, assessing for the presence or absence of a borderline condition-with a weighting toward developmental trauma as well as borderline features. ...
Purpose of Review
Differentiating bipolar (BP) disorders (in particular BP II) from borderline personality disorder (BPD) is a common diagnostic dilemma. We sought to critically examine recent studies that considered clinical differences between BP II and BPD, which might advance their delineation.
Recent Findings
Recent studies focused on differentiating biological parameters—genetics, epigenetics, diurnal rhythms, structural and functional neuroimaging—with indicative differences not yet sufficient to guide diagnosis. Key differentiating factors include family history, developmental antecedents, illness course, phenomenological differences in mood states, personality style and relationship factors. Less differentiating factors include impulsivity, neuropsychological profiles, gender distribution, comorbidity and treatment response.
Summary
This review details parameters offering differentiation of BP II from BPD and should assist in resolving a frequent diagnostic dilemma. Future studies should specifically examine the BP II subtype directly with BPD, which would aid in sharpening the distinction between the disorders.
... While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders (Parker, Bayes, McClure, Del Moral, & Stevenson, 2016). Frias et al. (2016) recently reviewed the literature on the clinical impact of one disorder on the other. ...
... Our results are consistent with prior studies which have found that bipolar/BPD patients, compared to patients with bipolar disorder without BPD, make more suicide attempts (Carpiniello, Lai, Pirarba, Sardu, & Pinna, 2011;Galfalvy et al., 2006;Joyce et al., 2010;Neves, Malloy-Diniz, & Correa, 2009;Parker et al., 2016;Perugi et al., 2013;Richard-Lepouriel et al., 2019;Zeng et al., 2015), are more frequently hospitalized (Neves et al., 2009;Parker et al., 2016), have more comorbid anxiety and substance use disorders (McDermid et al., 2015;Neves et al., 2009;Perugi et al., 2013;Richard-Lepouriel et al., 2019), lower ratings on the GAF (Carpiniello et al., 2011), greater childhood adversity (Goldberg & Garno, 2009;McDermid et al., 2015;Parker et al., 2016;Richard-Lepouriel et al., 2019), and more mood disorder episodes (McDermid et al., 2015;Neves et al., 2009;Perugi et al., 2013). ...
... Our results are consistent with prior studies which have found that bipolar/BPD patients, compared to patients with bipolar disorder without BPD, make more suicide attempts (Carpiniello, Lai, Pirarba, Sardu, & Pinna, 2011;Galfalvy et al., 2006;Joyce et al., 2010;Neves, Malloy-Diniz, & Correa, 2009;Parker et al., 2016;Perugi et al., 2013;Richard-Lepouriel et al., 2019;Zeng et al., 2015), are more frequently hospitalized (Neves et al., 2009;Parker et al., 2016), have more comorbid anxiety and substance use disorders (McDermid et al., 2015;Neves et al., 2009;Perugi et al., 2013;Richard-Lepouriel et al., 2019), lower ratings on the GAF (Carpiniello et al., 2011), greater childhood adversity (Goldberg & Garno, 2009;McDermid et al., 2015;Parker et al., 2016;Richard-Lepouriel et al., 2019), and more mood disorder episodes (McDermid et al., 2015;Neves et al., 2009;Perugi et al., 2013). ...
... 25,26 The tool has been found to have good reliability and validity for the screening of BPSDs with a sensitivity and specificity of 0.90 and 0.88, respectively. [27][28][29][30] In this study, individuals were considered positive for BPSDs when the following condition was satisfied: if individuals responded "yes" for seven or more symptoms among the first 13 "Yes" or "No" questions, and the co-occurrence of the symptoms and the severity of symptoms was either moderate or serious. 30,31 The level of alcohol consumption among respondents was measured using the AUDIT. ...
Background
Bipolar spectrum disorders (BPSDs) are more common among HIV-positive individuals than the general population. Although BPSDs have very diverse and devastating consequences (immune suppression, cognitive impairment and poor medication adherence), little is known about BPSDs among HIV-positive individuals in Ethiopia. Therefore, this study was aimed to assess the prevalence and associated factors of BPSDs among adults attending antiretroviral therapy (ART) clinics in Gedeo zone health centers, southern Ethiopia.
Patients and methods
An institutional-based cross-sectional study was conducted by screening 412 randomly selected HIV-positive individuals using Mood Disorder Questionnaire. SPSS version 20 was used for data analysis. Bivariable and multivariable logistic regression models were fitted to identify factors associated with BPSDs. Adjusted OR (AOR) with corresponding 95% CI was computed to determine the association.
Results
Of the total 412 participants, 11.2% were screened positive for BPSDs. Lower CD4 count (AOR =2.97; 95% CI: 1.11, 7.90), past history of mental health problem (AOR =3.35; 95% CI: 1.576, 7.144), poor social support (AOR =2.6; 95% CI: 1.06, 6.63) and poor ART drug adherence (AOR =3.59; 95% CI: 1.78, 7.21) had a positive association with BPSDs.
Conclusion
In this study, the prevalence of BPSDs was high among adult patients attending ART clinics in Gedeo zone health centers. Poor social support, poor ART drug adherence, lower CD4 level and history of mental illness had statistically significant association with BPSDs. This demonstrates a need for the integration of Mental Health and Psycho Social Support with HIV/AIDS care services. Moreover, establishing good social support and controlling ART adherence were found to be very crucial too.
... Friborg et al. (2014) found a mean prevalence of BPD in patients with bipolar disorder, major depressive disorder, and dysthymia of 16%, 14%, and 13% respectively. Although there has been much controversy for years about whether BPD belongs to the bipolar spectrum or not, most studies suggest that bipolar disorder and BPD are two independent disorders (Paris & Black, 2015;Paris, Gunderson, & Weinberg, 2007;Parker, Bayes, McClure, del Moral, & Stevenson, 2016). ...
... This study confirmed that among participants with DD and among participants with bipolar depression, BPD was significantly associated with a higher suicide risk. This is consistent with previous research (Joyce et al., 2003;Parker et al., 2016;Sharp et al., 2012). It also confirmed that Bold p-values are significant. ...
... Neurology, Psychiatry and Brain Research 31 (2019) 37-42 among participants with bipolar depression, BPD was significantly associated with lower global functioning. This is also consistent with Parker et al. (2016), who found that patients with bipolar disorder comorbid with BPD were less likely to be employed than those with bipolar disorder only. However, contrary to our hypothesis, our study did not find a significant association between BPD and global functioning in patients with DD. ...
... BPD has been shown to be a risk factor for developing BP (though not the reverse) [87] with McDermid finding BPD was a strong predictor of incident BP II [86]. Parker et al. [90], in a study of BPD and predominant BP II individuals, found that, irrespective of whether BPD occurs alone or comorbid with BP, individuals were more likely to have experienced childhood sexual abuse or other developmental trauma, report depersonalization in childhood, to have experienced deficient parenting, exhibit DSH and return higher borderline personality profile scores-thus explaining why some features viewed as specific to those with BPD are reported by those with a BP condition. Overall, while the literature suggests that the majority of those with BPD are not comorbid for BP II (and vice versa), their co-occurrence is not rare and likely contributes to the clinical differential diagnostic dilemma (which is generally a binary one of choosing between the two options rather than allowing that both may be present). ...
... Overall, the literature supports a diagnostic model whereby BP II and BPD exist as independent conditions [49] while acknowledging they can also co-exist in some individuals [90]. However, an over-reliance on the dominant psychiatric diagnostic paradigm, which focusses on polythetic symptombased criteria, may obscure accurate differential diagnosis due to shared features. ...
... For example, a large head-to-head comparison study of individuals with BPD or BP [49] found key differences across diagnostic validators, which favoured a BPD diagnosis-namely a history of childhood sexual abuse, depersonalization in childhood, personality features related to relationship difficulties and sensitivity to criticism and an absence of a family history of BP disorder-which yielded high diagnostic accuracy of between 92 and 95%. The related study by Parker et al. [90] extended these findings and demonstrated that, irrespective of whether the borderline condition occurred on its own or was comorbid with BP, the developmental antecedents, personality profile and deliberate self-harm rates were the same-thus arguing for the co-occurrence of two independent conditions. Such an independence model also argues for the following approach to clinical assessment [97]: firstly, assessing whether a BP II condition is present or absent-with a weighting of features specific to BP disorder; and, secondly, assessing for the presence or absence of a borderline condition-with a weighting toward developmental trauma as well as borderline features. ...
