Improving the Recognition of Borderline Personality Disorder in a Bipolar World

Abstract

Both bipolar disorder and borderline personality disorder (BPD) are serious mental health disorders resulting in significant psychosocial morbidity, reduced health-related quality of life, and excess mortality. Yet research on BPD has received much less funding from the National Institute of Health (NIH) than has bipolar disorder during the past 25 years. Why hasn't the level of NIH research funding for BPD been commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder? In the present article, the author illustrates how the bipolar disorder research community has done a superior job of "marketing" their disorder. Studies of underdiagnosis, screening, diagnostic spectra, and economics are reviewed for both bipolar disorder and BPD. Researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, developed and promoted several screening scales, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these four issues and research efforts. Although BPD is as frequent as (if not more frequent than) bipolar disorder, as impairing as (if not more impairing than) bipolar disorder, and as lethal as (if not more lethal than) bipolar disorder, it has received less than one-tenth the level of funding from the NIH and has been the focus of many fewer publications in the most prestigious psychiatric journals. The researchers of BPD should consider adopting the strategy taken by researchers of bipolar disorder before the diagnosis is eliminated in a future iteration of the DSM or the ICD.

Patients with borderline personality disorder and bipolar disorder: a descriptive and comparative study

“…Several review articles and commentaries about the importance of recognizing bipolar disorder in patients presenting for the treatment of depression have been published in peer reviewed journals (Bowden, 2001; Hirschfeld & Vornik, 2004; Ketter, 2011; McIntyre, 2014; Yatham, 2005). Much less has been written about the importance of improving the recognition of BPD (Zimmerman, 2016). Just as it is important for clinicians to include questions to screen for a history of manic or hypomanic episodes in their evaluation of depressed patients, it is important to screen for the presence of BPD in patients with mood disorders (Zimmerman, Balling, Dalrymple, & Chelminski, 2019).…”

Characterizing DSM-5 and ICD-11 personality disorder features in psychiatric inpatients at scale using electronic health records

“…Second, when using only a clinical diagnostic approach, there may be a variation regarding which disorders are more likely to be diagnosed and which may be overlooked. This may be based on factors such as symptom severity, expectation of response to treatment, or familiarity with particular PD diagnoses (Zimmerman and Morgan, 2013; Zimmerman, 2016). Finally, most prior personality studies have used a categorical diagnostic approach for PD diagnosis, which has been criticized for its questionable validity (Haslam et al ., 2012; Skodol, 2012; Tyrer et al ., 2015).…”

Second Generation Long-Acting Antipsychotics in the Treatment of Bipolar Disorder: A Clinical Viewpoint

“…Several studies have indicated an improvement in borderline symptoms in response to conventional mood stabilizers but some reports have pointed out the efficacy of SGAs (such as olanzapine, risperidone, paliperidone, aripiprazole etc.) in the control of some symptoms (i.e., psychotic symptoms, dissociation episodes, impulsive behavioral dyscontrol) that do not adequately respond to conventional mood stabilizers (including lithium) [21][22][23][24]. Despite this, it is worthy to note that the PD-BD comorbidity may further decrease treatment adherence and, therefore, the use of a SGA-LAI may improve the compliance and the overall outcomes in such cases [25][26][27][28].…”