Unblending Borderline Personality and Bipolar Disorders

Giacomo, Ester di; Aspesi, Flora; Fotiadou, Maria; Arntz, Arnoud; Aguglia, Eugenio; Barone, Lavinia; Bellino, Silvio; Carpiniello, Bernardo; Colmegna, Fabrizia; Lazzari, Marina; Lorettu, Liliana; Pinna, Federica; Sicaro, Aldo; Signorelli, Maria; Clerici, Massimo; Bozzatello, Paola; Brignolo, Elena; Ghiani, Alice; Battiato, Maria Catena; Bon, Roberta; Contiero, Luana; Denti, Antonella; Franco, Lucia; Ginanneschi, Anna Maria; Lai, Alon; Laneri, Giuseppe; Marchini, Monica; Miragliotta, Elena; Ostaldo, Laura; Paggi, Elisabetta; Ravasi, Sara; Roletto, Filippo; Ruta, Sara; Zaccheroni, Dario

doi:10.1016/j.jpsychires.2017.03.006

Cited by 20 publications

(26 citation statements)

References 18 publications

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“…sex and substance abuse) may resemble periods of hypomanic or manic disinhibition and so leads to a misdiagnosis of a BP disorder . Conversely, hypomanic episodes, especially irritable ‘highs’, may be misclassified as affective instability (AI) or anger, thus leading to a false diagnosis of BPD .…”

Section: Introductionmentioning

confidence: 99%

Differentiating borderline personality disorder (BPD) from bipolar disorder: diagnostic efficiency of DSM BPD criteria

Bayes

Parker

2019

Acta Psychiatr Scand

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Bayes AJ, Parker GB. Differentiating borderline personality disorder (BPD) from bipolar disorder: diagnostic efficiency of DSM BPD criteria.Objective: We sought to determine the differential diagnostic efficiency of all DSM-IV borderline personality disorder (BPD) criteria by studying a sample of those with BPD and a contrast group with a bipolar disorder (BP). Method: Participants were clinically assessed and assigned diagnoses based on DSM criteriawith prevalence rates and diagnostic efficiency values calculated. Results: Fifty-three participants were assigned a BPD diagnosis, 83 a BP diagnosis, with comorbid participants excluded. The mean number of DSM BPD criteria assigned was 6.6 (SD = 1.0) in the BPD group and 1.9 (SD = 1.3) in the BP group. The most prevalent criterion in the BPD group was 'affective instability' (AI) (92.5%), with 'inappropriate anger' least endorsed (49%). The highest specificity criterion was 'abandonment fears', which displayed the greatest positive predictive value (PPV) = 0.9, and with AI offering the lowest specificity. 'Unstable relationships' had the highest overall negative predictive value (NPV) = 0.91. The highest percentage accuracy of classification was provided by 'identity disturbance' and 'abandonment fears' criteria, both 85%. Conclusion: The transdiagnostic nature of 'affective instability' means it is less useful for diagnostic decisions, whereas 'abandonment fears' and 'identity disturbance' offer superior diagnostic efficiency in distinguishing BPD from BP. Significant outcomes• Prevalence estimates of a DSM criterion alone are less useful in establishing a diagnosis if it occurs with a reasonable prevalence in other conditions.• The prevalence of 'affective instability' was high in both conditions, being sensitive to BPD but not specific in differentiating from BP.• Study results challenge the DSM polythetic model, which gives equal weighting to criteria, with diagnostic efficiency indices pointing to specific items being superior (i.e. 'identity disturbance' and 'abandonment fears') in making a diagnosis of BPD. Limitations• Results may not generalise to differing age groups, as prevalence of certain BPD symptoms changes across the lifespan.• Prevalence estimates of criteria likely reflect the study's specific recruitment portals' base rates and may not be generalisable.• The study captures diagnostic efficiency in distinguishing BPD from BP, but not other potential differential diagnoses.

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Section: Introductionmentioning

confidence: 99%

Differentiating borderline personality disorder (BPD) from bipolar disorder: diagnostic efficiency of DSM BPD criteria

Bayes

Parker

2019

Acta Psychiatr Scand

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“…El abuso de sustancias no fue un patrón predominante en la muestra de pacientes, tanto con diagnóstico único de TB y comórbido, sin embargo, sí se evidenció en aquellos con diagnóstico de TLP en un poco más de la mitad de la muestra dentro de esta categoría. Esto se contradice a lo evidenciado por McDermid et al (2015) cuya muestra altamente representativa y con resultados significativos para los grupos de trastorno bipolar I y II comórbidos con TLP, tuvieron antecedentes de consumo de sustancias, incluyendo abuso de alcohol 28 .…”

Section: Discussionunclassified

“…En cuanto a los síntomas de gravedad, obtuvimos que la impulsividad puede ser manifestada objetivamente mediante conductas deliberadas como en la suicidabilidad y agresividad, sin embargo, contrariamente a los estudios antecesores, la conducta suicida no fue una característica importante en frecuencia ni significativa para los 3 grupos de pacientes, no siendo así para la agresividad que, a pesar de presentarse en los mismos, tampoco alcanzó la significancia estadística. Estos datos son comparables a los de Di Giacomo et al (2017), quienes encontraron en su muestra de pacientes con TB una predominancia de agresividad e irritabilidad, mientras que en su muestra de pacientes con TLP la conducta parasuicida fue significativa 28 . De la misma manera, Bayes et al (2016) determinaron que la conducta suicida y la agresividad representan síntomas representativos en grupos de pacientes con comorbilidad TB + TLP y que en estos últimos las conductas autolesivas y suicidabilidad resultaron ser un factor predictor de severidad clínica 29 .…”

Section: Discussionunclassified

Severidad clínica en trastorno bipolar, trastorno límite de la personalidad y su comorbilidad

Valdivieso-Jiménez¹

2019

Rev. chil. neuro-psiquiatr.

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Introduction: Bipolar disorder and borderline personality disorder are diagnoses that have a wide variety of symptoms, however, it is described that the comorbidity of both intensifies the clinical severity as the appearance of a greater number of suicide attempts or self-harm. The objective of the study was to determine and compare the sociodemographic characteristics, clinical severity and symptoms in patients within these 3 groups. Method: The type of study was descriptive and qualitative, observational and transversal design. A sample of 92 clinical records of patients treated at the National Hospital Víctor Larco Herrera during the periods of January 2010 to May 2018 was used. Sociodemographic variables (age, sex, marital status, religion, level of education and occupation) and clinical severity (number of hospitalizations, suicide attempts, refusal of medication, response to treatment, substance abuse, current hospitalization and severity symptoms) using a data collection form. Results: The sociodemographic variables with statistical significance and higher frequency were female sex (p = 0.049), single marital status (p = 0.003), catholic religion (p = 0.009), as well as the variables of clinical severity with statistical significance were the number of hospitalizations (p = 0.015), psychotic symptoms (p = 0.009), irritability (p = 0.038), impairment (p = 0.000) and number of symptoms of severity (p = 0.030) in TB, BPD and their comorbidity. Conclusions: The clinical severity is associated with the number of hospitalizations, the presence of psychotic symptoms, irritability, dysfunctionality and the number of severe symptoms in patients with only TB diagnosis, BPD and their comorbidity.

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“…Differentiating BPD from BD in young people is a clinical challenge, due to the presence of overlapping symptoms such as impulsivity, emotional and affective instability, irritability and sexual arousal (15). Because of these overlapping symptoms, there is a claim that BPD and BD lie in a singular spectrum.…”

Section: Diagnostic Overlap Between Adolescent Affective Instability mentioning

confidence: 99%

Diagnostic overlap between adolescent affective instability in borderline personality and juvenile bipolar disorder in Sri Lanka

2019

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Borderline personality disorder (BPD) and bipolar disorder (BD) could present a diagnostic challenge in the adolescent due to the presence of overlapping symptoms such as impulsivity, affective instability, and sexual arousal. Of these symptoms, affective instability is a central feature of BPD, and there is a rapid shift from the neutral affect to an intense affect, and this is associated with a dysfunctional modulation of emotions. We describe three Sri Lankan adolescents presenting with affective instability, treated with psychopharmacological agents as for BD. While BPD is characterized by transient mood shifts induced by interpersonal stressors, in BD, there are sustained mood changes. A longitudinal assessment of the symptomatic profile and collateral information clarified the diagnosis as being BPD. An examination of the nature of affective instability is vital for a proper diagnosis and provision of evidence-based treatment.

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Unblending Borderline Personality and Bipolar Disorders

Cited by 20 publications

References 18 publications

Differentiating borderline personality disorder (BPD) from bipolar disorder: diagnostic efficiency of DSM BPD criteria

Differentiating borderline personality disorder (BPD) from bipolar disorder: diagnostic efficiency of DSM BPD criteria

Severidad clínica en trastorno bipolar, trastorno límite de la personalidad y su comorbilidad

Diagnostic overlap between adolescent affective instability in borderline personality and juvenile bipolar disorder in Sri Lanka

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