Bipolar disorder and personality disorder

The many faces of bipolar disorder

Bipolar disorder is a chronic disease characterized by depressive, manic or hypomanic, and mixed episodes. Bipolar disorder may be confused with unipolar depression, because patients with bipolar disorder are usually symptomatic with depression rather than mania. Bipolar disorder may also be misdiagnosed as schizophrenia, since both disorders can present with psychotic symptoms. For children, the principal differential diagnostic consideration is ADHD. Making the correct diagnosis has important prognostic and treatment implications. Comorbidities with personality disorders, substance and alcohol abuse or dependence, and anxiety disorders complicate assessment, treatment, and recovery. Effective pharmacotherapy and maintenance monitoring are critical in order to minimize the risk of relapse and associated disability, morbidity, and mortality.

Significance of borderline personality-spectrum symptoms among adolescents with bipolar disorder

BACKGROUND

Little is known regarding correlates of borderline personality-spectrum symptoms (BPSS) among adolescents with bipolar disorder (BP).

METHODS

Participants were 90 adolescents, 13-19 years of age, who fulfilled DSM-IV-TR criteria for BP using semi-structured diagnostic interviews. BPSS status was ascertained using the Life Problems Inventory which assessed identity confusion, interpersonal problems, impulsivity, and emotional lability. Analyses compared adolescents with "high" versus "low" BPSS based on a median split.

RESULTS

Participants with high, relative to low, BPSS were younger, and had greater current and past depressive episode severity, greater current hypo/manic episode severity, younger age of depression onset, and reduced global functioning. High BPSS participants were more likely to have BP-II, and had higher rates of social phobia, generalized anxiety disorder, conduct disorder, oppositional defiant disorder, homicidal ideation, assault of others, non-suicidal self-injury, suicidal ideation, and physical abuse. Despite greater illness burden, high BPSS participants reported lower rates of lithium use. The most robust independent predictors of high BPSS, identified in multivariate analyses, included lifetime social phobia, non-suicidal self-injury, reduced global functioning, and conduct and/or oppositional defiant disorder.

LIMITATIONS

The study design is cross-sectional and cannot determine causality.

CONCLUSIONS

High BPSS were associated with greater mood symptom burden and functional impairment. Presence of high BPSS among BP adolescents may suggest the need to modify clinical monitoring and treatment practices. Future prospective studies are needed to examine the direction of observed associations, the effect of treatment on BPSS, and the effect of BPSS as a moderator or predictor of treatment response.

Schema therapy for bipolar disorder: a conceptual model and future directions

Schema therapy (ST) is an integrative form of psychotherapy developed for complex, chronic psychological disorders with a characterlogical underpinning. Bipolar disorder is just such a disorder--complex and often comorbid, with demonstrated stable cognitive and personality features that complicate the course of illness. This article presents the reasons justifying the application of ST to bipolar disorder and proposes a treatment rationale and future directions for treatment and research. If well adapted to the characteristics of bipolar disorder, ST might prove to be an effective adjunctive psychotherapy option that attenuates emotional reactivity, reduces symptoms and improves quality of life.

The clinician's dilemma: borderline personality disorder or bipolar spectrum disorder?

OBJECTIVES

This paper aims to explore the use of science as a basis for introducing bipolar spectrum disorder to conceptualize people who may otherwise be described as having borderline personality disorder, and offer suggestions for the management of clinical dilemmas.

CONCLUSIONS

Testable observations, thoughtfulness and humility are helpful in clinical practice.

Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: complexities and developmental issues

This review addresses the phenomenology of mania/bipolar disorder from a developmental psychopathology perspective and uses cases with longitudinal information to illustrate major points. Beginning with a summary of the phenomenology of bipolar illness as it occurs in adults, the authors identify diagnostic complexities unique to children and adolescents. These include the challenges of characterizing elation and grandiosity; differentiating mania from comorbid symptoms, rages, sequelae of maltreatment, and typical developmental phenomena; and the unique manifestations of psychosis. We conclude with the observation that a significant difference between early and later onset bipolar disorder is that, in the former, there appears to be a global delay or arrest in the development of appropriate affect regulation; whereas in adult-onset bipolar illness, emotion dysregulation generally presents as an intermittent phenomenon. At this juncture, the study of childhood bipolar illness would benefit from a developmental psychopathology perspective to move beyond the level of cross-sectional symptom description to begin to study individuals over time, focusing on developmental, environmental, genetic, and neurobiological influences on manifest behavior.

Characteristics of recent suicide attempters with and without Borderline Personality Disorder

The present research compared recent suicide attempters with and without a diagnosis of Borderline Personality Disorder (BPD). One hundred and eighty recent suicide attempters, recruited in the Emergency Department, participated in extensive research interviews. Results showed that suicide attempters with BPD displayed greater severity of overall psychopathology, depression, hopelessness, suicidal ideation, past suicide attempts, and had poorer social problem solving skills than those without a BPD diagnosis. No differences were found between the groups regarding the intent to die or lethality associated with the index suicide attempt. These findings highlight the seriousness of BPD and the risk that individuals diagnosed with this disorder will attempt suicide.