Borderline personality and bipolar disorder: the limits of phenomenology

Self over time: another difference between borderline personality disorder and bipolar disorder

RATIONALE, AIMS AND OBJECTIVES

The nature of the relationship between bipolar disorder and borderline personality disorder has been an intense field of debate in the last two decades. Current diagnostic classifications approach this complex phenomenon using syndromatic definitions based on presence or absence of a restricted set of signs or symptoms that have demonstrated low specificity. One of the several utilities of the phenomenological method in psychiatry is to complement the clinical panorama, helping in the process of identifying potential differences between two separated clinical syndromes. The main objective of this publication is to explore one particular clinical difference between these two conditions - that is, the experience of self-continuity and time perception.

METHODS

the argument explored in this paper is based on previous second-person or phenomenological accounts of sufferers of both conditions.

RESULTS AND CONCLUSIONS

Whereas borderline personality disorder patients tend to experience only the present moment, referring frequent difficulties of drawing experiences of the past in order to determine their own future, bipolar disorder patients are constantly worried about the contradictions in their past experiences and the latent risk of losing control of themselves in future episodes of their disease. This contrast should be, however, corroborated in future research comparing directly the two groups in terms of the continuity of the self and their temporal structures.

Comorbid bipolar disorder and borderline personality disorder and substance use disorder

Bipolar disorder (BD) and borderline personality disorder (BPD) are disabling and life-threatening conditions. Both disorders share relevant comorbidities, particularly the risk of having a lifetime substance use disorder (SUD). We tested the hypothesis that patients with both BD type I (BDI) or II (BDII) and BPD would have a higher rate of SUD than would patients with either disorder alone. A total of 3651 psychiatric patients were evaluated with semistructured diagnostic interviews for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, axis I and II disorders. A total of 63 patients were diagnosed with both BD and BPD, and these patients were significantly more likely to have a SUD compared with BDII patients without BPD (76% vs. 50%, χ = 9.69, p < 0.01). There were no differences when comparing the comorbid group with BPD patients without BD (76% vs. 71%, χ = 0.519, p = 0.4). The present study shows the importance of taking both BPD and BD into consideration insofar as the co-occurrence of the disorders increased the risk of having a SUD especially when compared with BDII alone.

Different impulsivity profiles in borderline personality disorder and bipolar II disorder

INTRODUCTION

Borderline personality disorder (BPD) and bipolar II disorder (BP II) share clinical characteristics including impulsivity. Their relationship is disputed. In this study, we investigated self-reported impulsivity in these patient groups and in a healthy control group. Effects of current mood state and of traumatic childhood experiences were explored.

METHODS

Twenty-five patients with BPD without comorbid bipolar disorder; 20 patients with BP II without comorbid BPD; and 44 healthy control subjects completed the UPPS questionnaire which yields assessments of four components of impulsivity: Urgency, Lack of Premeditation, Lack of Perseverance, and Sensation Seeking. Current mood state was rated using the Montgomery Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). Traumatic childhood experiences were assessed using the Childhood Trauma Questionnaire (CTQ). Group differences in UPPS levels; and effects of mood state and CTQ score on UPPS scores in patients were investigated.

RESULTS

BPD patients showed significantly higher levels of Urgency and Lack of Perseverance than BP II patients and controls, and a significantly higher level of Lack of Premeditation than controls. BP II patients showed higher levels of Urgency and Lack of Perseverance than controls. In BP II, higher MADRS scores were associated with higher impulsivity scores. Also, higher CTQ scores were associated with higher Urgency scores in BP II.

LIMITATIONS

Relatively small sample size; cross-sectional assessment of influence of mood state.

CONCLUSIONS

BPD patients exhibited markedly elevated UPPS impulsivity scores compared with healthy controls and BP II patients, and the elevations were not related to current mood state. BP II patients showed moderately elevated impulsivity scores which were associated with a depressed mood state and to some extent with a history of childhood trauma. The findings suggest that BPD and BP II have different impulsivity profiles.