Differential Diagnosis of Bipolar II Disorder and Borderline Personality Disorder
- 126 Downloads
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 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.
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.
KeywordsBipolar disorder Borderline personality disorder Diagnosis Affective instability
Compliance with Ethical Standards
Conflict of Interest
Adam Bayes, Gordon Parker and Joel Paris each declare no potential conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3•.del la Rossa I, Oquendo MA, García G, Stanley B, González-Pinto A, Liu SM, et al. Determining if borderline personality disorder and bipolar disorder are alternative expressions of the same disorder: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2017;78:e994–9. A large scale latent class analysis of BP and BPD symptoms in 34,653 individuals. CrossRefGoogle Scholar
- 18.Suppes T, Mintz J, McElroy SL, Altshuler LL, Kupka RW, Frye MA. Mixed hypomania in 908 patients with bipolar disorder evaluated prospectively in the Stanley Foundation Bipolar Treatment Network: a sex-specific phenomenon. Arch Gen Psychiatry. 2005;62:1089–96.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Benazzi, F. Bipolar disorder – focus on bipolar II disorder and mixed depression. Lancet. 2007;369:935–945.Google Scholar
- 24.Renaud S, Corbalan F. Beaulieu S. Differential diagnosis of bipolar affective disorder type II and borderline personality disorder: analysis of the affective dimension. Compr Psychiatry 2012;53:952–961.Google Scholar
- 28••.Arribas IP, Goodwin GM, Geddes JR, Lyons T, Saunders KE. A signature-based machine learning model for distinguishing bipolar disorder and borderline personality disorder. Transl Psychiatry. 2018;81:274. This study used a machine learning approach to classify individuals as either BP or BPD based on smartphone mood ratings. CrossRefGoogle Scholar
- 40.Goodwin FK, Jamison KR. Manic-depressive illness: bipolar disorders and recurrent depression. Oxford: Oxford University Press; 2007.Google Scholar
- 41.White CN, Gunderson JG, Zanarini MC, Hudson JI. Family studies of borderline personality disorder: a review. Harv Rev Psychiatry. 2003;12:118–9.Google Scholar
- 43.Benazzi F. Bipolar II disorder family history using the family history screen: findings and clinical implications. Compr Psychiatry 2004;45:77–82.Google Scholar
- 48.Rihmer Z. Prediction and prevention of suicide in bipolar disorders. Clin Neuropsychiatry. 2005;2:48–54.Google Scholar
- 57•.Yu H, Meng YJ, Li XJ, Zhang C, Liang S, Li ML, et al. Common and distinct patterns of grey matter alterations in borderline personality disorder and bipolar disorder: voxel-based meta-analysis. Br J Psychiatry. 2019;215:395–403. A large recent meta-analysis of structural brain differences in BP and BPD studies. CrossRefPubMedPubMedCentralGoogle Scholar
- 59••.Bøen E, Hjørnevik T, Hummelen B, Elvsåshagen T, Moberget T, Holtedahl JE, et al. Patterns of altered regional brain glucose metabolism in borderline personality disorder and bipolar II disorder. Acta Psychiatr Scand. 2019;139:256–68. One of the few studies that specifically examines the BP II subtype versus BPD in a functional neuroimaging paradigm. PubMedPubMedCentralGoogle Scholar
- 65•.Carr O, Saunders KE, Bilderbeck AC, Tsanas A, Palmius N, Geddes JR, et al. Desynchronization of diurnal rhythms in bipolar disorder and borderline personality disorder. Transl Psychiatry. 2018;8:79. This study examines diurnal rhythm fluctuations (in mood, sleep and activity) comparing BP and BPD, with the latter having more severe disruption. CrossRefPubMedPubMedCentralGoogle Scholar
- 78.Balling C, Chelminski I, Dalrymple K, Zimmerman M. Differentiating borderline personality from bipolar disorder with the Mood Disorder Questionnaire (MDQ): A replication and extension of the International Mood Network (IMN) Nosology Project. Compr Psychiatry. 2019;88:49–51.CrossRefPubMedPubMedCentralGoogle Scholar
- 81.Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008;69:533–45.CrossRefPubMedPubMedCentralGoogle Scholar
- 88•.Riemann G, Weisscher N, Post RM, Altshuler L, McElroy S, Frye MA, et al. The relationship between self-reported borderline personality features and prospective illness course in bipolar disorder. Int J Bipolar Disord. 2017;5:31. This study examines the interaction between borderline personality features and BP. CrossRefPubMedPubMedCentralGoogle Scholar
- 92.Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20:97–170.CrossRefPubMedPubMedCentralGoogle Scholar
- 93.Davidson K, Norrie J, Tyrer P, Gumley A, Tata P, Murray H, et al. The effectiveness of cognitive behaviour therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. J Personal Disord. 2006;20:450–65.CrossRefGoogle Scholar
- 97.Bayes A. Differentiation of the bipolar disorders from borderline personality disorder. Doctor of Philosophy (PhD) thesis. University of New South Wales; 2017.Google Scholar
- 98.Parker et al. (Ed). Bipolar II disorder. Modelling, measuring and managing. 3rd ed. Cambridge: Cambridge University Press; 2019.Google Scholar