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Current Psychiatry Reports

, 21:125 | Cite as

Differential Diagnosis of Bipolar II Disorder and Borderline Personality Disorder

  • Adam BayesEmail author
  • Gordon Parker
  • Joel Paris
Bipolar Disorders (R Hirschfeld, Section Editor)
  • 126 Downloads
Part of the following topical collections:
  1. Topical Collection on Bipolar Disorders

Abstract

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 Findings

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.

Summary

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.

Keywords

Bipolar disorder Borderline personality disorder Diagnosis Affective instability 

Notes

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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    MacKinnon DF, Pies R. Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders. Bipolar Disord. 2006;8:1–14.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Paris J, Black DW. Borderline personality disorder and bipolar disorder: what is the difference and why does it matter? J Nerv Ment Dis. 2015;203:3–7.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 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
  4. 4.
    Bassett D. Borderline personality disorder and bipolar affective disorder. Spectra or spectre? A review. Aust N Z J Psychiatry. 2012;46:327–39.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bayes A, Parker G, Fletcher K. Clinical differentiation of bipolar II disorder from borderline personality disorder. Curr Opin Psychiatr. 2014;27:14–20.CrossRefGoogle Scholar
  6. 6.
    Ghaemi SN, Dalley S, Catania C, Barroilhet S. Bipolar or borderline: a clinical overview. Acta Psychiatr Scand. 2014;130:99–108.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Yen S, Frazier E, Hower H, Weinstock LM, Topor DR, Hunt J. Borderline personality disorder in transition age youth with bipolar disorder. Acta Psychiatr Scand. 2015;132:270–80.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kernberg OF, Yeomans FE. Borderline personality disorder, bipolar disorder, depression, attention deficit/hyperactivity disorder, and narcissistic personality disorder: practical differential diagnosis. Bull Menn Clin. 2013;77:1–22.CrossRefGoogle Scholar
  9. 9.
    Ruggero CJ, Zimmerman M, Chelminski I, Young D. Borderline personality disorder and misdiagnosis of bipolar disorder. J Psychiatr Res. 2010;44:405–8.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Paykel ES, Abbott R, Morriss R, Hayhurst H, Scott J. Sub-syndromal and syndromal symptoms in the longitudinal course of bipolar disorder. Br J Psychiatry. 2006;189:118–23.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Parker GB, Fletcher K. Is bipolar II depression phenotypically distinctive? Acta Psychiatr Scand. 2009;120:446–55.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Benazzi F. Agitated depression in bipolar II disorder. World J Biol Psychiatry. 2005;6:198–205.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Russell J, Moskowitz D, Zuroff DC, Sookman D, Paris J. Affective instability in patients with borderline personality disorder. J Abnorm Psychol. 2007;116:578–88.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Benazzi F. Gender differences in bipolar II and unipolar depressed outpatients: a 557-case study. Ann Clin Psychiatry. 1999;11:55–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Perugi G, Fornaro M, Akiskal HS. Are atypical depression, borderline personality disorder and bipolar II disorder overlapping manifestations of a common cyclothymic diathesis? World Psychiatry. 2011;10:45–51.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Meares R, Gerull F, Stevenson J, Korner A. Is self disturbance the core of borderline personality disorder? An outcome study of borderline personality factors. Aust N Z J Psychiatry. 2011;45:214–22.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Koenigsberg H. Affective instability: toward an integration of neuroscience and psychological perspectives. J Personal Disord. 2010;24:60–82.CrossRefGoogle Scholar
  18. 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
  19. 19.
    Parker G, Graham R, Synnott H, Anderson J. Is the DSM-5 duration criterion valid for the definition of hypomania? J Affect Disord. 2014;156:87–91.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Zimmerman M, Morgan TA. Problematic boundaries in the diagnosis of bipolar disorder: the interface with borderline personality disorder. Curr Psychiatry Rep. 2013;15:422–32.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bayes A, Graham RK, Parker GB, McCraw S. Is ‘subthreshold’ bipolar II disorder more difficult to differentiate from borderline personality disorder than formal bipolar II disorder? Psychiatry Res. 2018;264:416–20.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Benazzi, F. Bipolar disorder – focus on bipolar II disorder and mixed depression. Lancet. 2007;369:935–945.Google Scholar
  23. 23.
    M’Bailara K, Demotes-Mainard J, Swendsen J, Mathieu F, Leboyer M, Henry C. Emotional hyper-reactivity in normothymic bipolar patients. Bipolar Disord. 2009;11:63–9.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 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
  25. 25.
    Henry C, Mitropoulou V, New AS, Koenigsberg HW, Silverman J, Siever LJ. Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. J Psychiatr Res. 2001;35:307–12.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Mneimne M, Fleeson W, Arnold EM, Furr RM. Differentiating the everyday emotion dynamics of borderline personality disorder from major depressive disorder and bipolar disorder. Personal Disord. 2018;9:192–209.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Tsanas A, Saunders KE, Bilderbeck AC, Palmius N, Osipov M, Clifford GD, et al. Daily longitudinal self-monitoring of mood variability in bipolar disorder and borderline personality disorder. J Affect Disord. 2016;205:225–33.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 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
  29. 29.
    Thompson RA. Emotional regulation: a theme in search for definition. Monogr Soc Res Child. 1994;59:25–52.CrossRefGoogle Scholar
  30. 30.
    Koole SL. The psychology of emotion regulation: an integrative review. Cognit Emot. 2009;23:4–41.CrossRefGoogle Scholar
  31. 31.
    Suvak MK, Litz BT, Sloan DM, Zanarini MC, Barrett LF, Hofmann SG. Emotional granularity and borderline personality disorder. J Abnorm Psychol. 2011;120:414–26.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Leible TL, Snell WE. Borderline personality disorder and multiple aspects of emotional intelligence. Pers Individ Differ. 2004;37:393–404.CrossRefGoogle Scholar
  33. 33.
    Baer RA, Sauer SE. Relationships between depressive rumination, anger rumination, and borderline personality features. Personal Disord. 2011;2:142–50.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Rosenthal MZ, Cheavens JS, Lejuez C, Lynch TR. Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms. Behav Res Ther. 2005;43:1173–85.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Van Rheenen TE, Murray G, Rossell SL. Emotion regulation in bipolar disorder: profile and utility in predicting trait mania and depression propensity. Psychiatry Res. 2015;225:425–32.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Bayes A, Parker G, McClure G. Emotional dysregulation in those with bipolar disorder, borderline personality disorder and their comorbid expression. J Affect Disord. 2016;204:103–11.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Bateman A, Fonagy P. Mentalization based treatment for borderline personality disorder. World Psychiatry. 2010;9:11–5.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Martino DJ, Strejilevich SA, Fassi G, Marengo E, Igoa A. Theory of mind and facial emotion recognition in euthymic bipolar I and bipolar II disorders. Psychiatry Res. 2011;189:379–84.CrossRefGoogle Scholar
  39. 39.
    Bayes A, Parker G. Borderline personality disorder in men: A literature review and illustrative case vignettes. Psychiatry Res. 2017;257:197–202.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Goodwin FK, Jamison KR. Manic-depressive illness: bipolar disorders and recurrent depression. Oxford: Oxford University Press; 2007.Google Scholar
  41. 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
  42. 42.
    Distel MA, Trull TJ, Derom CA, Thiery EW, Grimmer MA, Martin NG, et al. Heritability of borderline personality disorder features is similar across three countries. Psychol Med. 2008;38:1219–29.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 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
  44. 44.
    Luby JL, Navsaria N. Pediatric bipolar disorder: evidence for prodromal states and early markers. J Child Psychol Psychiatry. 2010;51:459–71.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Lewinsohn PM, Seeley JR, Klein DN. Bipolar disorders during adolescence. Acta Psychiatr Scand. 2003;108:47–50.CrossRefGoogle Scholar
  46. 46.
    Tijssen MJA, van Os J, Wittchen H-U, Lieb R, Beesdo K, Mengelers R, et al. Prediction of transition from common adolescent bipolar experiences to bipolar disorder: 10-year study. Br J Psychiatry. 2010;196:102–8.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Paris J, Zweig-Frank H. The 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry. 2001;42:482–7.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Rihmer Z. Prediction and prevention of suicide in bipolar disorders. Clin Neuropsychiatry. 2005;2:48–54.Google Scholar
  49. 49.
    Bayes AJ, McClure G, Fletcher K, Román Ruiz del Moral YE, Hadzi-Pavlovic D, Stevenson JL, et al. Differentiating the bipolar disorders from borderline personality disorder. Acta Psychiatr Scand. 2016;133:187–95.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Joyce PR, Light KJ, Rowe SL. Self-mutilation and suicide attempts: relationships to bipolar disorder, borderline personality disorder, temperament and character. Aust N Z J Psychiatry. 2010;44:250–7.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Lenzenweger MF, Clarkin JF, Fertuck EA, Kernberg OF. Executive neurocognitive functioning and neurobehavioural systems indicators in borderline personality disorder: a preliminary study. J Personal Disord. 2004;18:421–38.CrossRefGoogle Scholar
  52. 52.
    McClure G, Hawes DJ, Dadds MR. Borderline personality disorder and neuropsychological measures of executive function: a systematic review. Personal Ment Health. 2016;10:43–57.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Coulston CM, Tanious M, Mulder RT, Porter RJ, Malhi GS. Bordering on bipolar: the overlap between borderline personality and bipolarity. Aust N Z J Psychiatry. 2012;46:506–21.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Bora E. Neurocognitive features in clinical subgroups of bipolar disorder: a meta-analysis. J Affect Disord. 2018;229:125–34.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Malhi GS, Ivanovski B, Szekeres V, Olley A. Bipolar disorder: it’s all in your mind? The neuropsychological profile of a biological disorder. Can J Psychiatr. 2004;49:813–9.CrossRefGoogle Scholar
  56. 56.
    Clark L, Goodwin GM. State- and trait-related deficits in sustained attention in bipolar disorder. Eur Arch Psychiatry Clin Neurosci. 2004;254:61–8.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 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
  58. 58.
    Rossi R, Pievani M, Lorenzi M, Boccardi M, Beneduce R, Bignotti S, et al. Structural brain features of borderline personality and bipolar disorders. Psychiatry Res-Neuroim. 2013;213:83–91.CrossRefGoogle Scholar
  59. 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
  60. 60.
    Malhi GS, Tanious M, Fritz K, Coulston CM, Bargh DM, Phan KL, et al. Differential engagement of the fronto-limbic network during emotion processing distinguishes bipolar and borderline personality disorder. Mol Psychiatry. 2013;18:1247–8.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Das P, Calhoun V, Malhi GS. Bipolar and borderline patients display differential patterns of functional connectivity among resting state networks. NeuroImage. 2014;98:73–81.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Arikan MK, Metin B, Gunver MG, Tarhan N. Borderline personality and bipolar disorders cannot be differentiated electrophysiologically. Clin EEG Neurosci. 2019;50:383–8.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Witt SH, Streit F, Jungkunz M, Frank J, Awasthi S, Reinbold CS, et al. Genome-wide association study of borderline personality disorder reveals genetic overlap with bipolar disorder, major depression and schizophrenia. Transl Psychiatry. 2017;7:e1155.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Perroud N, Zewdie S, Stenz L, Adouan W, Bavamian S, Prada P, et al. Methylation of serotonin receptor 3A in ADHD, borderline personality, and bipolar disorders: link with severity of the disorders and childhood maltreatment. Depress Anxiety. 2016;33:45–55.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 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
  66. 66.
    Carr O, Saunders KE, Tsanas A, Bilderbeck AC, Palmius N, Geddes JR, et al. Variability in phase and amplitude of diurnal rhythms is related to variation of mood in bipolar and borderline personality disorder. Sci Rep. 2018;8:1649.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Lawrence KA, Allen JS, Chanen AM. Impulsivity in borderline personality disorder: reward-based decision-making and its relationship to emotional distress. J Personal Disord. 2010;24:786–99.CrossRefGoogle Scholar
  68. 68.
    Swann AC, Anderson JC, Dougherty DM, Moeller FG. Measurement of inter-episode impulsivity in bipolar disorder. Psychiatry Res. 2001;101:195–7.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Wilson ST, Stanley B, Oquendo MA, Goldberg P, Zalsman G, Mann JJ. Comparing impulsiveness, hostility, and depression in borderline personality disorder and bipolar II disorder. J Clin Psychiatry. 2007;68:1533–9.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Boen E, Hummelen B, Elvsashagen T, Boye B, Andersson S, Karterud S, et al. Different impulsivity profiles in borderline personality disorder and bipolar II disorder. J Affect Disord. 2015;170:104–11.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Bayes AJ, Parker GB. Cognitive and behavioral differentiation of those with borderline personality disorder and bipolar disorder. J Nerv Ment Dis. 2019;207:620–5.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Skodol AE, Gunderson JG, Pfohl B, Widiger TA, Livesley WJ, Siever LJ. The borderline diagnosis I: psychopathology, comorbidity, and personality structure. Biol Psychiatry. 2002;51:936–50.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Mazzarini L, Colom F, Pacchiarotti I, Nivoli AM, Murru A, Bonnin CM, et al. Psychotic versus not psychotic bipolar II disorder. J Affect Disord. 2010;126:55–60.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Zimmerman M. Improving recognition of borderline personality disorder in a bipolar world. J Personal Disord. 2016;30:320–35.CrossRefGoogle Scholar
  75. 75.
    Akiskal HS, Hantouche EG, Allilaire JF. Bipolar II with and without cyclothymic temperament: ‘dark’ and ‘sunny’ expressions of soft bipolarity. J Affect Disord. 2003;73:49–57.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Zimmerman M, Chelminski I, Dalrymple K, Martin J. Screening for bipolar disorder and finding borderline personality disorder: A replication and extension. J Personal Disord. 2019;33:533–43.CrossRefGoogle Scholar
  77. 77.
    Vöhringer PA, Barroilhet SA, Alvear K, Medina S, Espinosa C, Alexandrovich K, et al. The International Mood Network (IMN) Nosology Project: differentiating borderline personality from bipolar illness. Acta Psychiatr Scand. 2016;134:504–10.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 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
  79. 79.
    Fowler JC, Madan A, Allen JG, Oldham JM, Frueh BC. Differentiating bipolar disorder from borderline personality disorder: diagnostic accuracy of the difficulty in emotion regulation scale and personality inventory for DSM-5. J Affect Disord. 2019;245:856–60.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Vieta E, Colom F. Martı́nez-Arán A, Benabarre A, Reinares M, Gastó C. Bipolar II disorder and comorbidity. Compr Psychiatry. 2000;41:339–43.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 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
  82. 82.
    Merikangas KR, Jin R, He J-P, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar spectrum disorder in the world health survey initiative. Arch Gen Psychiatry. 2011;68:241–51.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Philipsen A, Limberger MF, Lieb K, Feige B, Kleindienst N, Ebner-Priemer U, et al. Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder. Br J Psychiatry. 2008;192:118–23.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Zanarini M, Frankenburg F, Dubo E, Sickel AE, Trikha A, Levin A, et al. Axis I comorbidity of borderline personality disorder. Am J Psychiatry. 1998;155:1733–9.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Vieta E, Colom F, Martinez-Aran A, Benabarre A, Gastó C. Personality disorders in bipolar II patients. J Nerv Ment Dis. 1999;187:245–8.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    McDermid J, Sareen J, El-Gabalawy R, Pagura J, Spiwak R, Enns MW. Co-morbidity of bipolar disorder and borderline personality disorder: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Compr Psychiatry. 2015;58:18–28.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Frías Á, Baltasar I, Birmaher B. Comorbidity between bipolar disorder and borderline personality disorder: prevalence, explanatory theories, and clinical impact. J Affect Disord. 2016;202:210–9.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 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
  89. 89.
    Gunderson JG, Stout RL, Shea MT, Grilo CM, Markowitz JC, Morey LC, et al. Interactions of borderline personality disorder and mood disorders over ten years. J Clin Psychiatry. 2014;75:829–34.CrossRefPubMedPubMedCentralGoogle Scholar
  90. 90.
    Parker G, Bayes A, McClure G, Del Moral YR, Stevenson J. Clinical status of comorbid bipolar disorder and borderline personality disorder. Br J Psychiatry. 2016;209:209–15.CrossRefPubMedPubMedCentralGoogle Scholar
  91. 91.
    Bellino S, Paradiso E, Bogetto F. Efficacy and tolerability of pharmacotherapies for borderline personality disorder. CNS Drugs. 2008;22:671–92.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 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. 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
  94. 94.
    Gunderson JG. Borderline personality disorder. N Engl J Med. 2011;364:2037–42.CrossRefPubMedPubMedCentralGoogle Scholar
  95. 95.
    Van Dijk S, Jeffrey J, Katz MR. A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. J Affect Disord. 2013;145:386–93.CrossRefPubMedPubMedCentralGoogle Scholar
  96. 96.
    Fowler JC, Madan A, Allen JG, Oldham JM, Frueh BC. Differentiating bipolar disorder from borderline personality disorder: diagnostic accuracy of the difficulty in emotion regulation scale and personality inventory for DSM-5. J Affect Disord. 2019;245:856–60.CrossRefPubMedPubMedCentralGoogle Scholar
  97. 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. 98.
    Parker et al. (Ed). Bipolar II disorder. Modelling, measuring and managing. 3rd ed. Cambridge: Cambridge University Press; 2019.Google Scholar
  99. 99.
    McDermid J, McDermid RC. The complexity of bipolar and borderline personality: an expression of 'emotional frailty'? Curr Op Psychiatry. 2016;29:84–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of PsychiatryUniversity of New South Wales (UNSW)SydneyAustralia
  2. 2.Black Dog InstituteSydneyAustralia
  3. 3.Institute of Community and Family Psychiatry, SMBD-Jewish General HospitalMcGill UniversityMontrealCanada

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