The Borderline Personality Disorder and Bipolar Disorder Connection?

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Bipolar Disord. 2006 Feb;8(1):1-14. Affective instability as rapid cycling: theoretical and clinical implicationsfor borderline personality and bipolar spectrum disorders.Mackinnon DF, Pies R.Department of Psychiatry and Behavioral Sciences, The Johns Hopkins UniversitySchool of Medicine, Baltimore, MD, USA.Objectives: The Diagnostic and Statistical Manual of Mental Disorders guidelinesprovide only a partial solution to the nosology and treatment of bipolardisorder in that disorders with common symptoms and biological correlates may becategorized separately because of superficial differences related to behavior,life history, and temperament. The relationship is explored between extremelyrapid switching forms of bipolar disorder, in which manic and depressivesymptoms are either mixed or switch rapidly, and forms of borderline personalitydisorder in which affective lability is a prominent symptom. Methods: A MedLinesearch was conducted of articles that focused on rapid cycling in bipolardisorder, emphasizing recent publications (2001-2004). Results: Studies examinedhere suggest a number of points of phenomenological and biological overlapbetween the affective lability criterion of borderline personality disorder andthe extremely rapid cycling bipolar disorders. We propose a model for thedevelopment of 'borderline' behaviors on the basis of unstable mood states thatsheds light on how the psychological and somatic interventions may be aimed at'breaking the cycle' of borderline personality disorder development. A review ofpharmacologic studies suggests that anticonvulsants may have similar stabilizingeffects in both borderline personality disorder and rapid cycling bipolardisorder. Conclusions: The same mechanism may drive both the rapid moodswitching in some forms of bipolar disorder and the affective instability ofborderline personality disorder and may even be rooted in the same geneticetiology. While continued clinical investigation of the use of anticonvulsantsin borderline personality disorder is needed, anticonvulsants may be useful inthe treatment of this condition, combined with appropriate psychotherapy.PMID: 16411976 [PubMed - in process]----------J Affect Disord. 2005 Jul;87(1):17-23. Borderline personality disorder characteristics in young adults with recurrentmood disorders: a comparison of bipolar and unipolar depression.Smith DJ, Muir WJ, Blackwood DH.Division of Psychiatry, School of Molecular and Clinical Medicine, University ofEdinburgh, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF, UK.daniel.smith@ed.ac.ukBACKGROUND: In young adults it can be difficult to differentiate between anearly bipolar illness and borderline personality disorder. There areconsiderable areas of clinical overlap between cyclothymic temperament,bipolar-spectrum disorders and borderline characteristics. The aim of this studywas to measure borderline characteristics in young adults during an indexdepressive episode and to compare three diagnostic groups: DSM-IV bipolaraffective disorder (BPAD); bipolar spectrum disorder (BSD); and DSM-IV recurrentmajor depressive disorder (MDD). METHODS: Eighty-seven young adults with acurrent episode of major depression and at least one previous episode ofdepression were recruited from consecutive referrals to a psychiatric clinic.Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID-1)and recently proposed structured diagnostic criteria for BSD. All patients alsocompleted the borderline questions from the screening questionnaire of theInternational Personality Disorders Examination (IPDE). RESULTS: Diagnostically,the cohort of 87 patients divided into three groups: 14 with BPAD; 27 with BSD;and 46 with MDD. None of the subjects fulfilled DSM-IV or ICD-10 diagnosticcriteria for personality disorder and all three groups were well matched interms of age, gender distribution, ethnicity, socioeconomic and educationalstatus, age at onset of illness, and severity of index depressive episode. Bothof the bipolar-depressed groups reported significantly higher median levels ofborderline characteristics than the MDD group (p