Patients with borderline personality disorder and bipolar disorder: a descriptive and comparative study

2020 ◽  
pp. 1-12
Author(s):  
Mark Zimmerman ◽  
Caroline Balling ◽  
Iwona Chelminski ◽  
Kristy Dalrymple
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Rhode Island ◽  
Childhood Trauma ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Psychiatric Outpatients ◽  
Structured Interviews ◽  
Psychosocial Morbidity

Abstract Background Bipolar disorder and borderline personality disorder (BPD) are each significant public health problems. It has been frequently noted that distinguishing BPD from bipolar disorder is challenging. Consequently, reviews and commentaries have focused on differential diagnosis and identifying clinical features to distinguish the two disorders. While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compare psychiatric outpatients with both BPD and bipolar disorder to patients with BPD without bipolar disorder and patients with bipolar disorder without BPD. Methods Psychiatric outpatients presenting for treatment were evaluated with semi-structured interviews. The focus of the current study is the 517 patients with both BPD and bipolar disorder (n = 59), BPD without bipolar disorder (n = 330), and bipolar disorder without BPD (n = 128). Results Compared to patients with bipolar disorder, the patients with bipolar disorder and BPD had more comorbid disorders, psychopathology in their first-degree relatives, childhood trauma, suicidality, hospitalizations, time unemployed, and likelihood of receiving disability payments. The added presence of bipolar disorder in patients with BPD was associated with more posttraumatic stress disorder in the patients as well as their family, more bipolar disorder and substance use disorders in their relatives, more childhood trauma, unemployment, disability, suicide attempts, and hospitalizations. Conclusions Patients with both bipolar disorder and BPD have more severe psychosocial morbidity than patients with only one of these disorders.

scholarly journals Psychosocial morbidity associated with bipolar disorder and borderline personality disorder in psychiatric out-patients: Comparative study

2015 ◽  
Vol 207 (4) ◽  
pp. 334-338 ◽  
Author(s):  
Mark Zimmerman ◽  
William Ellison ◽  
Theresa A. Morgan ◽  
Diane Young ◽  
Iwona Chelminski ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
College Graduates ◽  
Borderline Personality ◽  
Structured Interviews ◽  
Public Health Perspective ◽  
Repeated Calls ◽  
History Of ◽  
Psychosocial Morbidity

BackgroundThe morbidity associated with bipolar disorder is, in part, responsible for repeated calls for improved detection and recognition. No such commentary exists for the improved detection of borderline personality disorder. Clinical experience suggests that it is as disabling as bipolar disorder, but no study has directly compared the two disorders.AimsTo compare the levels of psychosocial morbidity in patients with bipolar disorder and borderline personality disorder.MethodPatients were assessed with semi-structured interviews. We compared 307 patients with DSM-IV borderline personality disorder but without bipolar disorder and 236 patients with bipolar disorder but without borderline personality disorder.ResultsThe patients with borderline personality disorder less frequently were college graduates, were diagnosed with more comorbid disorders, more frequently had a history of substance use disorder, reported more suicidal ideation at the time of the evaluation, more frequently had attempted suicide, reported poorer social functioning and were rated lower on the Global Assessment of Functioning. There was no difference between the two patient groups in history of admission to psychiatric hospital or time missed from work during the past 5 years.ConclusionsThe level of psychosocial morbidity associated with borderline personality disorder was as great as (or greater than) that experienced by patients with bipolar disorder. From a public health perspective, efforts to improve the detection and treatment of borderline personality disorder might be as important as efforts to improve the recognition and treatment of bipolar disorder.

The Clinical Characteristics of Patients With Borderline Personality Disorder in Different Treatment Settings

2021 ◽  
pp. 1-13
Author(s):  
Madeline Ward ◽  
Isabel Benjamin ◽  
Mark Zimmerman
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Rhode Island ◽  
Suicide Attempts ◽  
Present Report ◽  
Hospital Setting ◽  
Borderline Personality ◽  
Partial Hospital ◽  
Outpatient Practice ◽  
Psychosocial Morbidity

The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project compares patients with borderline personality disorder (BPD) in an outpatient practice (n = 390) and a partial hospital setting (n = 358) on diagnostic comorbidities, symptoms experienced, suicidality, and occupational impairment. The patients in the partial program were diagnosed with significantly more psychiatric disorders and were more frequently diagnosed with dysthymia, generalized anxiety disorder, alcohol and substance use disorders, adjustment disorders, and posttraumatic stress disorder. Those at the partial hospital had significantly higher levels of suicidal ideation than those in the outpatient practice. The samples did not differ on utilization of disability or suicide attempts. Treatment setting may have implications in the recognition of the disorder in clinical practice, the development and support of etiological theories, identification of core deficits, and evaluation of psychosocial morbidity associated with BPD.

Comorbid Bipolar Disorder and Borderline Personality Disorder and History of Suicide Attempts

2014 ◽  
Vol 28 (3) ◽  
pp. 358-364 ◽  
Author(s):  
Mark Zimmerman ◽  
Jennifer Martinez ◽  
Diane Young ◽  
Iwona Chelminski ◽  
Theresa A. Morgan ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
History Of

Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

2014 ◽  
Vol 32 (1) ◽  
pp. 21-30 ◽  
Author(s):  
J. Cotter ◽  
M. Kaess ◽  
A. R. Yung
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Childhood Trauma ◽  
Psychotic Disorders ◽  
Functional Disability ◽  
Clinical Work ◽  
Borderline Personality ◽  
Response To Treatment ◽  
Neurocognitive Deficits

ObjectivesWe aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work.MethodsNarrative review of the peer-reviewed English language literature in the area.ResultsHigh rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment.ConclusionsRoutine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those individuals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.

Body dysmorphic disorder in patients with borderline personality disorder: prevalence, clinical characteristics, and role of childhood trauma

2008 ◽  
Vol 20 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Umit Semiz ◽  
Cengiz Basoglu ◽  
Mesut Cetin ◽  
Servet Ebrinc ◽  
Ozcan Uzun ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Childhood Trauma ◽  
Body Dysmorphic Disorder ◽  
Rating Scale ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Clinical Interview ◽  
Traumatic Experiences ◽  
Axis I

Objective:The prevalence of body dysmorphic disorder (BDD) in patients with borderline personality disorder (BPD) is unidentified. We hypothesised that BDD would be more common than realised in patients with BPD and comorbidity with BDD would result in a more severe clinical profile. Also, childhood trauma may play a predictive role in this association.Methods:The study included 70 BPD in-patients and 70 matched healthy controls. The subjects were evaluated with a comprehensive assessment battery using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) diagnostic tool for BDD, Global Assessment of Functioning, Traumatic Experiences Checklist and Hamilton Depression Rating Scale.Results:The prevalence of BDD was 54.3% in the borderline sample. The BPD patients with BDD had significantly lower overall functioning and higher levels of BPD pathology, childhood traumatic experiences, suicide attempts, substance abuse and self-mutilation than those without BDD. Traumatic experiences were significant predictor of comorbid BDD diagnosis in BPD patients.Conclusions:Our results suggest a relatively high prevalence of BDD among patients with BPD, and co-occurrence of BDD and BPD remains to be clarified. The additional diagnosis of BDD in patients with BPD may cause a more severe global illness, and these two disorders may share, at least partly, a common psychopathologic mechanism.

Abuse and Neglect in Childhood: Relationship to Personality Disorder Diagnoses

CNS Spectrums ◽  
2003 ◽  
Vol 8 (10) ◽  
pp. 737-754 ◽  
Author(s):  
Linda M. Bierer ◽  
Rachel Yehuda ◽  
James Schmeidler ◽  
Vivian Mitropoulou ◽  
Antonia S. New ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Childhood Trauma ◽  
Emotional Abuse ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Antisocial Personality ◽  
Abuse And Neglect ◽  
History Of

ABSTRACTBackground:Childhood history of abuse and neglect has been associated with personality disorders and has been observed in subjects with lifetime histories of suicidality and self-injury. Most of these findings have been generated from inpatient clinical samples.Methods:This study evaluated self-rated indices of sustained childhood abuse and neglect in an outpatient sample of well-characterized personality disorder subjects (n=182) to determine the relative associations of childhood trauma indices to specific personality disorder diagnoses or clusters and to lifetime history of suicide attempts or gestures. Subjects met criteria for ~2.5 Axis II diagnoses and 24% reported past suicide attempts. The Childhood Trauma Questionnaire was administered to assess five dimensions of childhood trauma exposure (emotional, physical, and sexual abuse, and emotional and physical neglect). Logistic regression was employed to evaluate salient predictors among the trauma measures for each cluster, personality disorder, and history of attempted suicide and self-harm. All analyses controlled for gender distribution.Results:Seventy-eight percent of subjects met dichotomous criteria for some form of childhood trauma; a majority reported emotional abuse and neglect. The dichotomized criterion for global trauma severity was predictive of cluster B, borderline, and antisocial personality disorder diagnoses. Trauma scores were positively associated with cluster A, negatively with cluster C, but were not significantly associated with cluster B diagnoses. Among the specific diagnoses comprising cluster A, paranoid disorder alone was predicted by sexual, physical, and emotional abuse. Within cluster B, only antisocial personality disorder showed significant associations with trauma scores, with specific prediction by sexual and physical abuse. For borderline personality disorder, there were gender interactions for individual predictors, with emotional abuse being the only significant trauma predictor, and only in men. History of suicide gestures was associated with emotional abuse in the entire sample and in women only; self-mutilatory behavior was associated with emotional abuse in men.Conclusion:These results suggest that childhood emotional abuse and neglect are broadly represented among personality disorders, and associated with indices of clinical severity among patients with borderline personality disorder. Childhood sexual and physical abuse are highlighted as predictors of both paranoid and antisocial personality disorders. These results help qualify prior observations of the association of childhood sexual abuse with borderline personality disorder.

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