Relationship Between Borderline Personality
Disorder And Bipolar Disorder, Long-Term Study
July 2, 2006
Results from a long-term study indicate that borderline personality disorder
(BPD) and bipolar disorder do not commonly coexist, a finding which has
important implications for treatment. The findings are reported in the July 2006
issue of The
American Journal of Psychiatry (AJP), the official journal of the
American Psychiatric Association (APA).
BPD is a long-term, pervasive pattern of impulsive behavior, instability and
changeable mood. Whether it is a variant of bipolar disorder is the focus of the
AJP article, “Descriptive and Longitudinal Observations on the Relationship of
Borderline Personality Disorder and Bipolar Disorder” by John G. Gunderson,
M.D., medical director for the Borderline Personality Disorder Treatment Center
at McLean Hospital.
The study found only modest connections to bipolar disorder among 196 patients
with BPD. The rate of co-occurring bipolar disorder in these patients was 19
percent. In patients with other personality disorders, the rate was eight
percent. Among the patients who did not have bipolar disorder at the beginning
of the study, eight percent of the BPD patients developed bipolar disorder over
the next four years, compared to three percent of the patients with other
personality disorders.
Despite these differences, the rates of bipolar disorder in the BPD patients
remained under 20 percent. This low frequency has important implications for
treatment, as many BPD patients receive only a diagnosis of bipolar disorder and
the two diagnoses generally are treated with different approaches. Psychosocial
interventions are important in the treatment of BPD, whereas medication is
generally the first choice for bipolar disorder.
“The diagnosis of borderline personality disorder arose from psychoanalytic
psychotherapy practice, whereas bipolar disorder is the subject of intensive
neurobiological research and psychopharmacological treatment,” stated Robert
Freedman, M.D., AJP editor-in-chief. “This study is an important step in
examining the extent of overlap between the two disorders.”
The co-occurrence of bipolar disorder did not worsen the course of BPD over four
years. Remission occurred in two-thirds of both the BPD patients with and
without bipolar disorder.
In an accompanying editorial, Michael H. Stone, M.D., of Columbia University
notes the article's “more balanced position on the controversy” about the
relationship of borderline personality to bipolar disorder. He suggests that the
moderately higher rates of bipolar disorder in patients with BPD disorder may
indicate a subgroup of BPD patients with higher genetic risk for bipolar
disorder.
This study was funded by the National Institute of Mental Health.
(Am J Psychiatry. 2006; 163: 1173-1178).
About the American Journal of Psychiatry
The American Journal of Psychiatry, the official journal of the American
Psychiatric Association, publishes a monthly issue with scientific articles
submitted by psychiatrists and other scientists worldwide. The peer review and
editing process is conducted independently of any other American Psychiatric
Association components. Therefore, statements in this press release or the
articles in the Journal are not official policy statements of the American
Psychiatric Association. The Journal's editorial policies conform to the Uniform
Requirements of the International Committee of Medical Journal Editors, of which
it is a member.
For further information about the Journal visit http://www.ajp.psychiatryonline.org.
About the American Psychiatric Association:
The American Psychiatric Association is a national medical specialty society
whose more than 36,000 physician members specialize in diagnosis, treatment,
prevention and research of mental illnesses including substance use disorders.
Visit the APA at http://www.psych.org
and http://www.healthyminds.org.
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