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

Published online by Cambridge University Press:  17 March 2020

Mark Zimmerman Open the ORCID record for Mark Zimmerman [Opens in a new window] ,
Caroline Balling ,
Iwona Chelminski  and
Kristy Dalrymple
Mark Zimmerman*
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
Caroline Balling
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
Iwona Chelminski
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
Kristy Dalrymple
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
*
Author for correspondence: Mark Zimmerman, E-mail: mzimmerman@lifespan.org
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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.

Keywords

Bipolar disorderborderline personality disordercomorbidity
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 9 , July 2021 , pp. 1479 - 1490
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Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press

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