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Bordering on the bipolar: a review of criteria for ICD-11 and DSM-5 persistent mood disorders

  • Jason Luty (a1)


The principal manuals for psychiatric diagnosis have recently been updated (ICD-11 was released in June 2018 and DSM-5 was published in 2013). A common diagnostic quandary is the classification of people with chronic low mood, especially those with repeated self-harm (‘emotionally unstable’ or ‘borderline’ personality disorder). There has been a great interest in use of type II bipolar affective disorder (‘bipolar II disorder’) as a less pejorative diagnostic alternative to ‘personality disorder’, despite the radically different treatment options for these disorders. DSM-5 (but not ICD-11) clearly distinguishes between borderline personality disorder and bipolar II disorder, indicating that intense emotional experiences (such as anger, panic or despair; irritability; anxiety) should persist for only a few hours in people with a personality disorder. Both manuals now use the term ‘borderline personality disorder’ rather than ‘emotionally unstable personality disorder’. The diagnostic criteria for cyclothymic disorder remain confusing.


After reading this article you will be able to:

  • appreciate the key differences in diagnostic classification between persistent mood disorders: bipolar II disorder, borderline personality disorder and dysthymia
  • be aware of the modest differences between ICD-10, ICD-11 and DSM-5 in diagnostic criteria for these disorders
  • appreciate that intense emotional experiences need persist for only a few hours to meet criteria for DSM-5 borderline personality disorder and that persistent emotional dysregulation (e.g. irritability, impulsiveness, disinhibition) for a few days meets criteria for DSM-5 bipolar II disorder.


Corresponding author

Correspondence Dr Jason Luty, Consultant Psychiatrist, Athona Recruitment Ltd, 1st Floor, Juniper House, Warley Hill Business Park, The Drive, Brentwood CM13 3BE, UK. Email:


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American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). American Psychiatric Publishing.
Anonymous (2012) Do Any Health Insurance Plans Cover a Personality Disorder? US Insurance Agents ( Accessed 16 June 2018.
Angst, J, Cui, L, Swendsen, J, et al. (2010) Major depressive disorder with subthreshold bipolarity in the National Comorbidity Survey Replication. American Journal of Psychiatry, 167: 1194–201.
Benazzi, F (2007) Bipolar II disorder: epidemiology, diagnosis and management. CNS Drugs, 21: 727–40.
Bipolar UK (2019) What is Rapid Cycling? Bipolar UK ( Accessed 8 March 2019.
Borderline Personality Treatment (2018) Is BPD Treatment Covered by Insurance? Clearview Centers ( Accessed 16 June 2018.
Brieger, P, Ehrt, U, Marneros, A (2003) Frequency of comorbid personality disorders in bipolar and unipolar affective disorders. Comprehensive Psychiatry, 44: 2834.
Carey, B (2008) Psychiatrists Revise the Book of Human Troubles. New York Times, 17 Dec.
Corrigan, P (2004) How stigma interferes with mental health care. American Psychologist, 59: 614–25.
Coryell, W, Endicott, J, Keller, M (1992) Rapidly cycling affective disorder: demographics, diagnosis, family history, and course. Archives of General Psychiatry, 49: 126–31.
Cosgrove, L, Lisa, D (2012) A comparison of DSM-IV and DSM-5 panel members’ financial associations with industry: a pernicious problem persists. PLoS Medicine, 9(3): e1001190.
Fiedorowicz, JG, Black, DW (2010) Borderline, bipolar or both? Frame your diagnosis on the patient history. Current Psychiatry, 9: 2130.
Grant, BF, Chou, SP, Goldstein, RB, et al. (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69: 533–45.
Hall-Flavin, DK (2019) Bipolar Treatment: Are Bipolar I and Bipolar II Treated Differently? Mayo Foundation for Medical Education and Research ( ). Accessed 28 February 2019.
Hancock, C (2017) The Stigma Associated with Borderline Personality Disorder. National Alliance on Mental Illness ( Accessed 17 July 2018.
Hasin, DS, Sarvet, AL, Meyers, JL, et al. (2018) Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75: 336–46.
Kessler, RC, Berglund, PA, Demler, O, et al. (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62: 593602.
Korzekwa, MI, Dell, PF, Links, PS, et al. (2008) Estimating the prevalence of borderline personality disorder in psychiatric outpatients using a two-phase procedure. Comprehensive Psychiatry, 49: 380–6.
Kramlinger, KG, Post, RM (1996) Ultra-rapid and ultradian cycling in bipolar affective illness. British Journal of Psychiatry, 168: 314–23.
Maj, M (2006) Rapid cycling in bipolar disorder: diagnostic issues and treatment options. Psychiatric Times, 23(9): 1 August.
Merikangas, KR, Akiskal, HS, Angst, J, et al. (2007) Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication. Archives of General Psychiatry, 64: 543–52.
Mohring, J (2019) Diagnosing Borderline Personality or Bipolar Disorder? Priory Group ( Accessed 8 March 2019.
National Institute for Health and Care Excellence (2009) Borderline Personality Disorder: Recognition and Management (Clinical Guideline CG78). NICE.
National Institute for Health and Care Excellence (2014) Bipolar Disorder: Assessment and Management. (Clinical Guideline CG185). NICE.
Oberg, B (2012) Legalized Discrimination: BPD and Health Insurance. HealthyPlace ( Accessed 16 June 2018.
Post, RM, Altshuler, LL, Leverich, GS, et al. (2006) Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. British Journal of Psychiatry, 189: 124–31.
Reed, GM, Sharan, P, Rebello, TJ, et al. (2018) The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 countries. World Psychiatry, 17: 174–86.
Regier, DA, Narrow, WE, Clarke, DE, et al. (2013) DSM-5 field trials in the United States and Canada, part II: test-retest. Reliability of selected categorical diagnoses. American Journal of Psychiatry, 170: 5970.
Sartorius, N, Schulze, H (2005) Reducing the Stigma of Mental Illness: A Report from a Global Programme of the World Psychiatric Association. Cambridge University Press.
Welch, S, Klassen, C, Borisova, O, et al. (2013) The DSM-5 controversies: how should psychologists respond? Canadian Psychology/Psychologie Canadienne, 54: 166–75.
Wong, MMC (2011) Management of bipolar II disorder. Indian Journal of Psychological Medicine, 33: 1828.
World Health Organization (2018) ICD-11 for Mortality and Morbidity Statistics. WHO ( Accessed 9 August 2019.
Zanarini, MC, Frankenburg, FR, Dubo, ED, et al. (1998) Axis I comorbidity of borderline personality disorder. American Journal of Psychiatry, 155: 1733–9.


Bordering on the bipolar: a review of criteria for ICD-11 and DSM-5 persistent mood disorders

  • Jason Luty (a1)


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Bordering on the bipolar: a review of criteria for ICD-11 and DSM-5 persistent mood disorders

  • Jason Luty (a1)
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