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

  • Mark Zimmerman (a1), William Ellison (a1), Theresa A. Morgan (a1), Diane Young (a1), Iwona Chelminski (a1) and Kristy Dalrymple (a1)...

Abstract

Background

The 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.

Aims

To compare the levels of psychosocial morbidity in patients with bipolar disorder and borderline personality disorder.

Method

Patients 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.

Results

The 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.

Conclusions

The 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.

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Copyright

Corresponding author

Dr Mark Zimmerman, 146 West River Street, Providence, RI 02904, USA. Email: mzimmerman@lifespan.org

Footnotes

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Declaration of interest

None.

Footnotes

References

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1 Bryant-Comstock, L, Stender, M, Devercelli, G. Health care utilization and costs among privately insured patients with bipolar I disorder. Bipolar Disord 2002; 4: 398405.
2 Kent, S, Fogarty, M, Yellowlees, P. A review of studies of heavy users of psychiatric services. Psychiatr Serv 1995; 46: 1247–53.
3 Isometsa, ET, Henriksson, MM, Aro, HM, Lonnqvist, JK. Suicide in bipolar disorder in Finland. Am J Psychiatry 1994; 151: 1020–4.
4 Angst, F, Stassen, HH, Clayton, PJ, Angst, J. Mortality of patients with mood disorders: follow-up over 34–38 years. J Affect Disord 2002; 68: 167–81.
5 Ruggero, CJ, Chelminski, I, Young, D, Zimmerman, M. Psychosocial impairment associated with bipolar II disorder. J Affect Disord 2007; 104: 5360.
6 Kessler, RC, Akiskal, HS, Ames, M, Birnbaum, H, Greenberg, P, Hirschfeld, RM, et al. Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. Am J Psychiatry 2006; 163: 1561–8.
7 Morgan, VA, Mitchell, PB, Jablensky, AV. The epidemiology of bipolar disorder: sociodemographic, disability and service utilization data from the Australian National Study of Low Prevalence (Psychotic) Disorders. Bipolar Disord 2005; 7: 326–37.
8 Pompili, M, Girardi, P, Ruberto, A, Tatarelli, R. Suicide in borderline personality disorder: a meta-analysis. Nord J Psychiatry 2005; 59: 319–24.
9 Zanarini, MC, Jacoby, RJ, Frankenburg, FR, Reich, DB, Fitzmaurice, G. The 10-year course of social security disability income reported by patients with borderline personality disorder and axis II comparison subjects. J Pers Disord 2009; 23: 346–56.
10 Smith, DJ, Muir, WJ, Blackwood, DH. Is borderline personality disorder part of the bipolar spectrum? Harv Rev Psychiatry 2004; 12: 133–9.
11 Antoniadis, D, Samakouri, M, Livaditis, M. The association of bipolar spectrum disorders and borderline personality disorder. Psychiatr Q 2012; 83: 449–65.
12 Coulston, CM, Tanious, M, Mulder, RT, Porter, RJ, Malhi, GS. Bordering on bipolar: the overlap between borderline personality and bipolarity. Aust NZ J Psychiatry 2012; 46: 506–21.
13 Paris, J. Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders. Harv Rev Psychiatry 2004; 12: 140–5.
14 Sripada, CS, Silk, KR. The role of functional neuroimaging in exploring the overlap between borderline personality disorder and bipolar disorder. Curr Psychiatry Rep 2007; 9: 40–5.
15 Ghaemi, SN, Dalley, S, Catania, C, Barroilhet, S. Bipolar or borderline: a clinical overview. Acta Psychiatr Scand 2014; 130: 99108.
16 Bayes, A, Parker, G, Fletcher, K. Clinical differentiation of bipolar II disorder from borderline personality disorder. Curr Opin Psychiatry 2014; 27: 1420.
17 Zimmerman, M, Morgan, TA. The relationship between borderline personality disorder and bipolar disorder. Dialogues Clin Neurosci 2013; 15: 155–69.
18 Zimmerman, M, Galione, JN, Chelminski, I, Young, D, Dalrymple, K, Ruggero, CJ. Sustained unemployment in psychiatric outpatients with bipolar disorder: frequency and association with demographic variables and comorbid disorders. Bipolar Disord 2010; 12: 720–6.
19 Zimmerman, M, Martinez, JH, Morgan, TA, Young, D, Chelminski, I, Dalrymple, K. Distinguishing bipolar II depression from major depressive disorder with comorbid borderline personality disorder: demographic, clinical, and family history differences. J Clin Psychiatry 2013; 74: 880–6.
20 First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID-I/P, version 2.0). Biometrics Research Department, New York State Psychiatric Institute, 1995.
21 Pfohl, B, Blum, N, Zimmerman, M. Structured Interview for DSM-IV Personality. American Psychiatric Press, 1997.
22 Endicott, J, Spitzer, RL. A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia. Arch Gen Psychiatry 1978; 35: 837–44.
23 Zimmerman, M, Ruggero, CJ, Chelminski, I, Young, D. Psychiatric diagnoses in patients previously overdiagnosed with bipolar disorder. J Clin Psychiatry 2010; 71: 2631.
24 Zimmerman, M, Galione, JN, Ruggero, CJ, Chelminski, I, Dalrymple, K, Young, D. Overdiagnosis of bipolar disorder and disability payments. J Nerv Ment Dis 2010; 198: 452–4.
25 Angst, J. Do many patients with depression suffer from bipolar disorder? Can J Psychiatry 2006; 51: 35.
26 Angst, J, Azorin, JM, Bowden, CL, Perugi, G, Vieta, E, Gamma, A, et al. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE Study. Arch Gen Psychiatry 2011; 68: 791–8.
27 Bowden, CL. Strategies to reduce misdiagnosis of bipolar depression. Psychiatr Serv 2001; 52: 51–5.
28 Ghaemi, SN, Ko, JY, Goodwin, FK. ‘Cade's disease’ and beyond: misdiagnosis, antidepressant use, and a proposed definition for bipolar spectrum disorder. Can J Psychiatry 2002; 47: 125–34.
29 Ghaemi, S, Sachs, G, Chiou, A, Pandurangi, A, Goodwin, F. Is bipolar disorder still underdiagnosed? Are antidepressants overutilized? J Affect Disord 1999; 52: 135–44.
30 Hantouche, EG, Akiskal, HS, Lancrenon, S, Allilaire, JF, Sechter, D, Azorin, JM, et al. Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a French national multi-site study (EPIDEP). J AffectDisord 1998; 50: 163–73.
31 Hirschfeld, RM. Bipolar spectrum disorder: improving its recognition and diagnosis. J Clin Psychiatry 2001; 62 (suppl 14): 59.
32 Hirschfeld, RM, Lewis, L, Vornik, LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry 2003; 64: 161–74.
33 Angst, J, Adolfsson, R, Benazzi, F, Gamma, A, Hantouche, E, Meyer, TD, et al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 2005; 88: 217–33.
34 Ghaemi, SN, Miller, CJ, Berv, DA, Klugman, J, Rosenquist, KJ, Pies, RW. Sensitivity and specificity of a new bipolar spectrum diagnostic scale. J Affect Disord 2005; 84: 273–7.
35 Hirschfeld, R, Williams, J, Spitzer, R, Calabrese, J, Flynn, L, Keck, P, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry 2000; 157: 1873–5.
36 Parker, G, Fletcher, K, Barrett, M, Synnott, H, Breakspear, M, Hyett, M, et al. Screening for bipolar disorder: the utility and comparative properties of the MSS and MDQ measures. J Affect Disord 2008; 109: 83–9.
37 Zimmerman, M, Galione, J. Screening for bipolar disorder with the Mood Disorders Questionnaire: a review. Harv Rev Psychiatry 2012; 19: 219–28.
38 Zanarini, MC, Vujanovic, AA, Parachini, EA, Boulanger, JL, Frankenburg, FR, Hennen, J. A screening measure for BPD: the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). J Pers Disord 2003; 17: 568–73.
39 Murray, C, Lopez, A. The Global Burden of Disease. Harvard University Press, 1996.
40 Zimmerman, M, Gazarian, D. Is research on borderline personality disorder underfunded by the National Institute of Health? Psychiatry Res 2014; 220: 941–4.
41 Birnbaum, HG, Shi, L, Dial, E, Oster, EF, Greenberg, PE, Mallett, DA. Economic consequences of not recognizing bipolar disorder patients: a cross-sectional descriptive analysis. J Clin Psychiatry 2003; 64: 1201–9.
42 Shi, L, Thiebaud, P, McCombs, JS. The impact of unrecognized bipolar disorders for patients treated for depression with antidepressants in the fee-for-services California Medicaid (Medi-Cal) program. J Affect Disord 2004; 82: 373–83.
43 Matza, LS, Rajagopalan, KS, Thompson, CL, de Lissovoy, G. Misdiagnosed patients with bipolar disorder: comorbidities, treatment patterns, and direct treatment costs. J Clin Psychiatry 2005; 66: 1432–40.
44 Manning, JS, Haykal, RF, Connor, PD, Akiskal, HS. On the nature of depressive and anxious states in a family practice setting: the high prevalence of bipolar II and related disorders in a cohort followed longitudinally. Compr Psychiatry 1997; 38: 102–8.
45 Hirschfeld, RM, Vornik, LA Recognition and diagnosis of bipolar disorder. J Clin Psychiatry 2004; 65 (suppl 15): 59.
46 Yatham, LN. Diagnosis and management of patients with bipolar II disorder. J Clin Psychiatry 2005; 66 (suppl 1): 13–7.
47 Perugi, G, Akiskal, HS, Lattanzi, L, Cecconi, D, Mastrocinque, C, Patronelli, A, et al. The high prevalence of ‘soft’ bipolar (II) features in atypical depression. Compr Psychiatry 1998; 39: 6371.
48 Akiskal, H, Bourgeois, M, Angst, J, Post, R, Moller, H, Hirschfeld, R. Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 2000; 59: S530.
49 Angst, J. The bipolar spectrum. Br J Psychiatry 2007; 190: 189–91.
50 Moller, HJ, Curtis, VA. The bipolar spectrum: diagnostic and pharmacologic considerations. Expert Rev Neurother 2004; 4: S38.
51 Akiskal, HS. Demystifying borderline personality: critique of the concept and unorthodox reflections on its natural kinship with the bipolar spectrum. Acta Psychiatr Scand 2004; 110: 401–7.
52 Ferrie, JE, Kivimaki, M, Head, J, Shipley, MJ, Vahtera, J, Marmot, MG. A comparison of self-reported sickness absence with absences recorded in employers' registers: evidence from the Whitehall II study. Occup Environ Med 2005; 62: 74–9.

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

  • Mark Zimmerman (a1), William Ellison (a1), Theresa A. Morgan (a1), Diane Young (a1), Iwona Chelminski (a1) and Kristy Dalrymple (a1)...

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

  • Mark Zimmerman (a1), William Ellison (a1), Theresa A. Morgan (a1), Diane Young (a1), Iwona Chelminski (a1) and Kristy Dalrymple (a1)...
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