In the Journals

Researchers call for improved borderline personality disorder detection, treatment efforts

Patients with borderline personality disorder experienced similar or worse psychosocial morbidity as patients with bipolar disorder, suggesting that efforts to improve detection and treatment of borderline personality disorder are needed.

“Citing high levels of comorbidity between these disorders and similarities in phenomenology, some reviewers have suggested that borderline personality disorder should be included under the bipolar spectrum umbrella, whereas others support the maintenance of their distinction. Noteworthy in these reviews is the scarcity of studies comparing patients with the two disorders,” study researcher Mark Zimmerman, MD, of Brown Medical School in Providence, R.I., and colleagues wrote.

To compare levels of psychosocial morbidity between the two disorders, researchers assessed interviews with 307 patients with borderline personality disorder and 236 patients with bipolar disorder. The study cohort had a mean age of 34.8 years, ranging from 18 to 75 years.

Patients with borderline personality disorder were significantly younger, had lower levels of education and were less likely to be married compared with patients with bipolar disorder.

Patients with borderline personality disorder were more likely to be diagnosed with Axis I disorders and were diagnosed with at least three Axis I disorders significantly more often vs. patients with bipolar disorder.

Global Assessment of Function (GAF) scores were significantly lower among patients with borderline personality disorder, as more than two-thirds of patients with borderline personality disorder had GAF ratings of 50 or lower vs. less than half of study participants with bipolar disorder.

Suicidal ideation was more commonly reported among patients with borderline personality disorder, and they were significantly more likely to attempt suicide multiple times vs. patients with bipolar disorder (P < .01).

Conversely, patients with borderline personality disorder were less likely to be admitted to the hospital for a psychiatric reason.

When adjusting for age and gender, patients with borderline personality disorder had lower GAF scores, lower social functioning and a greater number of Axis I disorders vs. patients with bipolar disorder (P < .001 for all).

“Despite the clinical and public health significance of both of these disorders, it sometimes seems as if borderline personality disorder lives in bipolar disorder’s shadow. The literature ‘promoting’ the importance of bipolar disorder is much more robust than it is for borderline personality disorder,” Zimmerman and colleagues wrote. “A potential consequence of the campaign to improve recognition of bipolar disorder has been its overdiagnosis (and overtreatment) in patients with borderline personality disorder. The overdiagnosis of bipolar disorder to the neglect of borderline personality disorder might become an even greater problem in the future if efforts to expand bipolar disorder’s diagnostic boundary take hold.” – by Amanda Oldt

Disclosures: The researchers report no relevant financial disclosures.

Patients with borderline personality disorder experienced similar or worse psychosocial morbidity as patients with bipolar disorder, suggesting that efforts to improve detection and treatment of borderline personality disorder are needed.

“Citing high levels of comorbidity between these disorders and similarities in phenomenology, some reviewers have suggested that borderline personality disorder should be included under the bipolar spectrum umbrella, whereas others support the maintenance of their distinction. Noteworthy in these reviews is the scarcity of studies comparing patients with the two disorders,” study researcher Mark Zimmerman, MD, of Brown Medical School in Providence, R.I., and colleagues wrote.

To compare levels of psychosocial morbidity between the two disorders, researchers assessed interviews with 307 patients with borderline personality disorder and 236 patients with bipolar disorder. The study cohort had a mean age of 34.8 years, ranging from 18 to 75 years.

Patients with borderline personality disorder were significantly younger, had lower levels of education and were less likely to be married compared with patients with bipolar disorder.

Patients with borderline personality disorder were more likely to be diagnosed with Axis I disorders and were diagnosed with at least three Axis I disorders significantly more often vs. patients with bipolar disorder.

Global Assessment of Function (GAF) scores were significantly lower among patients with borderline personality disorder, as more than two-thirds of patients with borderline personality disorder had GAF ratings of 50 or lower vs. less than half of study participants with bipolar disorder.

Suicidal ideation was more commonly reported among patients with borderline personality disorder, and they were significantly more likely to attempt suicide multiple times vs. patients with bipolar disorder (P < .01).

Conversely, patients with borderline personality disorder were less likely to be admitted to the hospital for a psychiatric reason.

When adjusting for age and gender, patients with borderline personality disorder had lower GAF scores, lower social functioning and a greater number of Axis I disorders vs. patients with bipolar disorder (P < .001 for all).

“Despite the clinical and public health significance of both of these disorders, it sometimes seems as if borderline personality disorder lives in bipolar disorder’s shadow. The literature ‘promoting’ the importance of bipolar disorder is much more robust than it is for borderline personality disorder,” Zimmerman and colleagues wrote. “A potential consequence of the campaign to improve recognition of bipolar disorder has been its overdiagnosis (and overtreatment) in patients with borderline personality disorder. The overdiagnosis of bipolar disorder to the neglect of borderline personality disorder might become an even greater problem in the future if efforts to expand bipolar disorder’s diagnostic boundary take hold.” – by Amanda Oldt

Disclosures: The researchers report no relevant financial disclosures.