Adam Bayes

Clinical differentiation of bipolar II disorder from borderline personality disorder.

Purpose of review Differentiating bipolar II disorder (BP II) from borderline personality disorder (BPD) is a common diagnostic dilemma. The purpose of this review is to focus on recent studies that have considered clinical differences between the conditions including family history, phenomenology, longitudinal course, comorbidity and treatment response, and which might advance their clinical distinction. Recent findings Findings suggest key differentiating parameters to include family history, onset pattern, clinical course, phenomenological profile of depressive and elevated mood states, and symptoms of emotional dysregulation. Less specific differentiation is provided by childhood trauma history, deliberate self-harm, comorbidity rates, neurocognitive features, treatment response and impulsivity parameters. Summary This review refines candidate variables for differentiating BP II from BPD, and should assist the design of studies seeking to advance their phenomenological and clinical distinction.

Emotion regulation strategies in bipolar II disorder and borderline personality disorder: Differences and relationships with perceived parental style

BACKGROUND Bipolar II disorder (BP II) and Borderline Personality Disorder (BPD) share common features and can be difficult to differentiate, contributing to misdiagnosis and inappropriate treatment. Research contrasting phenomenological features of both conditions is limited. The current study sought to identify differences in emotion regulation strategies in BP II and BPD in addition to examining relationships with perceived parental style. METHOD Participants were recruited from a variety of outpatient and community settings. Eligible participants required a clinical diagnosis of BP II or BPD, subsequently confirmed via structured diagnostic interviews assessing DSM-IV criteria. Participants completed a series of self-reported questionnaires assessing emotion regulation strategies and perceived parental style. RESULTS The sample comprised 48 (n=24 BP II and n=24 BPD) age and gender-matched participants. Those with BPD were significantly more likely to use maladaptive emotion regulation strategies, less likely to use adaptive emotion regulation strategies, and scored significantly higher on the majority of (perceived) dysfunctional parenting sub-scales than participants with BP II. Dysfunctional parenting experiences were related to maladaptive emotion regulation strategies in participants with BP II and BPD, however differential associations were observed across groups. LIMITATIONS Relatively small sample sizes; lack of a healthy control comparator group; lack of statistical control for differing sociodemographic and clinical characteristics, medication and psychological treatments; no assessment of state or trait anxiety; over-representation of females in both groups limiting generalisability of results; and reliance on self-report measures. CONCLUSIONS Differences in emotion regulation strategies and perceived parental style provide some support for the validity of distinguishing BP II and BPD. Development of intervention strategies targeting the differing forms of emotion regulatory pathology in these groups may be warranted.

Differentiating the bipolar disorders from borderline personality disorder.

To identify features differentiating bipolar disorder (BP) from borderline personality disorder (BPD) and with each condition variably defined.

Early onset eating disorders in male adolescents: a series of 10 inpatients

Objective: This case series aims to describe the demographic and clinical features of male inpatients with early onset eating disorders. Method: Retrospective review was made of medical files of male patients treated for eating disorders at two childrens hospitals over a 2 year period, with an onset of eating disorder before age 14 years, presenting for index admission. Demographic characteristics, DSM-IV diagnosis, clinical characteristics and treatment received were reviewed. Results: Ten male patients with a median age of 12.8 years (range 10.2 to 13.5) were identified; three met the full criteria for anorexia nervosa (AN) and four met all except the weight criterion. There was high psychiatric comorbidity: four with a major depressive episode, seven an anxiety disorder, three with obsessive-compulsive disorder (OCD) symptoms. Seven engaged in over-exercise. Seven were treated with an antidepressant, and five with an atypical antipsychotic; six required nasogastric tube (NGT) feeding. Conclusion: A minority of patients met full diagnostic criteria for AN, with many not meeting weight criteria despite medical instability. The main clinical features were food restriction, over-exercise and psychiatric comorbidity. Treatment with antidepressants, antipsychotics and NGT feeding was frequent. Future prospective studies could help identify gender-specific features as well as benefits and potential side effects of pharmacotherapy in this age group.

Clinical status of comorbid bipolar disorder and borderline personality disorder

BACKGROUND The status and differentiation of comorbid borderline personality disorder and bipolar disorder is worthy of clarification. AIMS To determine whether comorbid borderline personality disorder and bipolar disorder are interdependent or independent conditions. METHOD We interviewed patients diagnosed with either a borderline personality disorder and/or a bipolar condition. RESULTS Analyses of participants grouped by DSM diagnoses established that those with comorbid conditions scored similarly to those with a borderline personality disorder alone on all key variables (i.e. gender, severity of borderline personality scores, developmental stressors, illness correlates, self-injurious behaviour rates) and differed from those with a bipolar disorder alone on nearly all non-bipolar item variables. Similar findings were returned for groups defined by clinical diagnoses. CONCLUSIONS Comorbid bipolar disorder and borderline personality disorder is consistent with the formal definition of comorbidity in that, while coterminous, individuals meeting such criteria have features of two independent conditions.

Emotional dysregulation in those with bipolar disorder, borderline personality disorder and their comorbid expression

BACKGROUND Differentiation of the bipolar disorders (BP) from a borderline personality disorder (BPD) can be challenging owing to shared features, with emotional dysregulation being the likely principal one. AIM To assess differences in emotion regulation strategies in those with BP alone, BPD alone and those comorbid for both. METHODS We interviewed participants previously receiving a BP or BPD diagnosis, studying those who met DSM criteria for one or both conditions. RESULTS The sample comprised 83 with bipolar disorder, 53 with BPD and 54 comorbid for both. Analyses established linear trends, with the greatest impairment in emotion regulation strategies in the comorbid group followed by the BPD group, and with the lowest in the BP group. Specific deficits in the comorbid group included impulsivity, difficulties with goal directed behaviour, and accessing strategies. A similar linear profile was quantified for maladaptive cognitive emotion regulation strategies, weighted to catastrophizing and rumination. Adaptive emotion regulation strategies were superior in the bipolar group, without significant differences observed between the comorbid and BPD groups. LIMITATIONS Reliance on self-report measures; combined BP I and II participants limits generalisability of results to each bipolar sub-type; use of DSM diagnoses risking artefactual comorbidity; while there was an over-representation of females in all groups. CONCLUSIONS Differences in emotion regulation strategies advance differentiation of those with either BP or BPD, while we identify the specificity of differing strategies to each condition and their synergic effect in those comorbid for both conditions. Study findings should assist the development and application of targeted strategies for those with either or both conditions.

Comparison of guidelines for the treatment of unipolar depression: a focus on pharmacotherapy and neurostimulation

To determine the level of agreement across a set of evidence‐based guidelines for management of the unipolar depressive disorders and with a focus on physical treatments.

Is ‘subthreshold’ bipolar II disorder more difficult to differentiate from borderline personality disorder than formal bipolar II disorder?

Recent research indicates that borderline personality disorder (BPD) can be diagnostically differentiated from the bipolar disorders. However, no studies have attempted to differentiate participants with sub-threshold bipolar disorder or SubT BP (where hypomanic episodes last less than 4 days) from those with a BPD. In this study, participants were assigned a SubT BP, bipolar II disorder (BP II) or BPD diagnosis based on clinical assessment and DSM-IV criteria. Participants completed self-report measures and undertook a clinical interview which collected socio-demographic information, a mood history, family history, developmental history, treatment information, and assessed cognitive, emotional and behavioural functioning. Both bipolar groups, whether SubT BP or BP II, differed to the BPD group on a number of key variables (i.e. developmental trauma, depression correlates, borderline personality scores, self-harm and suicide attempts), and compared to each other, returned similar scores on nearly all key variables. Borderline risk scores resulted in comparable classification rates of 0.74 (for BPD vs BP II) and 0.82 (for BPD vs sub-threshold BP II). Study findings indicate that both SubT BP and BP II disorder can be differentiated from BPD on a set of refined clinical variables with comparable accuracy.

Relationship between photoperiod and hospital admissions for mania in New South Wales, Australia

BACKGROUND Causes for a seasonal impact on admissions for mania remain to be clarified. We examined the impact of photoperiod, rate of change of photoperiod and hours of sunshine on admissions over an extended period. METHODS Monthly admission data to NSW psychiatric hospitals for more than twenty thousand patients admitted for mania over a fifteen-year period were correlated with photoperiod and sunshine changes. RESULTS While the peak in admissions occurred in spring, the shift in admissions being under-represented to being precipitously over-represented corresponded with the photoperiod commencing to increase in winter (i.e. July). Analyses identified rate of change in photoperiod as somewhat more influential than change in photoperiod and with hours of sunshine not making a distinctive contribution. Immediate and delayed impacts of rate of change as well as change in photoperiod across the whole year accounted for a distinctive 20% of the variance in hospital admissions. LIMITATIONS Validity of mania diagnoses cannot be established from the data set, admission data were obtained from across the state while meteorological data were obtained from the capital city, lag periods between onset of a mania and hospitalization (while identified) would impact on associations, social factors were not included and study associations do not imply causality. CONCLUSIONS The lack of a strong year-long correlation may reflect photoperiod changes being only a weak causal factor or that its influence may be through a strong impact phase after the winter solstice and with the spring peaking of admissions reflecting secondary photoperiod or other influences.

Borderline personality disorder: does its clinical features show specificity to differing developmental risk factors?

Objectives: To determine if differing developmental factors show specificity to differing manifestations of borderline personality disorder (BPD). Methods: A clinical sample of 73 females diagnosed with BPD undertook a psychiatrist interview and completed self-report questionnaires, including the semi-structured Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV) assessing for BPD status. A set of negative and potentially traumatic developmental factors were included in the assessment. Results: Childhood sexual abuse, affirmed by 49% of the sample, showed specificity in being linked with DIPD-defined affective instability. DIPD-defined identity disturbance also showed specificity in being associated only with reporting significant non-sexual developmental trauma. DIPD-defined anger and paranoia/dissociation showed minimal specificity and were associated with most antecedent developmental factors in adulthood. Conclusions: Differing manifestations of BPD are likely to be shaped by specific and non-specific developmental events. Clarification of such links has the potential to shape more specific therapeutic interventions.