Not appearing in a diagnostic manual doesn’t make a disorder any less real. Consider what’s being called borderpolar, a combination of borderline personality disorder and bipolar disorder…
Borderpolar patients reported more episodes of depression, more anger, suicidal ideation, history of suicide attempts, childhood trauma…
It’s important that you have this information because you, or someone close to you, may be dealing with borderpolar – and not have a clue.
That would sure make relief tough to come by, so we need to take a look.
“Borderpolar: Patients with Borderline Personality Disorder and Bipolar Disorder”
Dr. Zimmerman kicks things off by emphasizing the seriousness of bipolar disorder (BD) and borderline personality disorder (BPD), both associated with high rates of impaired functioning, substance use disorders, and suicidality.
He goes on to say BD and BPD are frequently under-diagnosed, which calls for improved recognition. And that’s what we’re doing here.
It’s not as though the strong relationship between BD and BPD hasn’t been known, as some experts have suggested BPD can be found somewhere along the bipolar spectrum.
However, pros from the other side of the fence believe there isn’t such a spectrum (I disagree), and BD and BPD are distinct entities.
That disagreement can make life difficult for the patient because the first-line intervention for BD is meds. For BPD it’s therapy.
Dr. Zimmerman explains that the most frequently researched aspect of the relationship between BD and BPD is their comorbidity (co-occurrence).
Several studies report a diagnostic frequency overlap right at 20%. And though the number isn’t over-the-top, it’s still significant.
The diagnostic either-or perspective continues. Zimmerman believes framing the discussion as such underplays the fact that one-fifth of patients have both BD and BPD.
Indeed, having to make a choice can discourage clinicians from noting both diagnoses when indicated, which ignores an important comorbidity in patients with the greatest need.
Zimmerman cites a specific literature review addressing the clinical impact of one disorder on the other. The study reveals that there have been far more studies comparing patients who have BD with and without BPD than the other way around.
Also, among patients with BD, those with comorbid BPD reported more mood episodes, earlier age of BD onset, greater suicidality, greater hostility, and a higher prevalence of substance use disorders.
Sadly, the reviews found little research pertaining to treatment response, psychosocial functioning, length of unemployment, disability payments, or prognosis.
Dr. Zimmerman’s research
Believing that patients with borderpolar are at elevated risk for marked impairment and suicide, Dr. Zimmerman and colleagues did their own research utilizing the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project.
The team compared psychiatric outpatients with borderpolar to patients with BPD without BD and patients with BD without BPD.
The team hypothesized that the borderpolar patients would exhibit significantly more psychosocial risks and negative life realities than patients with only one of the disorders.
The results were telling. Here are a few….
- Significantly more borderpolar patients had three or more diagnoses than BD patients.
- Borderpolar patients reported significantly more diagnoses of PTSD, OCD, substance use disorders, and somatic disorders compared to BD patients. Borderpolar patients reported significantly more OCD diagnoses than the BPD patients.
- Borderpolar patients had the most psychopathology in their first-degree relatives.
- Borderpolar patients had a significantly higher risk of being diagnosed with depression, BD, PTSD, specific phobia, and substance use disorders compared to BD patients. Similar results were found compared to the BPD patients.
- Borderpolar patients reported more episodes of depression, more anger, suicidal ideation, history of suicide attempts, childhood trauma, chronic and persistent unemployment, impaired social functioning, and psychiatric hospitalizations. They were more likely to receive disability payments and exhibited significantly more psychosocial risks and negative life realities than the patients with BPD.
And now you know
Bottom-line: Dr. Zimmerman believes the importance of diagnosing comormid bipolar disorder and borderline personality disorder – borderpolar – has gotten lost in the dialogue.
Given what we’ve reviewed, that’s unfortunate.
Okay, if you didn’t know what borderpolar was, you do now. Best part is, if you believe you, or someone close to you, may have it, help can be pursued in an educated manner.
The original article on Psychiatric Times: “Borderpolar: Patients with Borderline Personality Disorder and Bipolar Disorder”
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