Not appearing in a diagnostic manual doesn’t make a disorder any less real and potentially crippling. And who knows? Said disorder may windup in a text revision or new edition. That may well apply to what we’re discussing today: borderpolar…
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.
I couldn’t resist and had to bring it to you. Why? It’s possible you, or someone close to you, is dealing with borderpolar – and don’t know it. How, then, can relief be secured if we don’t fill in the blanks?
“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 with borderpolar.
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. Z. explains that the most frequently researched aspect of the relationship between BD and BPD has been their comorbidity (co-occurrence). Several reviews report a diagnostic frequency overlap right at 20%. And though the number isn’t over-the-top, it’s still significant.
But the diagnostic either/or perspective continues. Dr. Z. 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 making both diagnoses when indicated, which ignores an important comorbidity in patients with the greatest need.
Dr. Z. 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. Z. and colleagues did their own digging 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 disorder, and somatoform disorder 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 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.
Let’s Wrap It Up
Dr. Z. points out that though all sorts of work is being done on how to treat bipolar disorder and borderline personality disorder, practically no research exists that examines interventions for patients with borderpolar. He believes the importance of diagnosing both disorders when comorbid has gotten lost in the dialogue.
Well, if you didn’t know what borderpolar was coming into this piece, you do now. Best part is, if you believe you, or someone close to you, has 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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