Borderline personality disorder as debilitating as bipolar disorder

April 23, 2015, Lifespan

The deterioration of psychiatric and physical health caused by borderline personality disorder (BPD) rivals that of bipolar disorder, according to Mark Zimmerman, M.D., a researcher at Rhode Island Hospital. His research was published online in the British Journal of Psychiatry today.

"The level of psychosocial morbidity and suicidality associated with BPD is as great, or greater, than that experienced by patients with bipolar disorder," said Zimmerman, director of outpatient psychiatry at Rhode Island Hospital and director of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project. "From a public health perspective, improving the detection and treatment of BPD is as imperative as diagnosing and treating ."

The National Institute of Mental Health estimates that 1.6 percent of the U.S. population is diagnosed with BPD, compared with 2.6 percent of those with bipolar disorder.

This is the largest comparison of patients who have been diagnosed with BPD or bipolar disorder. Persons with BPD have difficulty regulating emotions and thoughts, often teetering at extremes. They engage in impulsive and reckless behavior, and their relationships with other people are rocky. While persons with bipolar disorder experience the same mood for weeks, those with BPD cope with intense bouts of anger, depression and anxiety that are short in duration. According to Zimmerman's study, clinical experience suggests that BPD is as disabling as bipolar disorders. In psychiatric patient samples, BPD is as frequent as bipolar disorder.

Like bipolar patients, persons with BPD are likely to also suffer from depression, anxiety disorders, substance abuse, eating disorders and suicidal behaviors. These co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to recognize BPD in patients with these other mental illnesses.

"Despite the clinical and public health significance of both of these disorders, it sometimes seems as if BPD lives in the shadow of bipolar disorder," said Zimmerman. "Bipolar disorder is a widely researched, well-publicized, well-funded topic. By contrast, BPD is seldom discussed and it is not included in the Global Burden of Disease study, a comprehensive registry that quantifies diseases by cost, mortality, geography, risk and other factors."

This study was a component of the MIDAS project, which is an ongoing clinical research study at Rhode Island Hospital involving the integration of research assessment methods into routine clinical practice.

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not rated yet Apr 23, 2015
It all depends on how severe the symptoms/disorder is for someone--an extreme case of bipolar disorder could easily be more distressing than a "mild" case of BPD (not to mention the fact that *no* disorder exists in isolation, symptoms of *all* of them overlap with one or more diagnoses).

(This is why the most recent version of the DSM almost adopted a dimensional versus categorical nosology.)
not rated yet Apr 23, 2015
I am not sure that any case of BPD could be considered "mild", as Oliverlu70 stated. BPD is classified as a personality disorder, as opposed to Bipolar, and is much more of an inflexible disorder, with an extremely global effect on functioning. I think the comparison in the study is valid, as far as need for further research and funding, but you cannot accurately compare severity, as BPD is an axis 2 disorder and Bipolar is an axis 1 disorder.
not rated yet Apr 23, 2015
That's why I put it in quotation marks, but again the larger point is that all mental disorders exist along a spectrum, there is no absolute dividing line between having the condition and not.

(I agree about the different axes making it a little like apples and oranges but again this diagnostic classification is also a construct with more reliability than validity, also I don't know what you mean when you say it is "inflexible" [do you mean resistant to treatment? that's not necessarily the case with well-trained Dialectrical Behavioral therapists]).
not rated yet Apr 23, 2015
I am more in agreement with you than it may have appeared by my comment, and I know that even with disorders on different axis's there are definitely overlaps of symptoms. Inflexible was probably not the exact word I should have used. Truthfully, I have never really completely understood the classification separation between axis 1 and 2 as far as some mental disorders are concerned. A severe paranoid schizophrenia seems to me to be just as lifelong and severe as most other personality disorders would be, yet it is an axis 1 disorder.
not rated yet Apr 23, 2015
Axis 2 iirc are personality disorders, a short-hand I once heard is common among graduate students is that if the person's crazy it's Axis 1, if they drive other people crazy, it's Axis 2. :-0

(So it's not a distinction of severity, unlike say for example illegal drugs which are "scheduled" into five classifications iirc).
not rated yet Apr 23, 2015
That's funny, thank you!
5 / 5 (1) Apr 24, 2015
I have bipolar 1 disorder with psychosis. Had a friend with borderline personality disorder. I think I'm in a unique position to comment. My illness, even in a psychotic phase, can be treated and causes very little disruption to others when under close psychiatric supervision. I have no problem with my social relationships. I have never mistreated anyone. I have never gone on vicious borderline rants that hurt other people. I've never used manipulation to get what I want from another person. I treat people with dignity and respect. I never misuse my therapist or psychiatrist. I respect boundaries. These are some of the differences between someone with bipolar disorder and borderline personality disorder. Borderline personality disorder is pervasive, deeply engrained, and highly destructive to other human beings. I know therapists that will not treat borderline personality disorder because the client's disrespect of therapeutic boundaries is so severe that they cannot be dealt with.
not rated yet Apr 24, 2015
I think that therapists who cannot treat certain clients also need to be honest that it also represents a shortcoming on their part--some therapists *specialize* in treating Borderline Personality Disorder so it can be done.

(And again I think it's important to keep in mind how arbitrary and constructed psychiatric diagnoses are--someone who is not highly manipulative of others by definition does not "have" borderline PD, unlike traditional medical diseases mental disorders are defined *entirely* in terms of their symptoms).

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