Borderline Personality Disorder

Widely Used Bipolar Screening Test Widely Wrong

A widely-used screening technique (the Mood Disorder Questionnaire) mistook borderline personality disorder for bipolar disorder.

Is it really bipolar disorder?
Published: Thursday, March 25, 2010 – 13:00 in Health & Medicine

A study from Rhode Island Hospital has shown that a widely-used screening tool for bipolar disorder may incorrectly indicate borderline personality disorder rather than bipolar disorder. In the article that appears online ahead of print in the Journal of Clinical Psychiatry, the researchers question the effectiveness of the Mood Disorder Questionnaire (MDQ). The MDQ is the most widely-used and studied screening tool for bipolar disorder. It is a brief questionnaire that assesses whether a patient displays some of the characteristic behaviors of bipolar disorder. It can be administered by clinicians or taken by patients on their own to determine if they screen positively for bipolar disorder. For the purposes of this study, the MDQ was scored by researchers.

Bipolar and borderline personality disorders share some clinical features, including fluctuations in mood and impulsive actions. The treatments, however, will vary depending on the individual and the diagnosis. Principal investigator Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital, conducted a study to test the accuracy of the MDQ.

The research team interviewed nearly 500 patients using the Structured Clinical Interview for Diagnostic Statistical Manual IV (DSM-IV) and the Structured Interview for DSM-IV for personality disorders. The patients were also asked to complete the MDQ. The research team then scored the questionnaires and found that patients with a positive indication for bipolar disorder using the MDQ were as likely to be diagnosed with borderline personality disorder as bipolar disorder when using the structured clinical interview. Further, their findings indicate that borderline personality disorder was four times more frequently diagnosed in the group who screened positive on the MDQ.

Zimmerman says that these findings raise caution for using the MDQ in clinical practice because of how differently the disorders are treated. “An incorrect diagnosis of bipolar disorder will usually lead to a treatment involving medications. If a patient truly has bipolar disorder, that treatment may work. However, at this time there are no approved medications to treat borderline personality disorder.

“Without an accurate diagnosis of borderline personality disorder, we may have many people in treatment who are taking medications that will not work to alleviate the characteristics of the condition from which they really suffer.” Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, continues, “In addition, patients with unrecognized borderline personality disorder will not be treated with one of the effective psychotherapies for this condition. It is therefore vital that we develop or identify a more accurate method to distinguish between these two conditions, and adopt it into clinical practice.”


  • Kris Ulland

    Too often the diagnosis is inconclusive even after taking the MDQ. The next step invariably is a course of meds – these would be medications designed to relieve the symptoms of bipolar. Sometimes there is a short term relief of symptoms for the misdiagnosed borderline patient. Maybe the extreme mood swings are dampened down or there is a lag in the impulsivity. But, the relief seems to be the body’s initial reaction to the meds. The sedative effect wears off for the borderline patient and they are back where they started. Frustrated. Angry at behaviors that seem beyond control. I recognize that doctors truly want to help but with the borderline their only course of action seems to be to thrust another drug at the patient hoping that the relief will stick.
    My question: Is there on-going research being done by pharmaceutical companies (NOT another generation of antipsychotics!) targeting the borderline’s clinical features?

  • Bon Dobbs


    The question you pose is a great one. In a recent study, Drs. Barbara Stanley and Larry Siever suggested that a lack of u-opiods and over active u-piod receptors may be neurological basis (plus a lack of Oxycontin and other issues) for BPD. If this is proven to be the case, pharmaceutical companies have a fairly easy target with BPD. Heretofore the pharmaceutical companies have shied away from working on BPD directly, it seems because of the complexity and the general understanding that it is not biological. However, much research has been done in the past couple of years to suggest a biological configuration. I hope that, given the possibility that BPD is present in up to 5.9% of the adult population (the NIAAA study showed that) and that it can be shown to be biological, the drug companies would jump on it. The market is huge.

  • Danny M Reed

    These hair splitting or fine tuning individual diagnoses attempting to regulate the spectrum of madness is for the purpose of serving insurance and pharmaceutical corporations. These non medical absentee social engineers have no invested interest in the individual. These paper pushing policy and procedure people are telling my doctor(s) what they can and cannot do. In turn, the doctor(s) make evaluations and decisions based upon what they are allowed to do. Not what they know is right.

    I am speaking from a position closer to reality as maturely as possible right now. Although my diagnosis and treatment is nominal, I am more concerned about others who suffer gross misappropriation, abuse, and neglect in this System. Bipolar, BPD, Schizo- have been diagnosed by profile in the end including sex race, gender, social and economic status, IQ, and whether they have adequate insurance. Enough.

  • Dave

    My understanding is that BPD or Emotionally Unstable Personality can occur at the same time as mood disorders, as well as pretty much all sorts. My own diagnose is a mix of that and ADHD and medication has helped before with stuff before i knew i had borderline traits. It’s just a lot more complex and that i’d read that the thing with personality disorders is that they rarely ever stick to being just a problem of ‘personality’ (though its debateable whether it really is just to do with personality). And yeah the whole emotional lability I don’t think that’s something from my own experience is more like something that kind of just happens and it’s really intense. though other people i know who are borderline it sems like they have this kinda ‘dark image’ where they’re all slyvia plath and all like ‘oh i’m a tortured artist’ blah blah blha and seems to be like their personality in that way, like ‘oh life is misery’ rather than like what ii feel like which is i try and then i mess up and then it’s like ‘i can’t deal with this, i’ve done so many stupid things and before I was all like ‘yeah everythings fine, i’ll go do this and that and then i can do this then, etc.’ then it’s all like ‘crap, i forgot to pay my bills, i havn’t handed this in, i’ve lost this, and then i said that and then why did i do that? now lots of people hate me, i have no money and nothing useful has been done, i’ve been annoying blah blah.’ and it’s like a lot more than that then I start being all emotionally OTT and becoming suicidal. Though then maybe I’m all liek ‘the smiths’, and i do listen to a lot of miserable music… so i think my point is, is that in probably a lot of peoples cases with i any personality disorder from what i know there’s other stuff that overlaps and underlies it that might need treating and in some cases that the disorders are probably kinda similar and have certain things commmon to them. so it’s simple to say that someone is just borderline, there’s lots of different facets of anyone person with it that are different and are signifiicant and can be part of it.

  • Lisa

    The problem with an either/or approach is that the conditions can be comorbid. Also, a person with one of the established types of bipolar disorder may have grown up in an invalidating environment and have traits of BPD without meeting the full diagnostic criteria. A person with some mix of symptoms and traits can experience trauma and develop PTSD, either in childhood or as an adult.

    These are multi-gene syndromes and different genes and gene combinations can create the vulnerability, and everybody’s specific invalidating environment or specific trauma is different. Frequently individual clients need a treatment team that uses a multi-disciplinary approach to address individual symptoms.

    Any diagnosis, even one that is absolutely clinically correct, can become a “bad” diagnosis, if the treatment professionals using it apply a rigid, one-size-fits-all approach to the diagnosis and lose sight of the patient’s needs. One-size-fits-all can make things worse.

    A diagnosis that’s close but perhaps not complete or the absolute closest diagnosis possible diagnosis can be a “good” diagnosis if it suggests approaches to the treatment team that are effective at improving the patient’s condition. A good treatment team with an incomplete diagnosis can, by paying attention to the patient’s individual symptoms and needs, avoid making things worse and be effective at improving at least some life-impairing symptoms.

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