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Borderline or Bipolar: Objective Data Support a Difference

When euthymic bipolar patients played (ostensibly with another person, though the actual partner was a computer), they made choices very like control patients, choosing to cooperate almost 75% of the time. But patients with BPD cooperated only about 50% of the time (ANOVA difference, P = .03).

Borderline or Bipolar: Objective Data Support a Difference

News | April 12, 2016 | Bipolar Disorder, Borderline Personality, DSM-5
By James Phelps, MD

When a patient presents with episodes of depression, irritability, and emotional lability (especially tears and anger, with rapid changes), might he or she have borderline personality disorder (BPD)? Or could it be rapid cycling bipolar disorder (BD)?

Although there are other possibilities, such as substance use, differentiating these 2 common conditions can be extremely difficult. DSM criteria have a roughly 90% overlap: only 2 DSM criteria features are clearly present in one and absent in the other: namely, abandonment fear and chronic emptiness.1

Indeed, Deltito and colleagues,2 as well as others, have argued that borderlinity is just another version of bipolarity or at least that the “broadening of the bipolar diagnosis to include a spectrum of poorly defined conditions has added to the plausibility of this idea.”3 In refutation of this notion, data that demonstrate a clear difference between the 2 conditions, involving interpersonal trust, have recently been published.3

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