Borderline Personality Disorder,  Other Disorders,  Treatment

People with Borderline Personality Disorder over diagnosed with Bipolar Disorder

Article from Science Daily about over-diagnosis of bipolar disorder:

If Bipolar Disorder Is Over-diagnosed, What Are The Actual Diagnoses?

ScienceDaily (July 29, 2009) — A year ago, a study by Rhode Island Hospital and Brown University researchers reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool –the Structured Clinical Interview for DSM-IV (SCID). In this follow-up study, the researchers have determined the actual diagnoses of those patients.

Their study is published in the July 28 ahead of print online edition of The Journal of Clinical Psychiatry.

Under the direction of lead author Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital, the researchers’ findings indicate that patients who received a previous diagnosis of bipolar disorder that was not confirmed by a SCID, they were significantly more likely to be diagnosed with borderline personality disorder as well as impulse control disorders.

Their research involved the study of 82 psychiatric outpatients who reported that they received a previous diagnosis of bipolar disorder that was not later confirmed through the use of the SCID. The diagnoses in these patients were compared to 528 patients who were not previously diagnosed with bipolar disorder. The study was conducted between May 2001 and March 2005.

Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, says, “In our study, one quarter of the patients over-diagnosed with bipolar disorder met DSM-IV criteria for borderline personality disorder. Looking at these results another way, nearly 40 percent (20 of 52) of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder.”

The results of the study also indicate that patients who had been over-diagnosed with bipolar disorder were more frequently diagnosed with major depressive disorder, antisocial personality disorder, posttraumatic stress disorder and eating and impulse disorders.

Zimmerman and colleagues note that “we hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive.”

In their previously published study that concluded bipolar disorder was over-diagnosed, they studied 700 patients. Of the 700 patients, 145 reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the 145 patients (43.4 percent) were diagnosed with bipolar disorder based on the SCID. The authors state that the over-diagnosis of bipolar disorder can have serious consequences, because while bipolar disorder is treated with mood stabilizers, no medications have been approved for the treatment of borderline personality disorder. As a result, over-diagnosing bipolar disorder can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.

Zimmerman concludes, “Because evidence continues to emerge establishing the efficacy of certain forms of psychotherapy for borderline personality disorder, over-diagnosing bipolar disorder in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment.”

Along with Zimmerman, other researchers involved in the study include Camile Ruggero, PhD; Iwona Chelminski, PhD and Diane Young, PhD, all of Rhode Island Hospital and Brown University.


  • Faycin A Croud

    I have bipolar II, BPD, and OCD which in part manifests as hoarding disorder. A real trifecta of shit, not to put too fine a point on it. The bipolar is pretty indisputable in my case, as there is a cyclic component to some of my behaviors. Fortunately the lithium helped to some degree with the worst borderline behaviors as well, but I still have made the decision never to be involved in a romantic/sexual relationship again. It is far too destructive for me, always ends badly, and at this point I want nothing to do with it. You can only imagine what kind of pariah that makes me in this overly sexualized society!

  • Amanda

    I was diagnosed with major depression and bipolar I for all of my childhood and most of my adolescence. I was treated with every anti-depressant known to man, sometimes up to three at a time and nothing helped. I was in and out of hospitals telling them that I wasn’t bipolar. I never had any manic moments, only depressed moments stemming from rejection, abandonment, failed relationships and social phobias among other things. The shushed me for years until they finally did the thorough comprehensive Psych evaluation and came back with BPD and Bipolar II. I wasn’t told till later that all the meds they had given me had only made me worse because they were for Borderline I. Now I’m on Lamictal and Lexapro and feel better than ever even though everyday is still a struggle. The BPD diagnosis truley saved my life because I am not sure I would have survived the way I was going before.

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