Impulsivity and aggressiveness in bipolar disorder with co-morbid borderline personality disorder

Few studies to date have been performed to investigate impulsivity and aggressivity in patients with bipolar disorder (BD) and borderline personality disorder (BPD); the primary aim of the present study was to evaluate the impact of co-morbidity of BPD on impulsivity and aggressivity in patients affected by BD. A total of 57 patients (male = 20, female = 37) affected by BD (BD-I 51%; BD-II 49%) in clinical stable remission were recruited; 28 patients were affected by BD (49.1%), 18 by BD and BPD (31.6%) and 11 (19.3%) by BD plus other personality disorders (OPD) (19.3%). They were assessed with the Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II, and were evaluated by means of the Clinical Global Impression (CGI)-severity and Global Assessment Functioning (GAF) scales, the Barratt Impulsivity Scale (BIS-11) and the Aggression Questionnaire (AQ). Mean total scores were significantly higher among BD/BPD patients with respect to BD and to BD/OPD, both on the BIS-11 and the AQ; the rate of attempted suicides was approximately three times higher in BD/BPD patients with respect to BD and 7.6 times higher than in BD/OPD patients. The results of our study suggest that patients with co-morbid BD and BPD are more impulsive and aggressive. Furthermore, this co-morbid condition may be a risk factor for suicidality.     

Affective and impulsive personality disorder traits in the relatives of patients with borderline personality disorder

OBJECTIVE: This study tested the hypothesis that the risk for affective and impulsive personality disorder traits commonly found in patients with borderline personality disorder would be greater in the first-degree relatives of probands with borderline personality disorder than in two comparison groups. METHOD: Blind family history interviews were conducted with family informants to assess the extent to which first-degree relatives of 29 probands with borderline personality disorder, 22 probands with other personality disorders who met three or fewer of the criteria for borderline personality disorder, and 43 probands with schizophrenia fulfilled operationalized criteria for the two kinds of personality disorder traits and for other diagnostic categories. The crude proportions of adult relatives with each diagnosis, as well as the age-adjusted morbid risks, were assessed in the three groups of relatives. RESULTS: The risks for affective and impulsive personality disorder traits were independently greater in the 129 relatives of the borderline probands than in the 105 relatives of the probands with other personality disorders and the 218 relatives of the schizophrenic probands. There was no similarly greater risk for any other psychiatric disorder assessed, including major affective disorder. In addition, the relatives of borderline probands with current or past major depressive disorder showed a greater risk for major affective disorders than the relatives of never-depressed probands with other personality disorders but not the relatives of never-depressed borderline probands. CONCLUSIONS: These results suggest familial transmission of the hallmark borderline-related personality characteristics and raise the possibility that these familial traits may be partially independent.     

Affective instability in borderline personality disorder: Experience sampling findings

Affective instability, defined as repeated, rapid, and abrupt shifts in mood, is considered the core pathology in borderline personality disorder. The temporal pattern of affective instability can be best captured with the experience sampling method-longitudinal assessment of people’s affective states as they occur in real time and in their natural environment. A review of the experience sampling studies published to date for borderline personality disorder suggests the following mood variability pattern: intense negative mood, more frequent and abrupt mood changes than healthy controls and patients with major depression, and partial triggering of affect by external events. The method also has great potential to investigate the links between affective instability and other psychological and behavioral correlates of the disorder, such as suicide, lack of self-esteem, and erratic behaviors. However, the method requires systematic study to determine best data collection designs and mathematical models of mood variability.     

Differences in attention and impulsivity between borderline personality disorder and bipolar disorder

This study aims at investigating attention and impulsivity differences between borderline personality disorder and bipolar disorder, as both diseases may share neuropsychological deficits. Differential cognitive outcomes on the Continuous Performance Test-II were observed between disorders, and also when compared to healthy controls.     

Affective lability in offspring of parents with major depressive disorder,bipolar disorder and schizophrenia

European Child & Adolescent Psychiatry - Affective lability, defined as the propensity to experience excessive and unpredictable changes in mood, has been proposed as a potential...     

Affective responsiveness in borderline personality disorder: a psychophysiological approach.

OBJECTIVE: The aim of the study was to investigate affective responses to emotional stimuli in subjects with borderline personality disorder. METHOD: Twenty-four female patients with borderline personality disorder and 27 normal female comparison subjects were examined. The test stimuli were a set of standardized photographic slides with pleasant, neutral, or unpleasant emotional valence. In addition to self-reports, emotional reactions to the slides were measured by heart rate, skin conductance, and startle response. Psychometric tests for various aspects of impulsiveness were also completed. RESULTS: Neither self-report nor physiological data gave any evidence that the borderline patients showed more intense affective responses than did the normal subjects. The borderline subjects did not produce higher levels of startle amplitude, and while viewing unpleasant slides, they showed a startle potentiation effect that was largely similar to that of the comparison group. In fact, the borderline patients showed low electrodermal responses to all three stimulus categories, which points to physiological underarousal. CONCLUSIONS: The results do not agree with the hypothesis that there is a fundamental, biologically based affective hyperresponsiveness in borderline personality disorder, as is suggested by current theories of affect dysregulation in the disorder. Autonomic underarousal may seriously interfere with a flexible adaptation to environmental stimuli.     

Affect intensity and lability: the role of posttraumatic stress disorder symptoms in borderline personality disorder

Background: Emotion dysregulation is likely a core psychological process underlying the heterogeneity of presentations in borderline personality disorder (BPD) and is associated with BPD symptom severity. Emotion dysregulation has also been independently associated with posttraumatic stress disorder (PTSD), a disorder that has been found to co‐occur with BPD in 30.2% of cases in a nationally representative sample. However, relatively little is known about the specific relationships between emotion dysregulation and PTSD among those diagnosed with BPD. The purpose of this study was to evaluate relationships between PTSD symptom severity and negative affect intensity and affective lability among individuals with BPD. Method: Participants were 67 individuals diagnosed with BPD (79% women; M _age = 38, SD = 10), who reported one or more DSM‐IV PTSD Criterion A events. Results: Hierarchical multiple regression analyses indicated that when examined concurrently with BPD symptom severity, PTSD symptom severity, but not BPD symptom severity, was related to negative affect intensity and affective lability. Re‐experiencing symptoms uniquely predicted affective lability, and hyperarousal symptoms uniquely predicted negative affect intensity, lending additional support to emerging literature linking re‐experiencing and hyperarousal symptoms with emotion dysregulation. Conclusions: PTSD symptom severity among individuals with a BPD diagnosis is related to elevations in emotion dysregulation. It is important to evaluate whether early treatment of PTSD symptoms provided concurrently with BPD treatment leads to enhanced improvements in emotion regulation among individuals with co‐occurring PTSD and BPD. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

共病边缘型人格障碍的双相情感障碍患者认知功能状况

背景 双相情感障碍与边缘型人格障碍（BPD）共病率高,共病患者认知功能受损更严重。目的 探讨是否共病BPD的双相情感障碍患者认知功能的差异,为临床诊疗提供参考。方法 采用简单随机抽样,选取2021年4月-2022年4月在河北医科大学第一医院治疗的共病BPD的双相情感障碍患者60例（共病组）,其中双相抑郁患者33例,双相躁狂患者27例。同时选取双相情感障碍患者60例（未共病组）,其中双相抑郁35例,双相躁狂25例。采用中文版神经心理状态测验（RBANS）和Stroop色词测验评估患者的认知功能。结果 共病组RBANS中的即刻记忆、视觉广度、言语功能和总评分均低于未共病组,差异均有统计学意义（t=-2.356、-2.138、-3.306、-2.729,P<0.05或0.01）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组,差异均有统计学意义（t=4.808、3.341、5.249、5.167,P均<0.01）。共病BPD的双相抑郁患者RBANS中的即刻记忆、视觉广度、言语功能和总评分均低于未共病BPD的双相抑郁患者（t=-2.446、-2.407、-2.231、-2.078,P均<0.05）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组（t=3.652、3.035、4.406、5.016,P均<0.01）。共病组双相躁狂患者RBANS中的言语功能和总评分均高于未共病组（t=-2.777、-2.347,P<0.05或0.01）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组（t=3.600、2.658、2.943、4.337,P<0.05或0.01）。结论 相较于未共病BPD的双相情感障碍患者,共病BPD的双相情感障碍患者认知功能受损更严重。     

The interface between borderline personality disorder and bipolar spectrum disorders

OBJECTIVE: This review examines whether borderline personality disorder (BPD) should be considered part of the bipolar spectrum. METHODS: A literature review examined studies of co-occurrence, phenomenology, family prevalence, medication response, longitudinal course, and etiology. RESULTS: Borderline personality disorder and bipolar disorder co-occur, but their relationship is not consistent or specific. There are overlaps but important differences in phenomenology and in medication response. Family studies suggest clear distinctions, and it is unusual for BPD to evolve into bipolar disorder. Research is insufficient to establish whether these disorders have a common etiology. CONCLUSIONS: Existing data fail to support the conclusion that BPD and bipolar disorders exist on a spectrum but allows for the possibility of partially overlapping etiologies.     

Age at onset of bipolar disorder and risk for comorbid borderline personality disorder

Objectives: The relationship between bipolar disorder and cluster B personality disorders remains phenomenologically complex and controversial. We sought to examine the relationship between early age at onset of bipolar disorder and development of comorbid borderline personality disorder. Methods: A total of 100 adults in an academic specialty clinic for bipolar disorder underwent structured diagnostic interviews and clinical assessments to determine lifetime presence of comorbid borderline personality disorder, histories of childhood trauma, and clinical illness characteristics. Results: Logistic regression indicated that increasing age at onset of bipolar disorder was associated with a lower probability of developing comorbid borderline personality disorder (odds ratio = 0.91, 95% confidence interval: 0.83–0.99) while controlling for potential confounding factors, including a history of severe child trauma/abuse. Conclusion: Early onset of bipolar disorder increases the probability of developing comorbid borderline personality disorder, independent of the effects of severe childhood trauma/abuse. In patients with borderline personality disorder, prospective studies of new‐onset bipolar disorder may underestimate the prevalence of true comorbidity unless they capture the primary risk window for first‐episode mania arising before the end of adolescence.     

Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences

Objectives: many studies have reported a high degree of comorbidity between mood disorders, among which are bipolar disorders, and borderline personality disorder and some studies have suggested that these disorders are co-transmitted in families. However, few studies have compared personality traits between these disorders to determine whether there is a dimensional overlap between the two diagnoses. The aim of this study was to compare impulsivity, affective lability and intensity in patients with borderline personality and bipolar II disorder and in subjects with neither of these diagnoses. Methods: patients with borderline personality but without bipolar disorder (n=29), patients with bipolar II disorder without borderline personality but with other personality disorders (n=14), patients with both borderline personality and bipolar II disorder (n=12), and patients with neither borderline personality nor bipolar disorder but other personality disorders (OPD; n=93) were assessed using the Affective Lability Scale (ALS), the Affect Intensity Measure (AIM), the Buss–Durkee Hostility Inventory (BDHI) and the Barratt Impulsiveness Scale (BIS-7B). Results: borderline personality patients had significantly higher ALS total scores (P<0.05) and bipolar II patients tended to have higher ALS scores than patients with OPD (P<0.06). On one of the ALS subscales, the borderline patients displayed significant higher affective lability between euthymia and anger (P<0.002), whereas patients with bipolar II disorder displayed affective lability between euthymia and depression (P<0.04), or elation (P<0.01) or between depression and elation (P<0.01). A significant interaction between borderline personality and bipolar II disorder was observed for lability between anxiety and depression (P<0.01) with the ALS. High scores for impulsiveness (BISTOT, P<0.001) and hostility (BDHI, P<0.05) were obtained for borderline personality patients only and no significant interactions between diagnoses were observed. Only borderline personality patients tended to have higher affective intensity (AIM, P<0.07). Conclusions: borderline personality disorder and bipolar II disorder appear to involve affective lability, which may account for the efficacy of mood stabilizers treatments in both disorders. However, our results suggest that borderline personality disorder cannot be viewed as an attenuated group of affective disorders.     

Descriptive and longitudinal observations on the relationship of borderline personality disorder and bipolar disorder

OBJECTIVE: The purpose of this study was to test whether borderline personality disorder is a variant of bipolar disorder by examining the rates of co-occurrence in both disorders, the effects of co-occurrence on a longitudinal course, and whether the presence of either disorder confers the risk for new onsets of the other. METHOD: A prospective repeated-measures design with reliable independent diagnostic measures and 4 years of follow-up was used to assess 196 patients with borderline personality disorder and 433 patients with other personality disorders. RESULTS: Patients with borderline personality disorder had a significantly higher co-occurrence of bipolar disorder (19.4%) than did patients with other personality disorders. However, this co-occurrence did not appear to affect the subsequent course of borderline personality disorder. Although only 8.2% of the borderline personality disorder patients developed new onsets of bipolar disorder, this rate was higher than in patients with other personality disorders. Patients with other personality disorders with co-occurring bipolar disorder generally had more new onsets of borderline personality disorder (25%) than did patients with other personality disorders without co-occurring bipolar disorder (10%). CONCLUSIONS: A modest association between borderline personality disorder and bipolar disorder is reported.     

Multiple personality and borderline personality disorder

The authors offer their theory that multiple personality represents a "special instance" of borderline personality disorder, that the introjects are composed of a representation of the self, a representation of the object, and an affective bond.     

Interference control commonalities in patients with schizophrenia,bipolar disorder,and borderline personality disorder

Background: Whereas deficits in executive functioning have been widely reported in schizophrenia and, somewhat less, in bipolar disorder, few studies have addressed this issue in people diagnosed with borderline personality disorder. Importantly, no studies to date have compared the ability to cope with interfering information in all three groups of patients. Impairment in executive control has been associated with reduced daily functioning. Method: The sample included 20 patients diagnosed with schizophrenia, 19 with bipolar disorder, 20 with borderline personality disorder, and 19 demographically matched healthy volunteers. Participants were administered two different experimental tasks to assess the ability to exert control over interference arisen from semantic memory or from distracting perceptual information. Results: The three groups of patients showed similar impairment in solving interference from semantic memory compared to controls. However, no psychiatric group showed impairment in controlling interference from distracting perceptual information relative to controls. Conclusions: Our study shows, for the first time, that schizophrenia, bipolar disorder, and borderline personality disorder entail a common impairment in exerting control over interference arisen from memory but intact control over perceptual interference. These findings reinforce the idea that similar cognitive functioning may underlie severe mental disorders sharing poor global functioning but with different patterns of symptomatology.