Study Reveals Distinctive Differences Between Bipolar II and Borderline Personality Disorder

Study Reveals Distinctive Differences Between Bipolar II and Borderline Personality Disorder
When two illnesses share several common symptoms it can sometimes be difficult to distinguish one from the other. With this in mind, researchers in Australia looked at a small sample of patients, some with bipolar II and some with borderline personality disorder (BPD), to see what distinctions could be made between the two conditions, which in many ways look very much alike.

Bipolar II versus BPD

Bipolar disorder affects nearly 6 million Americans. The disorder is characterized by severe mood swings ranging from overly confident and energetic (mania) to immobilizing sadness (depression). One form of the illness, bipolar II, shares the same trajectory from emotional high to low, but the manic (high) phase is less intense and is therefore referred to as hypomanic. According to the National Institutes of Mental Health, symptoms of bipolar II include:

  • Mood swings
  • Trouble maintaining relationships
  • Impulsivity
  • Difficulty at school or work
  • Risk of suicide

BPD is a serious mental illness but has only been officially recognized since 1980. According to the National Alliance on Mental Illness symptoms of BPD include:

  • Trouble managing feelings (emotional dysregulation)
  • Mood swings
  • Impulsiveness
  • Poor self-image
  • Self-sabotaging behavior
  • Risk of suicide

The Study

The study, which took place through the University of New South Wales in Australia, examined 48 clinical outpatients. There were 24 patients with bipolar II and 24 with BPD. There were no control subjects involved in the study. The patients’ mean age was 33.

Study participants were asked to fill out several diagnostic tools. The first was the Cognitive Emotion Regulation Questionnaire. Next, they were assessed based on the 36-question Difficulties in Emotion Regulation Scale. Each of those tools is designed to evaluate how subjects manage emotions. In addition, each participant was assessed in terms of their parental relationship using the Measure of Parental Style, which gauges a person’s perception of parent treatment including possible indifference, abuse or excessive control.

Different Parent Perceptions

Although research shows that people with both disorders can come from homes where there was no maltreatment, it is believed that both conditions may also affect people with pre-existing vulnerabilities where parental loss or mistreatment triggered the illness’ onset. In other words, both BPD and bipolar II appear to have genetic and environmental causes. Nevertheless, the study reveals that assessing a patient’s perception of the parental relationship can be a helpful differential since the BPD patients had a stronger negative perception about the parent relationship in general.

Patients with BPD scored higher on nearly every subscale (indifference, abuse, over control) than patients with bipolar II. The BPD subjects strongly perceived parental relationships to be hallmarked by over control and abuse in particular.

Different Emotional Dysregulation

Compared with bipolar II patients, participants with BPD were also notably higher in measures of poor emotional regulation. Those with BPD showed significantly greater evidence of self-blame, blaming others, trouble putting the brakes on impulsive behavior and catastrophizing. At the same time, these subjects seemed less able to access healthy strategies for managing difficult emotions. Those with BPD showed markedly less aptitude for positively reappraising, making plans, and finding perspective – all healthy strategies for regulating emotions.

Different Onset and Outcomes

BPD patients tended to first experience symptoms of depression at a younger age compared with bipolar II patients. They were also more likely to have engaged in self-harming behavior including attempted suicide.

The study’s findings, which appeared in the Journal of Affective Disorders, reveal that while both bipolar II and BPD result in emotional dysregulation, those dysregulations come in different and distinctive patterns. The results help in separating one illness from the other, but they also help to inform appropriate therapies.

Treatment Helps

The good news is that while the disorders can be highly disruptive when untreated, they both can be positively managed when addressed with appropriate therapies. It is possible for a person with BPD, for example, to become more self-aware and learn healthy mechanisms for coping with stormy emotions. The study authors also suggest that therapies for both illnesses emphasize learning how to overcome adverse childhood experiences. The study, while insightful, is limited by its small scope and lack of controls. Therefore, further investigation is warranted.

On December 2nd, 2014, posted in: Borderline Personality Disorder Research by Tags: