Depression and borderline personality disorder

Abstract

orderline personality disorder (BPD) is a serious mental illness characterised by dysregulation of emotions and impulses, an unstable and inconsistent sense of self and of others in close relationships, and marked difficulties in interpersonal relationships, often accompanied by suicidal and selfharming behaviour.The instability of emotions and predominance of negative affect that characterise BPD often lead to problems determining whether the patient has major depression co-occurring with BPD, or whether the depressive symptoms are part and parcel of the BPD itself. In this article, we aim to assist clinicians facing this situation to make an accurate diagnosis.To prepare the article, we searched PsychInfo and MEDLINE databases for articles published between 2000 and 2012 relating to BPD co-occurring with major depression, other depressive disorders, or bipolar disorder. Review articles and those involving randomised controlled trials of treatment were particularly sought. Book chapters relevant to the search criteria were also examined. The diagnostic problemMajor depressive disorder (MDD) commonly co-occurs with BPD. The lifetime prevalence of major depression in the course of BPD was 83% in one large study, 1 which accords with other research and clinical experience.Patients with BPD often present to clinicians with depressive symptoms. As the symptoms of depression and BPD overlap significantly, it can be challenging to make an accurate diagnosis of a major depressive illness when the disorders co-occur. Accurate diagnosis is essential because each disorder requires treatment in its own right. It is important to note that rating scales of depression, whether patient-or clinician-rated, are less helpful for assessing the severity of depressive symptoms when BPD is present. 2 BPD is not a variant of affective disorderGiven the prominent overlap of symptoms between BPD and affective disorders, it has been suggested that BPD is a variant of affective disorder -either depressive disorder or bipolar disorder. 3,4 However, the consensus of expert opinion is that BPD is not a variant of either MDD or bipolar disorder, 5-12 although overlap of symptoms of both disorders can occur with BPD.The most significant evidence that BPD is not a variant of depressive disorder is that treatment of depression does not result in remission of BPD symptoms. An important longitudinal study found that effective treatment of BPD tends to result in remission of depression, and antidepressants often show only modest benefit for depressive disorders that co-occur with BPD. 6 A 2010 review of phenotype, endophenotype and genotype comparisons between BPD and MDD found that BPD differs from MDD in symptomatology, prognosis, heritability, patterns of brain region involvement, neurohormonal indices and sleep architecture. 7 Some biological processes overlapped, including amygdala hyperreactivity, volume changes in the anterior cingulate cortex, and deficient serotonin function. The authors noted that definitive clarification of the commonalit...

A systematic review of interventions for co‐occurring substance use and borderline personality disorders

“…Women experience higher rates of BPD than men and will present more frequently for hospital admissions [9]. Both BPD and SUD are associated with emotional dysregulation [10,11], impaired decision making [12] and high rates of relapse [13,14].…”

“…Practitioners often find it difficult to treat BPD and substance use, becoming pessimistic about treatment outcomes [11,17]. Identifying evidence‐based interventions for this group is crucial in both preventing relapse and achieving effective outcomes.…”

Depression and borderline personality disorder

“…In a 1‐year study of psychiatric morbidity in 358 general practice patients, GPs diagnosed personality disorder in 5.3%, but this increased to 28% when patients were assessed using a structured interview 2 . It seems likely that the GPs did take “a longitudinal history, with careful examination of depressive symptoms”, 1 as the study psychiatrist also diagnosed personality disorder in 5.6%, although not in the same patients.…”

“…T o the Editor: Beatson and Rao's article 1 appeared in the MJA Open supplement subtitled “A guide to management in primary care”. Despite acknowledging that it “can be difficult to distinguish between [borderline personality disorder] and [major depressive disorder]”, the authors offer no specific guidance for general practitioners on how to do this.…”

Examining the Shared and Unique Features of Self-Concept Content and Structure in Borderline Personality Disorder and Depression

“…Major depressive disorder is the most ubiquitous comorbidity found in BPD, with estimates of lifetime prevalence of MDD in BPD as high as 83% (Zanarini et al, 1998). This high rate of comorbidity in part reflects the significant degree of symptom overlap between MDD and BPD (Beatson & Rao, 2012), with both disorders being characterised by elevations in negative affectivity. For example, chronic dysphoria seen in BPD is very similar to the sadness and worthlessness experienced in MDD (Abela, Payne & Moussaly, 2003).…”