Self over time: another difference between borderline personality disorder and bipolar disorder

Borda, Juan P.

doi:10.1111/jep.12550

Cited by 7 publications

(8 citation statements)

References 48 publications

(79 reference statements)

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“…The differential diagnosis between Bipolar (BD) and Borderline Personality (BPD) disorders remains controversial (Barroilhet, Vohringer, & Ghaemi, 2013;Ghaemi, Dalley, Catania, & Barroilhet, 2014). This controversy is also associated with the high comorbidity rate observed in both community-based (McDermid et al, 2015) and clinical (Henry et al, 2001;Fonseka et al, 2015) samples, and constitutes an obstacle for health care professionals (Bennazi, 2005;Borda, 2016), leads to a high number of misdiagnosed patients (Galione & Zimmerman, 2010) as well as to a large lag between diagnosis and beginning of treatment (Hirschfeld, Lewis, & Vornik, 2003;Zimmerman, Martinez, Young, Chelminski, Morgan & Dalrymple, 2014). The high comorbidity between these disorders was attributed to the vast array of shared clinical features that span from nuclear diagnostic criteria to etiopathogenic mechanisms (Bayes & Parker, 2017;Paris, Gunderson, & Weinberg, 2007) which led to the perspective that BPD is a disorder of the bipolar spectrum (e.g., Akiskal, 2004).…”

Section: Introductionmentioning

confidence: 99%

Bridges Between Bipolar and Borderline Personality Disorders: Clarifying Comorbidity Through the Analysis of the Complex Network of Connections Between Symptoms

Castro

Ferreira

Mendes

et al. 2018

Psychologist Practice & Research

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Background: The reasons for the high rates of comorbidity between Bipolar (BD) and Borderline Personality (BPD) disorders remain elusive, due to the vast array of shared clinical features, which makes the differential diagnosis difficult. This constitutes an obstacle to provide quality of care services, which results in detrimental effects on individual’s mental health. The analysis of the complex network of connections between symptoms of both disorders is a promising pathway to uncover the mechanisms underlying the comorbidity structure of both disorders. Goals: In this study, we explored the comorbidity network that represents the connections between 32 DSM-5 symptoms of BD and BPD in order to (1) compare its modular structure (i.e., the constitution of cohesive subgroups of symptoms within the comorbidity network) with the nosographic proposal of the DSM-5; (2) distinguish between the different roles those symptoms have in the comorbidity network and identify the symptoms that overlap and bridge both disorders, as well as the distinctive symptoms that better discriminate them; (3) identify the most central symptoms and those with the highest impact on the strength or on the structure of the connections on the comorbidity network; and (4) analyze the association between symptoms roles and their centrality and impact.Methods: An epidemiological sample from the National Comorbidity Survey: Baseline (NCS) was analyzed. Data regarding bipolar and borderline personality symptoms were collected through the Composite Network International Diagnostic Interview (CIDI). The network of complex interactions between symptoms was estimated using the Ising model with the L1-regularization penalty (EBIC) and the nosographic structure was detailed with Moduland algorithms. Results: Data regarding an overall sample of 7556 individuals was analyzed (48.6% male, Mage = 33.400 years, SDage = 10.447). Results revealed differences between the modular structure of the comorbidity network and the DSM-5 nosographic proposal, namely about unstable relationships and substance abuse, that were assigned to the module constituted by symptoms of manic episode (ME). Symptoms such as money spending and sexual indiscretions, that overlap ME and BPD in the DSM-5, were assigned to the ME module. Psychomotor agitation, which overlaps depressive episode (DE) and ME in the DSM-5, was assigned to the DE module. Additionally, emptiness and worthlessness were identified as bridge symptoms between DE and BPD; anger and substance abuse between ME and BPD; and unstable relationships and psychomotor agitation between DE and ME. Fatigue was the most distinctive symptom of the DE module, unstable relationships of the ME module, and anger of the BPD module. Strength centrality (r = .61, 95%CI [.33, .79], p < .001) and modular bridgeness (r = .64, 95%CI [.38, .81], p < .001) were positively correlated with the impact on the structure of the comorbidity network; and modular overlap was negatively correlated with the impact on the strength (r = -.43, 95%CI [-.10, -.68], p = .01) of its connections. Discussion: Results suggest a similar structure of the comorbidity network to the nosographic proposal of DSM-5. Distinctive and bridge symptoms were identified for each disorder which might help with the differential diagnosis. It can also help us to unveil possible development pathways of comorbidity that might promote an improvement in psychological treatments. Keywords: Bipolar disorder, Borderline personality disorder, Network analysis, Comorbidity.

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Section: Introductionmentioning

confidence: 99%

Bridges Between Bipolar and Borderline Personality Disorders: Clarifying Comorbidity Through the Analysis of the Complex Network of Connections Between Symptoms

Castro

Ferreira

Mendes

et al. 2018

Psychologist Practice & Research

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“…Several researchers suggest that temporality is often disturbed in psychopathological states, with different disturbances characteristic of different kinds of disorders (von Gebsattel, 1928;Minkowski, 1933;Straus, 1947;Binswanger, 1960;Kimura, 1992). Lived time may be disturbed across various conditions, including schizophrenia spectrum disorders (Minkowski, 1933;Kimura, 1992;Gallagher, 2000;Vogeley & Kupke, 2007;Arzy et al, 2011;Fuchs, 2007aFuchs, , 2013aFuchs, , 2013bBowden, 2013;Sass & Pienkos, 2013;Stanghellini et al, 2015;Giersch & Mishara, 2017;Sass, 2019;Vogel et al, 2019), depressive disorders (von Gebsattel, 1928;Straus, 1928Straus, , 1947Minkowski, 1933;Binswanger,1933Binswanger, , 1960Bech, 1975;Kimura, 1992;Kobayashi, 1998;van Beek et al 2011;Ratcliffe, 2012;Sass & Pienkos, 2013;Borda, 2016;Stanghellini et al, 2016;Moskalewicz, 2018aMoskalewicz, , 2018bVogel, 2018;Fuchs, 2001Fuchs, , 2013aFuchs, , 2014Fuchs, , 2019a, mania (Alonso-Fernandez, 1982;…”

Section: Introductionmentioning

confidence: 99%

Transdiagnostic assessment of temporal experience (TATE) a tool for assessing abnormal time experiences

et al. 2022

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Currently, anomalous lived temporality is not included in the main diagnostic criteria or standard symptom checklists. In this article, we present the Transdiagnostic Assessment of Temporal Experience (TATE), a structured interview that can be used by researchers and clinicians without a comprehensive phenomenological background to explore abnormal time experiences in persons with abnormal mental conditions regardless of their diagnosis. When extensive data gathered by this scale are available, it will be possible to delineate well-defined anomalous lived temporality profiles for each psychopathological disorder. This instrument may also prove useful for clinicians by providing a more refined assessment of relevant psychopathological symptoms (for instance, the differentiation of different types of delusions according to their temporal profile) and an in-depth understanding of the patient's abnormal behaviour (e.g., impulsivity or social withdrawal) as related to specific types of time experience. In the first part of the article, we provide a brief overview of the phenomenological concept of temporality, including pre-phenomenal and phenomenal time, synthesis, conation and synchronization, and of abnormal time experiences in persons affected by psychopathological conditions. In the following part, we describe the basic structure of the interview that comprises seven categories corresponding to the abnormal features of lived temporality: anomalies of synchrony, of time structure, of implicit time flow, of explicit time flow, and anomalous experiences of the past, the present and the future. The paper also includes a section on administration and scoring of the TATE scale, the complete interview and a Likert table for quantifying the frequency, intensity and interference with daily life of the phenomena explored.

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“…In this regard, we propose that a clinical analysis of identity, self‐concept and self‐esteem may help distinguish the two disorders. The comparison of these constructs in BPD and BD has already been conducted in the context of broader reviews (Bassett, 2012; Bayes et al, 2014) and one specific article (Borda, 2016). These suggest that these constructs might have high discriminatory specificity, unlike other clinical factors such as altered mood states and impulsivity that are considered transdiagnostic (Bayes & Parker, 2019; Ghaemi et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, antidepressants, anticonvulsant mood stabilizers and atypical antipsychotics appear beneficial for BD, although patients with BPD have lower rates of response to pharmacological treatment (Ripoll et al, 2011). These differences are clear in the scientific research, but their utility is limited in the psychiatric practice, where at a first glance the symptoms of the two disorders seem to overlap (Borda, 2016).…”

Section: Introductionmentioning

confidence: 99%

Differential diagnosis of borderline personality disorder and bipolar disorder: Self‐concept, identity and self‐esteem

Wright

Lari

Iazzetta

et al. 2021

Clin Psychology and Psychoth

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Symptoms of borderline personality disorder (BPD) and bipolar disorder (BD) often overlap. In some cases, it is difficult to conduct a differential diagnosis based only on current diagnostic criteria Therefore, it is important to find clinical factors with high discriminatory specificity that, used together with structured or semi‐structured interviews, could help improve diagnostic practice. We propose that a clinical analysis of identity, self‐concept and self‐esteem may help distinguish the two disorders, when they are not co‐morbid. Our review of the studies that analyse these constructs in BD and BPD, separately, points in the direction of qualitative differences between the two disorders. In BPD, there is a well‐documented identity diffusion, and the self‐concept appears predominantly negative; shifts in self‐concept and self‐esteem are often tied to interpersonal triggers. In BD, patients struggle with their identity, but narrative identity might be less compromised compared with BPD; the shifts in self‐concept and self‐esteem appear more linked to internal (i.e. mood and motivational) factors. We end the paper by discussing the implications for clinicians and ideas for future comparative research.

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Self over time: another difference between borderline personality disorder and bipolar disorder

Cited by 7 publications

References 48 publications

Bridges Between Bipolar and Borderline Personality Disorders: Clarifying Comorbidity Through the Analysis of the Complex Network of Connections Between Symptoms

Bridges Between Bipolar and Borderline Personality Disorders: Clarifying Comorbidity Through the Analysis of the Complex Network of Connections Between Symptoms

Transdiagnostic assessment of temporal experience (TATE) a tool for assessing abnormal time experiences

Differential diagnosis of borderline personality disorder and bipolar disorder: Self‐concept, identity and self‐esteem

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