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David Baxter

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Borderline personality disorder has 'distinct neuropathology'
By Andrew Czyzewski
29 October 2007
J Clin Psychiatry 2007; 68: 1533-1539

Borderline personality disorder (BPD) is a distinct condition with a unique symptom profile that differentiates it from other affective disorders, confirm the results of study.

Scott Wilson, from the New York State Psychiatric Institute, in New York, USA, and colleagues also found that patients with bipolar II disorder who have co-existing BPD might have more severe symptoms than patients with bipolar II disorder alone.

BPD and bipolar affective disorder frequently co-occur and there can be a degree of overlap in symptoms, leading some investigators to suggest that BPD exists along a spectrum of affective disorders, the researchers explain.

Some have even suggested that BPD may be an ultra-rapid cycling form of bipolar II disorder, they add.

To explore this relationship, the researchers recruited 173 patients with either major depressive disorder (MDD) or bipolar II disorder and further divided them based on the presence or absence of coexisting BPD.

Patients were interviewed and assessed for depression, impulsiveness, hostility, and guilt using various scales.

Wilson et al found that patients who had BPD scored significantly higher on both the Buss-Durkee Hostility Inventory and the Barratt Impulsiveness Scale than the other patients.

Patients with bipolar II and BPD had the highest average level of impulsivity, scoring 63.6, followed by patients with MDD and BPD, who scored 58.8. The lowest scores were for bipolar II disorder and MDD alone, scoring 29.4 and 26.0, respectively.

Noting that this finding hints at a complex relationship between the syndromes, the researchers looked in more detail at impulsiveness subscales.

They found that bipolar II disorder was uniquely associated with increasing levels of attention impulsiveness. In contrast, BPD was uniquely associated with an increase in non-planning impulsiveness.

This finding, say the researchers, supports the theory that different facets of impulsiveness are associated with each diagnostic syndrome and that there may be a distinct neuropathology underlying each diagnosis.

"This finding not only suggests a degree of independence between the diagnoses but also suggests that patients with this combination of disorders could have particularly high risk for self-destructive or damaging behavior such as suicide attempts and self-injury," the team concludes.

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