Overlap Between Borderline and Bipolar

Kermit Cole
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Researchers in Australia investigate the growing evidence that childhood trauma predisposes individuals to both bipolar and borderline syndromes, with the intention of examining areas of discrimination between the diagnoses. “No studies have examined the neurobiological underpinnings of both in the same design,” they say, and research comparing bipolar and borderline patients’ self-reports is limited. This paper provides an overview of emotional dysregulation, impulsivity, childhood environment and neurobiology in the context of bipolar and borderline diagnoses. The authors conclude with the question of whether the two belong to the same spectrum. The paper will appear in Australian and New Zealand Journal of Psychiatry.

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Note from Kermit Cole, “In the News” Editor:
I generally try to play it coy when posting a study, and let the authors speak for themselves and hope the MIA readership picks the study’s bones clean. However Alix and Altostrata’s comments inspired me to be more forthright. What interested me here is that the authors seemed to start out with the intention of differentiating bipolar and borderline, while acknowledging their apparently common connection to childhood trauma. Nevertheless, their conclusion seems to nod to the possibility that all three have “an integrated behavioural, aetiological and neurobiological” provenance.
This has long been my view.

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

5 COMMENTS

  1. Again, it’s hard to tell what the heck this is about without the full paper.

    It seems to me that creating diagnoses on the basis of behavior patterns is fundamentally flawed. There are only so many human behaviors. There have to be a lot of overlap between any “symptom” clusters. And, of course, there is expectation bias in the person doing the diagnosing.

    Therefore, bipolar disorder and borderline personality syndrome will inevitably be found to be similar in some regards. (We’ll have to see the full publication to find out what “neurobiological substrates” were found in both. Can’t wait!)

    Now, the Enneagram has done a good job typifying self-perceptions of attitude and behavior. Why doesn’t psychiatry use that instead of the DSM?

  2. Hi Kermit,
    I don’t wish to be unduly critical but I find your comment very worrying “What interested me here is that the authors seemed to start out with the intention of differentiating bipolar and borderline, while acknowledging their apparently common connection to childhood trauma. Nevertheless, their conclusion seems to nod to the possibility that all three have “an integrated behavioural, aetiological and neurobiological” provenance. This has long been my view.”
    Am I completely confused in thinking that the role of M.I.A. is to challenge to dominant thinking about distress and how it manifests in the lives of those who experience it?
    But yet here we have an reporter’s comment that gives validity to psychiatric labels, both of which are problematic – one extremely so. You further go on to support the unscientific psychiatric jargon and then inform us that the stance of the paper has long been your view.
    You later comment that you “think impulsivity is initiative with a diagnosis”. I’m not sure I can even decipher what it is you’re trying to say in that sentence.
    I find this to be extremely problematic given that you don’t remotely approach the content from anything resembling a critical perspective.
    Or perhaps I’ve wandered onto the APA website by mistake.