Clinical Differentiation of Bipolar II Disorder From Borderline Personality Disorder

Adam Bayes; Gordon Parker; Kathryn Fletcher


Curr Opin Psychiatry. 2014;27(1):14-20. 

In This Article

Treatment Response

As overviewed by Bassett,[5] antidepressants, anticonvulsant mood stabilizers and atypical antipsychotics appear more beneficial for bipolar conditions[73] relative to BPD. Lithium, in particular, appears to show no clear utility for personality disorders,[74] whereas those with BPD rarely remit on mood stabilizers[75] or report improvement only for secondary reasons (e.g. sedation).[39]

In relation to psychotherapy, different fundamental features of bipolar and BPD argue for differing psychotherapeutic approaches, with the latter arguing for a therapeutic focus on the disrupted sense of self and improving mutually satisfying relationships.[5] However, shared features of both conditions and the nonspecific benefits of psychological treatments limit the capacity for psychotherapeutic response to offer diagnostic differentiation. For example, Dialectical Behaviour Therapy (DBT) and mentalization-based therapies are effective for BPD,[72] yet preliminary evidence (from a combined BP I and II sample) suggests DBT is also effective in reducing bipolar depressive symptoms.[76] Further, Cognitive Behaviour Therapy is effective for BP (I and II),[73] with benefits also observed for BPD including reduction of suicidal acts, anxiety and of dysfunctional beliefs.[77]