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

Personality Factors

Personality factors, including affective temperament, have been assessed closely in both bipolar and BPD. Perugi et al.[30] suggest that mood liability and interpersonal sensitivity traits are related to a shared cyclothymic temperament linking BP II, BPD and atypical depression. The affective temperament characterizing BPD (when compared with BP I, not BP II) consists of a pattern of dysregulation involving depressive, cyclothymic, irritable and anxious features but without hyperthymic features (e.g. exuberance and self-confidence).[78] A shared irritable affective temperament has been associated with both bipolar disorder and BPD (as reviewed in),[79] with Fletcher et al.[79] reporting a BP II (compared with UP depression) profile characterized by elevated irritability (in addition to anxious worrying, self-criticism and interpersonal sensitivity). However, the presence of a cyclothymic temperament in those with BP II often leads to incorrectly diagnosing BPD.[80] Akiskal et al.[80] terms this 'dark', unstable variant of the 'sunny' BP II disorder – 'BP II 1/2' – and more highly associated with irritable risk taking compared with 'classic' euphoria-driven hypomanic symptoms.[80]