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

Depressive Symptoms

Phenomenological differences in depressive states have been reported. Melancholic features of depression are over-represented in BP II,[26] as are agitated and mixed symptoms,[27] whereas BPD is more characterized by nonmelancholic reactive depressive episodes.[9] Atypical features of depression (e.g. hypersomnia, hyperphagia) are over-represented in both BP II[28] and BPD, offering little diagnostic discriminatory value.[29,30]

In contrast to 'typical' depressive features (e.g. decreased self-esteem, self-criticism) frequently associated with BP II, BPD depressive states are often more characterized by emptiness, shame and 'painful incoherence'.[31] Other differences include higher levels of self-reported cognitive depressive symptoms in BPD relative to BP II – pointing to a more severe subjective experience in the former group.[32] Those with BPD tend to project responsibility onto others,[33] be accusatory, blaming, hostile and more angry than depressed[9] compared to those with a BP II condition.[32,34] In contrast, those with bipolar tend to be more likely to feel guilty about annoying others with any irritable mood[33] and be self-demeaning/self-accusatory.[9]