Clinical Differentiation of Bipolar II Disorder From Borderline Personality Disorder

Adam Bayes; Gordon Parker; Kathryn Fletcher

Disclosures

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

In This Article

Hypomanic Symptoms and Correlates

Individuals with a BP II disorder generally report elated mood, increased energy, creativity, connectedness, grandiosity and productivity, contrasting with the emotional dysregulation commonly reported by those with a BPD condition. Furthermore, hypomania is viewed by BP II patients as uncharacteristic.[39] Some BP II individuals experience hypomanic episodes characterized by irritability, akin to the irritability and anger occurring in BPD. However, in contrast to BPD, the irritability/anger is episodic and present only during elevated mood states in BP II, assisting differential diagnosis.[10] Mixed mood states, commonly observed in females with BP II,[40] as well as ultrarapid cycling may also be mistaken for borderline phenomena. In those with BPD, elation is rarely present and brief (less than 48 h).[2] In contrast to the grandiose sense of self, experienced in BP II hypomania, there remains an ongoing poor self-image in those with BPD.[33] Clinically, assessing anxiety levels during 'highs' can be central, with anxiety disappearing or attenuating in those with a BP II condition and increasing in those with BPD.[41]

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