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

Emotional Dysregulation

Emotional dysregulation, also referred to as affective instability, is defined as brief mood changes characterized by temporal instability, high intensity and delayed recovery from the actual dysphoria.[42] Emotional dysregulation is not pathognomonic of BPD as it can occur in BP II,[2,34,43] but analysis of the valence, frequency and intensity of affective shifts may assist differentiation. For example, in contrast to the affect shifts from euthymia to anger or anxiety observed in BPD, individuals with BP II display more affective lability from euthymia to depression or to elation, and from elation to depression.[34] More recently, Reich et al.[44] compared a combined BP II and cyclothymic group with BPD participants and reported the former as experiencing more frequent and intense shifts between euthymia and elation, and between depression and elation. By contrast, BPD participants experienced more frequent and intense lability between anxiety and depression, and between euthymia and anger. Neurobiological studies suggest that emotional dysregulation in bipolar may be internally driven, in contrast to the reactivity to social cues observed in BPD.[42] Thus, if emotional dysregulation is present, shifts between depression, euthymia and elation could suggest a BP II condition, whereas shifts between anger and anxiety may characterize BPD.