Examining Measurement Invariance in the Personality Inventory for DSM-5 Brief Form Across Sexual and Gender Minority Status.

The Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Brief Form (PID-5-BF) was developed with an assumption of invariance across sexual and gender minority (SGM) individuals. This assumption has yet to be tested empirically. Using multigroup confirmatory factor analysis, we examined measurement invariance in the PID-5-BF across the SGM status in clinical (N = 1,174; n = 254 SGM) and nonclinical (N = 1,456; n = 151 SGM) samples. Measurement invariance was supported for the PID-5-BF structure, item thresholds, and factor loadings, but not at the item intercept level. SGM individuals endorsed higher negative affectivity, antagonism, disinhibition, and psychoticism domains in both samples. In the clinical sample, adjusting for partial invariance decreased detachment and antagonism levels for SGM persons. In the nonclinical sample, adjusting for partial invariance reduced antagonism disparities in the SGM group, even rendering original group differences null. Our results support the use of the PID-5-BF in SGM populations but indicate that some measurement bias may drive observed disparities in maladaptive trait domains and, in turn, personality disorder diagnosis.

Is there a bias in the diagnosis of borderline personality disorder among racially minoritized patients?

Empirical evidence documents disparities in the diagnosis of severe forms of psychopathology among racial/ethnic minority persons. However, research on diagnostic differences in personality disorders is equivocal: Some suggest higher prevalence of personality disorders among racial/ethnic minority persons, whereas other results suggest the opposite. The goal of the current study was to investigate (a) differences in the diagnosis of borderline personality disorder (BPD) in a mostly cisgender, heterosexual sample among racial/ethnic minority patients compared with non-Hispanic White patients and (b) whether any observed differences were attributable to differences in underlying maladaptive personality domains. Using data from partial hospital patients (N = 2,657), we found few differences in the diagnosis of BPD based on racial/ethnic group membership. We also conducted measurement invariance analyses of the Personality Inventory for DSM-5-Brief Form (PID-5-BF), finding evidence of invariance across White and non-White participants in these data. Any instances of diagnostic disparity were explained by group differences in maladaptive personality domains. These results provide context to the extant literature documenting mixed results about racial/ethnic differences in prevalence of personality disorders. In addition, they suggest relative specificity in BPD diagnostic bias related to sexual minority populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Borderline personality disorder symptom networks across adolescent and adult clinical samples: examining symptom centrality and replicability.

BACKGROUND: Numerous theories posit different core features to borderline personality disorder (BPD). Recent advances in network analysis provide a method of examining the relative centrality of BPD symptoms, as well as examine the replicability of findings across samples. Additionally, despite the increase in research supporting the validity of BPD in adolescents, clinicians are reluctant to diagnose BPD in adolescents. Establishing the replicability of the syndrome across adolescents and adults informs clinical practice and research. This study examined the stability of BPD symptom networks and centrality of symptoms across samples varying in age and clinical characteristics. METHODS: Cross-sectional analyses of BPD symptoms from semi-structured diagnostic interviews from the Collaborative Longitudinal Study of Personality Disorders (CLPS), the Methods to Improve Diagnostic Assessment and Service (MIDAS) study, and an adolescent clinical sample. Network attributes, including edge (partial association) strength and node (symptom) expected influence, were compared. RESULTS: The three networks were largely similar and strongly correlated. Affective instability and identity disturbance emerged as relatively central symptoms across the three samples, and relationship difficulties across adult networks. Differences in network attributes were more evident between networks varying both in age and in BPD symptom severity level. CONCLUSIONS: Findings highlight the relative importance of affective, identity, and relationship symptoms, consistent with several leading theories of BPD. The network structure of BPD symptoms appears generally replicable across multiple large samples including adolescents and adults, providing further support for the validity of the diagnosis across these developmental phases.

A Population-Based Examination of Criterion-Level Disparities in the Diagnosis of Borderline Personality Disorder Among Sexual Minority Adults.

Sexual minority individuals are diagnosed with borderline personality disorder (BPD) at higher proportions than heterosexual individuals regardless of presenting psychopathology. It is unclear if such bias is reflective of diagnostician idiosyncrasies or population-based diagnostic/criterion bias. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III were utilized to examine if differences in BPD endorsement were related to/independent of transdiagnostic factor differences between sexual minority and heterosexual individuals. BPD diagnosis/criterion endorsement was higher among sexual minority compared with heterosexual individuals (odds ratios = 1.47-3.82). Furthermore, when dysfunction/impairment associated with criterion endorsement was ignored, endorsement disparities were magnified. Diagnostic/criterion differences were mostly explained by transdiagnostic factor differences associated with sexual minority status, with some notable exceptions. These results suggest that the predilection toward BPD diagnosis among sexual minority individuals does not appear reflective of criterion-related bias. They further highlight the importance of understanding group-specific forms of psychiatric malaise and reinforce the importance of cultural humility for equitable assessment. These results further raise questions pertaining to the conceptualization and epistemology of BPD as it relates to sexual minority individuals.

Conducting Outcomes Research in a Clinical Practice Setting: The Effectiveness and Acceptability of Acceptance and Commitment Therapy (ACT) in a Partial Hospital Program.

Multiple challenges exist integrating research into clinical practice, particularly in acute care settings where randomized controlled trials may be impractical or unethical. Partial or day hospitals are one such setting. As compared to outpatients and inpatients, relatively little research is conducted or reported in partial hospital program (PHP) patients, leaving providers in this setting without a solid empirical basis from which to draw. We report treatment outcomes and patient satisfaction from the first 750 patients enrolled in a clinical research PHP utilizing the acceptance and commitment therapy (ACT) treatment model. ACT is a well-established, transdiagnostic behavior therapy. However, to date no study has examined the use of ACT in acute day hospitals. We hypothesized that applying ACT with this patient group would result in significantly improved depression, anxiety, functioning, and quality of life from intake to discharge. We additionally expected that patients would report high satisfaction with ACT treatment groups. Patients (n = 750 full sample, n = 518 completed treatment) completed daily measures of symptoms, functioning, and ACT processes at intake and discharge, and postgroup satisfaction surveys. Results showed significant improvements in symptoms and impairment. ACT process variables also increased over the course of treatment. Importantly, patient satisfaction was high for all groups. Thus, ACT provides an appropriate, flexible, effective, and satisfactory model for this patient group. A comparison of our findings using ACT to the limited research using other models in PHP settings is discussed, as well as challenges in the overall process of integrating research into routine clinical care.

Is There a Bias in the Diagnosis of Borderline Personality Disorder Among Lesbian, Gay, and Bisexual Patients?

High prevalence of borderline personality disorder (BPD) diagnosis is observed among sexual minority samples. It is unclear if sexual minority individuals are systematically diagnosed with BPD at higher rates than heterosexual individuals, and if potential diagnostic disparity can be explained by differences in maladaptive personality domains. Utilizing data from partial hospital patients (N = 1,099) the current study explored (a) differences in the frequency of diagnosis of BPD based on sexual orientation, (b) whether disparities explained differences in psychopathology across groups, and (c) the congruence between traditional methods of BPD diagnosis (i.e., clinical assessment) versus diagnosis based on elevations in self-reported maladaptive personality domains consistent with the alternative model for personality disorders. Sexual minority individuals were more likely to be diagnosed with BPD than heterosexual individuals (odds ratio [OR] = 2.43, p < .001), even after controlling for differences in clinical correlates of BPD diagnosis (age, gender, comorbid posttraumatic stress disorder, maladaptive personality domains; OR = 1.59, p < .05). Diagnostic disparity was highest for bisexual compared with heterosexual patients. These results suggest that clinicians may be predisposed to provide a BPD diagnosis to sexual minority patients that is independent of presenting psychopathology and bear important implications for future research aimed at discerning whether such predisposition is due to measure or clinician bias.

Emotion regulation accounts for associations between mindfulness and depression across and within diagnostic categories.

BACKGROUND: Previous research shows that mindfulness and emotion regulation (ER) are highly related to each other. Preliminary evidence in small clinical populations show that ER may partially account for the relationship between mindfulness and depressive symptoms. The present study aimed to investigate which diagnostic categories were associated with depressive symptoms after controlling for ER in a heterogeneous sample of treatment-seeking patients. METHODS: A large sample of psychiatric outpatients (N = 911) completed the Structured Clinical Interview for DSM-IV (SCID), Five Facet Mindfulness Questionnaire (FFMQ), Difficulties in Emotion Regulation Scale (DERS), and Clinically Useful Depression Outcome Scale (CUDOS). Partial correlations were conducted to evaluate to what degree the relationship between depression scores and facets of mindfulness were accounted for by ER scores. RESULTS: When controlling for baseline mindfulness, the relationship between emotion dysregulation and depression symptoms remained significant for all data points; however, when controlling for baseline emotion dysregulation, the association between mindfulness and depression was not significant in the majority of cases. Nonjudging was most resistant to this result. CONCLUSIONS: Although mindfulness is negatively associated with depressive symptoms, this association may be better accounted for by emotion dysregulation.

Stability and consistency of maladaptive personality domains across multiple admissions to an acute care setting.

Personality has recently been positioned as one overarching framework for conceptualizing psychopathology. Further, the DSM-5 put forth an alternative dimensional model of personality pathology which includes measurement of maladaptive personality domains. Few studies have examined the stability of maladaptive personality scores, and even fewer have done so using clinical samples not characterized by the diagnosis of personality disorder. The goal of the current study, therefore, was to examine the extent to which individual ratings of maladaptive personality were stable across multiple presentations in a clinically acute setting. Using a large sample of patients who repeatedly presented-between 2 and 4 times-for treatment at a partial hospital program (N = 482), we assessed the extent to which their scores on the Personality Inventory for DSM-5, Brief Form (PID-5 BF), differed across subsequent admissions. Results indicated that across admissions, individuals showed little differences in scores on the PID-5 BF across time, in either rank-order stability, or mean level differences. In addition, though previous scores predicted subsequent admission scores of the same maladaptive personality domains, there were few between-domain temporal associations. These results suggest that DSM-5 personality pathology domains appear highly stable and consistent over time. In addition, these findings bear implications for the continued understanding of how maladaptive personality is associated with both personality and nonpersonality psychopathology. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Associations between maladaptive personality domains and premature termination in an acute clinical setting.

Maladaptive personality has been positioned as one overarching framework with the potential to streamline conceptualization of both personality- and nonpersonality-related psychopathology. However, few studies have examined maladaptive personality in relation to (a) clinical outcomes in a naturalistic setting and (b) using measures short enough to be incorporated into standard clinical care. The goal of the current study, therefore, investigated the extent to which maladaptive personality domains-as measured by the Personality Inventory for DSM-5-Brief Form (PID-5 BF)-predicted premature treatment termination in one naturalistic clinical setting. Using a large sample (N = 2,730; 64% female) of psychiatric patients referred for treatment at a partial hospital program, we explored the associations between PID-5 BF domains and the likelihood of premature termination. Individuals who terminated treatment prematurely reported higher levels on all PID-5 BF domains, except antagonism, compared with those who successfully completed treatment. Further, elevations in the disinhibition and psychoticism domains were associated with approximately twice the odds of premature termination than normative levels, when examined in both single and multiple regression frameworks. Negative affectivity and antagonism were associated with reduced likelihood of premature termination only after controlling for elevations in other PID-5 BF domains; they showed no bivariate associations with premature termination. These results add to the literature on the clinical utility of the PID-5. Further, they suggest importance of considering personality pathology within diverse clinical populations and the use of the PID-5 BF as one easily administered screening tool that can provide important information about differential treatment response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Should childhood conduct disorder be necessary to diagnose antisocial personality disorder in adults?

BACKGROUND: Antisocial personality disorder (ASPD) is the only DSM personality disorder that requires a diagnosis of conduct disorder (CD) during childhood. Previous research comparing adults diagnosed with ASPD with adults who meet all ASPD criteria except for a history of CD (referred to in this study as adult antisocial syndrome [AAS]) have reported mixed results. This study sought to clarify the differences among adults with ASPD, adults with AAS, and a large psychiatric outpatient control group. METHODS: A series of semi-structured interviews were conducted with 2,691 psychiatric outpatients. We compared groups on demographic variables, psychiatric comorbidity, symptom presentation, parental history, and psychosocial morbidity. RESULTS: Significant differences were found among ASPD, AAS, and controls in regard to demographic variables, comorbidity, symptom presentation, and parental history. The ASPD and AAS groups were similarly impaired with respect to global functioning, occupational and social functioning, and suicidality. CONCLUSIONS: Findings suggest that by including a history of CD in ASPD criteria, our diagnostic system excludes an important group of later-onset patients who also require attention and resources. Implications, limitations, and future directions are discussed.

Community and Clinical Epidemiology of Borderline Personality Disorder.

Several studies of the prevalence of borderline personality disorder in community and clinical settings have been carried out to date. Although results vary according to sampling method and assessment method, median point prevalence is roughly 1%, with higher or lower rates in certain community subpopulations. In clinical settings, the prevalence is around 10% to 12% in outpatient psychiatric clinics and 20% to 22% among inpatient clinics. Further research is needed to identify the prevalence and correlates of borderline personality disorder in other clinical settings (eg, primary care) and to investigate the impact of demographic variables on borderline personality disorder prevalence.

The severity of psychiatric disorders.

The issue of the severity of psychiatric disorders has great clinical importance. For example, severity influences decisions about level of care, and affects decisions to seek government assistance due to psychiatric disability. Controversy exists as to the efficacy of antidepressants across the spectrum of depression severity, and whether patients with severe depression should be preferentially treated with medication rather than psychotherapy. Measures of severity are used to evaluate outcome in treatment studies and may be used as meaningful endpoints in clinical practice. But, what does it mean to say that someone has a severe illness? Does severity refer to the number of symptoms a patient is experiencing? To the intensity of the symptoms? To symptom frequency or persistence? To the impact of symptoms on functioning or on quality of life? To the likelihood of the illness resulting in permanent disability or death? Putting aside the issue of how severity should be operationalized, another consideration is whether severity should be conceptualized similarly for all illnesses or be disorder specific. In this paper, we examine how severity is characterized in research and contemporary psychiatric diagnostic systems, with a special focus on depression and personality disorders. Our review shows that the DSM-5 has defined the severity of various disorders in different ways, and that researchers have adopted a myriad of ways of defining severity for both depression and personality disorders, although the severity of the former was predominantly defined according to scores on symptom rating scales, whereas the severity of the latter was often linked with impairments in functioning. Because the functional impact of symptom-defined disorders depends on factors extrinsic to those disorders, such as self-efficacy, resilience, coping ability, social support, cultural and social expectations, as well as the responsibilities related to one's primary role function and the availability of others to assume those responsibilities, we argue that the severity of such disorders should be defined independently from functional impairment.

Suicide attempts and emotion regulation in psychiatric outpatients.

BACKGROUND: Suicidal behavior has been associated with maladaptive strategies for emotion regulation; however, limited research has explored this association after controlling for diagnosis. This study aims to explore this connection across diagnoses. We hypothesized that patients who reported greater difficulty with emotion regulation would be more likely to have made suicide attempts. METHOD: Participants included 1046 psychiatric outpatients. Diagnoses and information about suicide history were determined using semi-structured interviews. Patients also completed the Difficulties in Emotion Regulation Scale (DERS). Analyses were conducted to determine the relationships between emotion regulation difficulties and lifetime suicide attempts. RESULTS: Emotion regulation difficulties did not independently predict suicidal behavior. After controlling for the contribution of emotion dysregulation on lifetime suicide attempts, diagnoses of borderline personality disorder and posttraumatic stress disorder were the only disorders independently associated with a history of suicidal behavior. LIMITATIONS: The generalizability of our findings may be limited based on the sample's demographic characteristics and low base rate of suicide attempts. This study was cross-sectional in nature; therefore, the predictive capacity of either DERS scores or psychiatric diagnoses in terms of future suicidal behavior could not be determined. CONCLUSIONS: The independent effect of emotion dysregulation on suicidal behavior was negated after controlling for psychiatric diagnosis. Individuals with certain disorders tend to make suicide attempts for reasons that are distinct from emotion dysregulation, whereas emotion dysregulation may be at the core of suicidality for individuals with other clinical presentations.

Psychosocial morbidity associated with bipolar disorder and borderline personality disorder in psychiatric out-patients: comparative study.

BACKGROUND: The morbidity associated with bipolar disorder is, in part, responsible for repeated calls for improved detection and recognition. No such commentary exists for the improved detection of borderline personality disorder. Clinical experience suggests that it is as disabling as bipolar disorder, but no study has directly compared the two disorders. AIMS: To compare the levels of psychosocial morbidity in patients with bipolar disorder and borderline personality disorder. METHOD: Patients were assessed with semi-structured interviews. We compared 307 patients with DSM-IV borderline personality disorder but without bipolar disorder and 236 patients with bipolar disorder but without borderline personality disorder. RESULTS: The patients with borderline personality disorder less frequently were college graduates, were diagnosed with more comorbid disorders, more frequently had a history of substance use disorder, reported more suicidal ideation at the time of the evaluation, more frequently had attempted suicide, reported poorer social functioning and were rated lower on the Global Assessment of Functioning. There was no difference between the two patient groups in history of admission to psychiatric hospital or time missed from work during the past 5 years. CONCLUSIONS: The level of psychosocial morbidity associated with borderline personality disorder was as great as (or greater than) that experienced by patients with bipolar disorder. From a public health perspective, efforts to improve the detection and treatment of borderline personality disorder might be as important as efforts to improve the recognition and treatment of bipolar disorder.

Does Borderline Personality Disorder Manifest Itself Differently in Patients With Bipolar Disorder and Major Depressive Disorder?

Perugi and colleagues (2013) recently reported that some features of borderline personality disorder (BPD) significantly predicted a diagnosis of bipolar disorder among depressed patients. They interpreted these findings as indicating that some BPD criteria are nonspecific and are indicators of bipolar disorder rather than BPD, whereas other criteria are more specific to BPD. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors tested the hypothesis that BPD presents itself differently in psychiatric outpatients diagnosed with bipolar disorder or major depressive disorder. The authors found that the patients with bipolar disorder were significantly more likely to report impulsive behavior and transient dissociation. No criterion was significantly more common in the BPD patients with MDD. The authors therefore do not consider the BPD criteria to be nonspecific with regard to the distinction between BPD and bipolar disorder.

A brief, clinically useful, clinician-rated dimensional rating system for psychiatric diagnoses: reliability and validity in psychiatric outpatients.

BACKGROUND: In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we describe the development of a dimensional rating system for Axis I disorders. METHODS: We evaluated 1,600 psychiatric outpatients with a semi-structured diagnostic interview for Axis I disorders and completed a self-report measure of psychosocial morbidity. A Standardized Clinical Outcome Rating (SCOR), a 7-point dimensional rating, was made for 17 Axis I disorders and 1 symptom construct. RESULTS: The dimensional ratings were highly reliable. After controlling for the number of Axis I disorders, each of the partial correlations between the dimensional rating and the measures of psychosocial morbidity was significant (mean partial r = 0.21). However, when the dimensional score was controlled, none of the partial correlations between the sum of the number of Axis I disorders and measures of psychosocial morbidity were significant (mean partial r = 0.03). CONCLUSIONS: The SCORs are brief standardized outcome ratings that clinicians can incorporate into routine clinical practice without incurring undue burden. These ratings could make it more feasible to conduct effectiveness studies in clinical practice and to extend measurement-based care recommendations to include clinical ratings as well as self-report assessments.

An Integrated, Acceptance-Based Behavioral Approach for Depression With Social Anxiety: Preliminary Results.

Depression and social anxiety disorder (SAD) are highly comorbid, resulting in greater severity and functional impairment compared with each disorder alone. Although recently transdiagnostic treatments have been developed, no known treatments have addressed this comorbidity pattern specifically. Preliminary support exists for acceptance-based approaches for depression and SAD separately, and they may be more efficacious for comorbid depression and anxiety compared with traditional cognitive-behavioral approaches. The aim of the current study was to develop and pilot test an integrated acceptance-based behavioral treatment for depression and comorbid SAD. Participants included 38 patients seeking pharmacotherapy at an outpatient psychiatry practice, who received 16 individual sessions of the therapy. Results showed significant improvement in symptoms, functioning, and processes from pre- to post-treatment, as well as high satisfaction with the treatment. These results support the preliminary acceptability, feasibility, and effectiveness of this treatment in a typical outpatient psychiatry practice, and suggest that further research on this treatment in larger randomized trials is warranted.

Comorbid bipolar disorder and borderline personality disorder and history of suicide attempts.

Both bipolar disorder and borderline personality disorder are associated with elevated rates of attempted suicide; however, no studies have examined whether there is an independent, additive risk for suicide attempts in patients diagnosed with both disorders. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, 3,465 psychiatric outpatients were interviewed with semistructured interviews. Compared to the bipolar patients without borderline personality disorder, the patients diagnosed with both bipolar and borderline personality disorder were significantly more likely to have made a prior suicide attempt. The patients with borderline personality disorder and bipolar disorder were nonsignificantly more likely than the borderline patients without bipolar disorder to have made a prior suicide attempt. Bipolar disorder and borderline personality disorder were each associated with an increased rate of suicide attempts. The co-occurrence of these disorders conferred an additive risk, although the influence of borderline personality disorder was greater than that of bipolar disorder.

Problematic boundaries in the diagnosis of bipolar disorder: the interface with borderline personality disorder.

It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. The most studied question on the relationship between BPD and bipolar disorder is their diagnostic concordance. Across studies approximately 10 % of patients with BPD had bipolar I disorder and another 10 % had bipolar II disorder. Likewise, approximately 20 % of bipolar II patients were diagnosed with BPD, though only 10 % of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is, nonetheless, diagnosed in the absence of the other in the vast majority of cases (80-90 %). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are more commonly diagnosed in patients with BPD than is bipolar disorder. Studies comparing patients with BPD and bipolar disorder find significant differences on a range of variables. These findings challenge the notion that BPD is part of the bipolar spectrum. While a substantial literature has documented problems with the under-recognition and under-diagnosis of bipolar disorder, more recent studies have found evidence of bipolar disorder over-diagnosis and that BPD is a significant contributor to over-diagnosis. Re-conceptualizing the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, diagnostic criteria for bipolar disorder as a type of test, rather than the final word on diagnosis, shifts the diagnostician from thinking solely whether a patient does or does not have a disorder to considering the risks of false-positive and false-negative diagnoses, and the ease by which each type of diagnostic error can be corrected by longitudinal observation.

The relationship between borderline personality disorder and bipolar disorder.

It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum.

En los pacientes que buscan un tratamiento para la depresíón es importante, clínicamente, reconocer tanto el trastorno bipolar como el trastorno de personalidad borderline (TPB) y es primordíal poder distinguirlos. Las investigaciones que consideran que el TPB debe ser íncluido como parte del espectro bípolar llegan a distintas conclusiones. Se revisó la pregunta más estudiada acerca de la relación entre el TPB y el trastorno bipolar: ¿cuál es su concordancía diagnóstica? Entre los estudíos se encontró que aproxímadamente el 10% de los pacientes con TPB tenía un trastorno bipolar I y otro 10% tenía un trastorno bipolar II. Asimismo, aproxímadamente el 20% de los pacíentes bípolares II fue diagnostícado con TPB, en cambio sólo el 10% de los bípolares I tuvo ese díagnóstico. A pesar de que las cifras de comorbilidad son considerables, cada trastorno es díagnostícado en ausencía del otro en la gran mayoría de los casos (80% a 90%). En los estudios que examínan en general los trastornos de personalidad, los pacientes bipolares fueron díagnostícados más comúnmente con otros trastornos de la personalidad que con el TPB. Asimismo, lo inverso también es verdadero: otros trastornos del eje I como la depresión mayor, el abuso de sustancías y el trastorno por estrés postraumático también fueron díagnostícados con mayor frecuencia en pacientes con TPB que en el trastorno bípolar. Estos hallazgos ponen en tela de juícío la idea que el TPB es parte del espectro bípolar.

Il est important de reconnaître cliniquement le trouble bipolaire et la personnalité « borderline ¼ (PBL) chez les patients demandant un traitement antidépresseur, et de les distinguer l'un de l'autre. Pour la recherche, l'appartenance de la PBL au cadre des troubles bipolaires a donné lieu à des conclusions divergentes. Nous analysons la question la plus étudiée sur la relation entre la PBL et le trouble bipolaire: leur concordance diagnostique. Dans les études, environ 10% des patients ayant une PBL sont atteints de trouble bipolaire 1 et 10% de trouble bipolaire II. De même, environ 20% des patients bipolaires II souffrent de PBL alors que seulement 10% des patients bipolaires I ont une PBL. Les taux de comorbidité sont importants mais chaque maladie est néanmoins diagnostiquée en l'absence de l'autre dans la grande majorité des cas (80 à 90%). Dans les études s'intéressant aux troubles de la personnalité de manière plus large, les autres troubles de la personnalité ont été plus fréquemment diagnostiqués chez les patients bipolaires. L'inverse est également vrai: les autres troubles de l'axe I comme la dépression majeure, les abus de substance et les états de stress post-traumatique sont plus fréquemment rencontrés chez les patients PBL que chez les patients bipolaires. Ces résultats remettent en question la notion de l'appartenance de la PBL au cadre bipolaire.