Borderline personality disorder and bipolar II disorder share some common features, but the illnesses can be distinguished by patients’ differences in emotion regulation strategies and perceptions of how their parents raised them, according to a report published online in the Journal of Affective Disorders.
Forty-eight psychiatric outpatients, half with borderline personality disorder and half with bipolar II, were recruited by Kathryn Fletcher of the University of New South Wales, Sydney, and the Black Dog Institute, Randwick, and her colleagues. The mean age of the outpatients was 33 years. Those with borderline reported a younger age of depression onset, and a higher proportion of patients in that group had more lifetime suicide and attempts at self-harm.
Ms. Kathryn Fletcher
The participants completed the Cognitive Emotion Regulation Questionnaire and the Difficulties in Emotion Regulation Scale, both 36-item tests aimed at assessing strategies to regulate emotion. They also completed the Measure of Parental Style, a test that seeks to assess perceived parent abuse, indifference, and overcontrol.
Overall, the investigators found that the outpatients with borderline personality disorder scored "significantly higher than those with [bipolar II] on a number of maladaptive emotion regulation strategies, including difficulty controlling impulsive behaviors, having limited access to emotion regulation strategies, and a tendency to self-blame, catastrophize, and blame others," Ms. Fletcher and her colleagues wrote (J. Affect. Disord. 2014;157:52-9).
They found that the outpatients with borderline personality disorder were "significantly less likely than those with [bipolar II] to use adaptive cognitive emotion regulation strategies, including planning, positive reappraisal, and putting things into perspective."
Those with borderline also scored significantly higher on most perceived parental style subscales, "indicating a maternal relationship characterized by indifference, abuse, and overcontrol and a paternal relationship characterized by abuse and overcontrol."
Identifying "maladaptive strategies to regulate emotion highlights specific targets for psychological intervention," the authors said. "However, given that those with [borderline personality disorder] and [bipolar II] displayed differing patterns of emotion dysregulation, there may be a need to tailor intervention strategies," such as positive reappraisal and promotion of acceptance in borderline.
Psychological therapies focusing on lessening the impact of "toxic childhood experiences" might help patients with both disorders, they said.
Ms. Fletcher and her colleagues cited several limitations. Among them were a relatively small sample size and the absence of statistical control for numerous sociodemographic and clinical characteristics that differed between the groups.
This study was supported by the National Health and Medical Research Council, Australia’s main funding body for medical research. The authors reported no relevant financial conflicts of interest.