Borderline Personality Disorder - Diagnosis - Differential Diagnosis and Comorbidity

Differential Diagnosis and Comorbidity

Comorbid (co-occurring) conditions are common in BPD. When comparing individuals diagnosed with BPD to those diagnosed with other personality disorders, the former showed a higher rate of also meeting criteria for

  • anxiety disorders – the large majority of borderlines have an anxiety disorder
  • mood disorders (including clinical depression and bipolar disorder) – the vast majority of BPD patients have a mood disorder
  • eating disorders (including anorexia nervosa, and bulimia)
  • somatoform or factitious disorders – these occur to a somewhat lesser extent
  • dissociative disorders
  • Substance abuse is a common problem in BPD, whether due to impulsivity or as a coping mechanism, and 50 percent to 70 percent of psychiatric inpatients with BPD have been found to meet criteria for a substance use disorder, especially alcohol dependence or abuse which is often combined with the abuse of other drugs.

A high proportion of people with BPD also have attention deficit hyperactivity disorder. The two conditions share some features, including impulsivity.

Borderline personality disorder and mood disorders often appear concurrently. Some features of borderline personality disorder may overlap with those of mood disorders, complicating the differential diagnostic assessment. Both diagnoses involve symptoms commonly known as "mood swings." In borderline personality disorder, the term refers to the marked lability and reactivity of mood defined as emotional dysregulation. The behavior is typically in response to external psychosocial and intrapsychic stressors, and may arise or subside, or both, suddenly and dramatically and last for seconds, minutes, hours, days, weeks or months. Bipolar depression is generally more pervasive with sleep and appetite disturbances, as well as a marked non-reactivity of mood, whereas mood with respect to borderline personality and co-occurring dysthymia remains markedly reactive and sleep disturbance not acute.

Some hold that BPD represents a subthreshold form of affective disorder, while others maintain the categorical distinction between the disorders while noting they often co-occur. Some findings suggest BPD lies on a bipolar spectrum, with a number of points of phenomenological and biological overlap between the affective lability criterion of borderline personality disorder and the extremely rapid cycling bipolar disorders. Other findings suggest that the DSM-IV BPD diagnosis mixes up two sets of unrelated items—an affective instability dimension related to Bipolar-II, and an impulsivity dimension not related to Bipolar-II.

General medical conditions can cause behavioral dysfunction resulting in a clinical picture that may resemble to some degree BPD. This may include hormonal dysfunction over a long period, and brain dysfunction (e.g. the encephalopathy caused by Lyme disease). These conditions may isolate the patient socially and emotionally, and/or cause limbic damage to the brain. However, it is not BPD that results, but rather a reaction to the isolating circumstances caused by a medical condition and the possibly coincident struggles of the patient to control his or her mood given damage to the brain's limbic system. Heavy alcohol usage over a long period itself can cause an encephalopathy which may cause limbic damage, and various frontal lobe syndromes can also result in disinhibition and impulsive behavior resembling BPD.

Read more about this topic:  Borderline Personality Disorder, Diagnosis

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