Approximately 20% of patients diagnosed with bipolar disorder are also found to suffer from borderline personality disorder (Zimmerman & Morgan, 2013). While some of the symptoms and characteristics of both disorders are similar, it is important, as Zimmerman and Morgan (2013) point out, to distinguish between the two, as each requires its own form of treatment in order to allow the patient to overcome the issues associated with each. This paper will discuss the treatment considerations for a person presenting with both bipolar disorder and personality disorder.
Comorbid Disorders
DSM-5 (2013) states that the diagnostic criteria for Bipolar 1 Disorder are: “For a diagnosis of bipolar 1 disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes” (p. 123). Mania is described as a distinct period of high self-esteem, flighty ideas, easy distraction, pursuit of high risk ideas and lack of sleep. Depression is described as consisting of decreased energy, feelings of worthlessness, trouble concentrating, possible suicidal ideation, changes in psychomotor activity. Bipolar episodes consist of irrational periods of both manic episodes followed by or preceded by episodes of severe depression.
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DSM-5 (2013) also describes a variety of personality disorders—paranoia, antisocial, borderline, narcissism. Borderline personality disorder is frequently found in patients suffering from bi-polar disorder but there is a need to distinguish them as one is a mood disorder and the other is a personality disorder (Yao et al., 2015). The DSM-5 states that for borderline personality disorder, day-to-day changes in the person’s emotions are likely to be seen based on stress levels, the individual will engage in intense relationships and lack the ability to control the emotions, there will be signs of self-harm while feelings of boredom and apathy persist or coincide with feelings of intense emotion, whether joy or anger, typically followed by feelings of intense guilt and remorse.
Treatment Considerations for Personality Disorders
Four possible treatment options for a diagnosis of Bipolar I disorder would be a) psychopharmacological treatments, b) psychological treatments, c) family therapy based treatments, and d) biomedical treatments. These options are not really any different from those that might be provided for a patient suffering from personality disorder. For comorbidity of bipolar and personality disorder, the treatment would likely consider a combination of drugs and therapy. ….....
American Psychiatric Association. (2013). DSM-V. DC: APA.
Connolly, K. & Thase, M. (2011). The clinical management of bipolar disorder: A review of evidence-based guidelines. Primary Care Companion for CNS Disorders, 13(4): 1-4.
Yao, J., Xu, Y., Qin, Y., Liu, J., Shen, Y., Wang, W., & Chen, W. (2015). Relationship between personality disorder functioning styles and the emotional states in bipolar I and II disorders. PloS one, 10(1), e0117353.
Zimmerman, M., & Morgan, T. A. (2013). The relationship between borderline personality disorder and bipolar disorder. Dialogues in Clinical Neuroscience, 15(2), 155.
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