Bipolar and Borderline Disorders

Bipolar and Personality Disorder Introduction 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. 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.

A pharmacological approach to treatment would include the use of lithium, divalproex, or an antipsychotic medication for manic episodes and quetiapine or lamotrigine for depression (Connolly & Thase, 2011). However, not all patients are going to want to use drugs, as the side effects can be troublesome.

Nonetheless, this method is helpful in stabilizing the patient, while cognitive behavioral therapy can be used to help treat the patient by focusing on thought patterns, identifying troubling impulses and working with the patient to engage in thought processes with target behaviors as goals to change the way the individual responds to stimuli that would otherwise push the person from one extreme of feeling to another. Case Example A case example would be a young man in college named Brad who will often stay up for days playing video games.

He gets good grades and is well-regarded but has moments of severe depression about not being as good as others, and generally his emotions are hard to predict from one day to the next as he bounces between extremes so randomly. Moments of depression are usually followed by episodes of delusions of grandeur regarding how great he could be if he just got the chance to show everyone.

One day at school, he saw a student driving a nice BMW park the car but leave it idling while the student ran into the book store. Brad decided to take the car for a joy ride and return it before the student noticed it was gone. Ten minutes later, Brad was pulled over in the BMW and arrested. He had never done anything like this before and he could not understand what the big deal was.

He became quite angry about everyone’s overreaction only later in the jail to be overcome with grief and remorse. Brad displays characteristics of both bipolar disorder and borderline personality disorder. His manic episodes (delusions of grandeur) following depressive episodes (feeling like he is not.