Borderline personality disorder as debilitating as bipolar disorder, experts say

"The level of psychosocial morbidity and suicidality associated with BPD is as great, or greater, than that experienced by patients with bipolar disorder," said Zimmerman, director of outpatient psychiatry at Rhode Island Hospital and director of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project. "From a public health perspective, improving the detection and treatment of BPD is as imperative as diagnosing and treating bipolar disorders."

The National Institute of Mental Health estimates that 1.6 percent of the U.S. population is diagnosed with BPD, compared with 2.6 percent of those with bipolar disorder.

This is the largest comparison of patients who have been diagnosed with BPD or bipolar disorder. Persons with BPD have difficulty regulating emotions and thoughts, often teetering at extremes. They engage in impulsive and reckless behavior, and their relationships with other people are rocky. While persons with bipolar disorder experience the same mood for weeks, those with BPD cope with intense bouts of anger, depression and anxiety that are short in duration. According to Zimmerman's study, clinical experience suggests that BPD is as disabling as bipolar disorders. In psychiatric patient samples, BPD is as frequent as bipolar disorder.

Like bipolar patients, persons with BPD are likely to also suffer from depression, anxiety disorders, substance abuse, eating disorders and suicidal behaviors. These co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to recognize BPD in patients with these other mental illnesses.

"Despite the clinical and public health significance of both of these disorders, it sometimes seems as if BPD lives in the shadow of bipolar disorder," said Zimmerman. "Bipolar disorder is a widely researched, well-publicized, well-funded topic. By contrast, BPD is seldom discussed and it is not included in the Global Burden of Disease study, a comprehensive registry that quantifies diseases by cost, mortality, geography, risk and other factors."

This study was a component of the MIDAS project, which is an ongoing clinical research study at Rhode Island Hospital involving the integration of research assessment methods into routine clinical practice.