In the past ten years, it has become increasingly obvious that often Borderline Personality Disorder doesn't seem to be a Personality Disorder at all . Or, looking at it from another direction, what is called Bipolar II is, in over 75% of the cases, difficult to distinguish from Borderline Personality. The treatments for BPD are identical to those for BP, from the particular types of drugs to the particular types of psychotherapies. Symptom and Behavioral ranges are the same.

Also, while Bipolar II is already known to be genetic, both BD and BPD are known to be associated with emotionally traumatic childhoods. It is thought that Bipolar is likely to be triggered by aggravating life circumstances.

Bipolar II disorder DSM-IV definition 'needs widening'

3 January 2007

And international team of researchers argue that the DSM-IV definition of bipolar II disorder should be widened to give greater emphasis to temperamentally based mood and anxious reactivity, which is likely to result in better genotyping.

Bipolar II disorder is characterized by depression and hypomania in DSM-IV, with scant attention paid to Affective Instability, which is often linked to anxiety disorder comorbidities, primarily Panic Disorder and Agoraphobia (PDA).

Noting that this has implications for genetic–familial associations, Hagop Akiskal, from the University of California at San Diego, and colleagues studied 107 patients classified on DSM-IV as having a major depressive episode with atypical features, dividing them into groups depending on whether they met the co-occurring criteria for Panic Disorder and Agoraphoria (PDA).

The patients were also examined using the Atypical Depression Diagnostic Scale, the Hopkins Symptoms Check-list, and the Hamilton Rating Scale for Depression, the team reports in the Journal of Affective Disorders.

The criteria for DSM-IV Panic Disorder and Agoraphoria (PDA) were met by 46.7% of the patients. Patients with PDA were significantly more likely to be female and have hypomanic episodes and stressors, in addition to which, they were significantly more likely to have bipolar II disorder and be cyclothymic than were patients without Panic Disorder and Agoraphoria (PDA).

The results also show that patients who had Panic Disorder and Agoraphoria (PDA) had significantly higher ratings of Reactivity, Somatization, Obsessive–Compulsive Disorder, and Phobic Anxiety than non-PDA individuals.


In all, 75.5% of patients met the criteria for bipolar II disorder, which was characterized by PDA and Borderline Personality features, as well as cyclothymic and hyperthymic temperaments.

"To summarize, our substantive findings in our attempt to redefine the phenomenology of Bipolar II Disorder indicate that Mood Instability along Cyclothymic Temperamental lines and associated Panic Attacks are significantly associated phenotypic characteristics," the team writes.

"The soft bipolar spectrum needs to be redefined by its Anxious-Sensitive, Impulse Dyscontrol, Addictive and Binge-Eating expressions, representing "Overlapping Diatheses" (i.e., "inherited as a package deal" - Teri)instead of being considered independent 'comorbidities'."

Diatheses -
A hereditary predisposition of the body to a disease, a group of diseases, an allergy, or another disorder. - The Medical Dictionary


Source: Journal of Affective Disorders 2006; 96: 239–247