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Factors associated with borderline personality disorder in major depressive patients and their relationship to bipolarity

Published online by Cambridge University Press:  15 April 2020

J.M. Azorin*
Affiliation:
SHU Psychiatrie Adultes, Sainte-Marguerite Hospital, 13274Marseille cedex 9, France
A. Kaladjian
Affiliation:
SHU Psychiatrie Adultes, Sainte-Marguerite Hospital, 13274Marseille cedex 9, France
M. Adida
Affiliation:
SHU Psychiatrie Adultes, Sainte-Marguerite Hospital, 13274Marseille cedex 9, France
E. Fakra
Affiliation:
SHU Psychiatrie Adultes, Sainte-Marguerite Hospital, 13274Marseille cedex 9, France
R. Belzeaux
Affiliation:
SHU Psychiatrie Adultes, Sainte-Marguerite Hospital, 13274Marseille cedex 9, France
E. Hantouche
Affiliation:
Anxiety and Mood Center, CTAH, Paris, France
S. Lancrenon
Affiliation:
Sylia-Stat, Bourg-La-Reine, France
*
*Corresponding author. Tel.: +33 4 91 74 40 82; fax: +33 4 91 74 55 78. E-mail address:jazorin@ap-hm.fr (J.M. Azorin).
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Abstract

Objective

To analyze the interface between borderline personality disorder (BPD) and bipolarity in depressed patients comorbid with BPD.

Methods

As part of National Multi-site Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 19 (3.9%) had comorbid BPD (BPD+), whereas 474 (96.1%) did not manifest this comorbidity (BPD−).

Results

Compared to BPD (−), BPD (+) patients displayed higher rates of bipolar (BP) disorders and temperaments, an earlier age at onset with a family history of affective illness, more comorbidity, more stressors before the first episode which was more often depressive or mixed, as well as a greater number and severity of affective episodes.

Conclusions

The hypothesis which fitted at best our findings was to consider BPD as a contributory factor in the development of BP disorder, which could have favoured the progression from unipolar major depression to BP disorder. We could not however exclude that some features of BP disorder may have contributed to the development of BPD.

Type
Original article
Copyright
Copyright © 2012 Elsevier Masson SAS

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