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Conclusion: Integration and Synthesis

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Borderline Personality and Mood Disorders

Abstract

The complex overlaps and distinctions between mood disorders and borderline personality disorder (BPD) have been increasingly clarified through debate, research, and clinical innovation. This book reviews the current literature on the complex relationships between these realms of psychiatric illness, leading to five general conclusions. First, depression and BPD are clinically and biologically distinguishable, yet highly comorbid, suggesting shared underlying liabilities which increase risk for comorbidity and prolonged course of illness. Second, bipolar disorder and BPD phenotypically overlap, leading to problems of misdiagnosis, but are far less frequently comorbid, suggesting more disparate etiologies. Third, depression, bipolar disorder, and BPD all involve the interaction between temperamental or trait-like features and acute episodic symptoms or state-like features. Fourth, in young patients, the overlap in symptoms, precursors, and risk factors shared among mood disorders and BPD challenges clinicians in making accurate early diagnosis, suggesting clinical interventions should be staged to reduce the tendency towards premature diagnostic certainty and poorly scaled interventions. Fifth, while psychopharmacologic treatment is primary for depression and bipolar disorder and adjunctive for BPD, psychotherapeutic approaches are primary for BPD and adjunctive for depression and bipolar disorder. The integration of findings suggests that depressive, bipolar, and borderline personality disorders are distinguishable but commonly co-occur, so proper diagnosis can facilitate more complex, comprehensive, and effective treatment for both the acute symptoms and chronic vulnerabilities underlying these diagnostic categories.

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Author information

Authors and Affiliations

  1. Department of Psychiatry, Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA

    Lois W. Choi-Kain MD, MEd & John G. Gunderson MD

  2. McLean Hospital, 115 Mill Street, M/S 312, Belmont, MA, 02478, USA

    Lois W. Choi-Kain MD, MEd & John G. Gunderson MD

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  1. Lois W. Choi-Kain MD, MEd
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  2. John G. Gunderson MD
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Correspondence to Lois W. Choi-Kain MD, MEd .

Editor information

Editors and Affiliations

  1. McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA

    Lois W. Choi-Kain

  2. McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA

    John G. Gunderson

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Choi-Kain, L.W., Gunderson, J.G. (2015). Conclusion: Integration and Synthesis. In: Choi-Kain, L., Gunderson, J. (eds) Borderline Personality and Mood Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1314-5_14

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  • DOI: https://doi.org/10.1007/978-1-4939-1314-5_14

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1313-8

  • Online ISBN: 978-1-4939-1314-5

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