Why Does BPD Receive Less Attention Than Bipolar Disorder?
Federal funding for research on borderline personality disorder (BPD) is considerably lower than funding for research on the group of mood disorders known collectively as bipolar disorder. In April 2015 in the Journal of Personality Disorders, a researcher from Brown Medical School reviewed some of the possible reasons why BPD receives less attention in the scientific community than bipolar disorder, despite known risks for co-occurrence of the two illnesses and a shared ability to produce a devastating impact on the lives of affected individuals.
Borderline Personality Disorder
Along with antisocial personality disorder, histrionic personality disorder and narcissistic personality disorder, borderline personality disorder belongs to a group of conditions officially known as Cluster B personality disorders. All four of these conditions reduce the ability to exert emotional control and to limit participation in impulsive behavior. BPD, in particular, centers on a level of emotional volatility that makes relationships with others difficult to maintain and frequently poses a threat to the health of the affected individual. The most severe potential manifestation of the disorder is a preoccupation with suicidal planning and behavior. The eight additional possible symptoms of BPD include highly polarized “night-and-day” attitudes toward friends and loved ones, prominent bouts of anxiety or depression, lack of a consistent sense of self, strong feelings of dissociation or detachment, recurring involvement in highly impulsive behavior and a strongly negative reaction to any real or imagined instances of abandonment by others.
The baseline estimate for the rate of borderline personality disorder in American adults is 1.6 percent; however, the actual number of affected individuals may be more than three times higher. Suicidal behaviors appear in as many as four out of five people with the condition, and completed suicide is the cause of death in up to 9 percent of all BPD cases. Psychotherapists have developed a treatment approach called dialectical behavior therapy specifically to address the suicidal tendencies associated with borderline personality disorder.
Overlap With Bipolar Disorder
Bipolar disorder (a group of conditions characterized by alternating or mixed bouts of mania and depression) is recognized as a possible co-occurring illness in people with borderline personality disorder. In a study published in 2014 in the Journal of Affective Disorders, a Swiss research team assessed the amount of overlap between cases of bipolar disorder and cases of BPD (as well as cases of attention-deficit hyperactivity disorder or ADHD). These researchers concluded that more than half of all people with bipolar disorder separately qualify for a borderline personality disorder diagnosis. They attributed this high degree of co-occurrence to the presence of cyclothymia, a form of bipolar disorder that produces long-lasting periods of relatively mild mania and depression, not to the presence of the more well-known and severe bipolar I disorder.
Why Does BPD Receive Less Attention?
In the report published in the Journal of Personality Disorders, the Brown Medical School researcher looked at a range of reasons why the federal National Institute of Health—one of the primary funders of mental health research in the U.S.—provides far more financial resources for the study of bipolar disorder than for the study of equally severe and commonly co-occurring borderline personality disorder. Specifically, the researcher wanted to know if professionals who research bipolar disorder do something different than their counterparts who research BPD.
The Brown Medical School researcher ultimately identified several key differences between the approaches used by bipolar disorder researchers and BPD researchers. Practices in the bipolar disorder research community that likely highlight the importance of the condition for funders include emphasizing the problem of bipolar disorder underdiagnosis, producing and popularizing screening tools specifically designed to help identify people affected by bipolar illness, emphasizing the diverse range of symptoms that can appear in people with bipolar illness and stressing the societal costs of failing to help individuals dealing with bipolar illness.
The report’s author believes that borderline personality disorder researchers simply don’t address these issues frequently enough or well enough to highlight the potentially severe outcomes associated with BPD. The importance of this failure is highlighted by the fact that the American Psychiatric Association (which sets the standards for mental health diagnoses in the U.S.) seriously considered eliminating or drastically changing the definitions for BPD and all other personality disorders in 2013.