Differentiating bipolar disorder from borderline personality disorder: Diagnostic accuracy of the difficulty in emotion regulation scale and personality inventory for DSM-5

James Chris Fowler, Alok Madan, Jon G. Allen, John M. Oldham, B. Christopher Frueh

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Background: Confusion abounds when differentiating the diagnoses of bipolar disorder (BD) from borderline personality disorder (BPD). This study explored the relative clinical utility of affective instability and self-report personality trait measures for accurate identification of BD and BPD. Methods: Receiver operator characteristics and diagnostic efficiency statistics were calculated to ascertain the relative diagnostic efficiency of self-report measures. Inpatients with research-confirmed diagnoses of BD (n = 341) or BPD (n = 381) completed the Difficulty in Emotion Regulation Scale (DERS) and Personality Inventory for DSM-5 (PID-5). Results: The total score for DERS evidenced relatively poor accuracy for differentiating the disorders (AUC = 0.72, SE = 0.02, p <.0001), while subscales of affective instability measures yielded fair discrimination (AUC range = 0.70–0.59). The PID-5 BPD algorithm (consisting of emotional lability, anxiousness, separation insecurity, hostility, depressivity, impulsivity, and risk taking) evidenced moderate-to-excellent accuracy (AUC = 0.83, SE = 0.04, p <.0001) with a good balance of specificity (SP = 0.79) and sensitivity (SN = 0.77). Conclusion: Findings support the use of the PID-5 algorithm for differentiating BD from BPD. Furthermore, findings support the accuracy of the DSM-5 alternative model Criteria B trait constellation for differentiating these two disorders with overlapping features.

Original languageEnglish (US)
Pages (from-to)856-860
Number of pages5
JournalJournal of Affective Disorders
Volume245
DOIs
StatePublished - Feb 15 2019

Keywords

  • Bipolar disorder
  • Borderline personality disorder
  • Diagnostic test
  • Emotion dysregulation

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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