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Borderline personality disorder risk raised in early-onset bipolar disorder

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Borderline personality disorder risk raised in early-onset bipolar disorder


Study findings suggest that early onset of bipolar disorder may be important in the pathogenesis of comorbid borderline personality features.

MedWire News: Regardless of severe childhood trauma/abuse, the risk for developing comorbid borderline personality is increased in early-onset bipolar disorder, say US scientists who warn the prevalence may be underestimated.

Early-onset bipolar disorder is increasingly seen as an important prognostic factor, as adults who have had adolescent or preadolescent affective symptoms appear to have increased familiality, substance abuse, and other comorbidities, mixed episodes and depressive symptoms, rapid cycling, and suicide attempts, and fewer days well.

To determine the relationship between bipolar disorder onset and the development of comorbid borderline personality disorder, a team led by Joseph Goldberg, from Mount Sinai School of Medicine in New York, studied 100 bipolar disorder patients attending a clinic.

Illness onset was before 19 years of age in 55% of participants, and the median age of onset was 18.5 years. The polarity of the first episode was depressed in 56% and manic or hypomanic in the remaining 44%, and there was no significant difference in age of onset between first-episode polarity groups.

The team reports in the journal Bipolar Disorders that 16 patients had comorbid borderline personality disorder. These patients had a significantly earlier age of onset than other patients, at 12.7 years versus 19.7 years.

While patients with comorbid borderline personality disorder had higher summed Childhood Trauma Questionnaire (CTQ) scores than other patients, at 61.8 versus 50.6, the difference in the prevalence of severe childhood sexual abuse, at 31% versus 19%, was not significant.

Taking into account age, gender, ethnicity, polarity of the initial lifetime episode, a history of severe childhood sexual abuse, or a history of any severe childhood abuse, the team found that, with every 1-year delay in the onset of bipolar disorder, the risk for developing comorbid borderline personality disorder reduced by 9%.

They conclude: “It is conceivable that severe childhood abuse could precipitate the expression of bipolar disorder in genetically vulnerable youth. At the same time, severe abuse coupled with affective symptoms during childhood or adolescence could also lead to synergistic neurotoxicity, as suggested by structural neuroimaging data.

“The current findings suggest that psychopathology features could result from the confluence of both childhood trauma and early-onset depression, particularly the latter.”

MedWire ([sign in to see URL]) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

  a.. Bipolar Disord 2009; 11: 205–208

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Mar/19/2009, 12:10 pm Link to this post  

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