Dr Gonzalez-Pinto and Colleagues Reply

See letter by di Giacomo et al and article by de la Rosa et al

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Dr Gonzalez-Pinto and Colleagues Reply

To the Editor: In their letter to the editor,1 Dr di Giacomo and colleagues point out that in their study,2 only 3.6% of individuals who were diagnosed with borderline personality disorder met criteria for bipolar II disorder. The difference in results between the di Giacomo et al study and ours3 is most likely due to methodological differences. For example, their study focused on treatment-seeking patients in 6 Italian cities. By contrast, the National Epidemiologic Survey on Alcohol and Related Conditions aimed to be representative of the US adult population, regardless of whether they sought treatment, and assessed comorbidity in all individuals. Further, di Giacomo et al2 used a categorical approach to comorbidity, based on diagnoses, and compared dimensional assessments of psychopathology between the 2 categories (113 bipolar I disorder patients in a mixed or manic state without borderline personality disorder versus 95 borderline personality disorder patients, 3 of whom met criteria for bipolar II disorder). Instead, our study3 used a dimensional approach, based on latent factors. Also, the personality disorder evaluation in the di Giacomo study2 was conducted when the patients were in a manic or mixed state, with an average Young Mania Rating Scale score of 33. All of these factors in their approach may have influenced the rates of comorbidity found in their sample.

Although as clinicians and researchers we agree that it is sometimes easy to differentiate borderline personality disorder from bipolar disorder, based on the published literature4 and our own findings, we believe that in some cases the differential diagnosis is more difficult and in others, the diagnoses co-occur. As our understanding of the phenomenology and neurobiology of psychiatric disorders advances, it will be important to continue to examine the relationship between borderline personality disorder and bipolar disorder.

References

1. di Giacomo E, Colmegna F, Aspesi F, et al. Distinguishing between borderline personality disorder and bipolar disorder. J Clin Psychiatry. 2018;79(2):17lr11919.

2. di Giacomo E, Aspesi F, Fotiadou M, et al. Unblending borderline personality and bipolar disorders. J Psychiatr Res. 2017;91:90-97. PubMed CrossRef

3. de la Rosa I, Oquendo MA, Garcí­a G, et al. Determining if borderline personality disorder and bipolar disorder are alternative expressions of the same disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2017;78(8):e994-e999. PubMed CrossRef

4. Wilson ST, Stanley B, Oquendo MA, et al. Comparing impulsiveness, hostility, and depression in borderline personality disorder and bipolar II disorder. J Clin Psychiatry. 2007;68(10):1533-1539. PubMed CrossRef

Ana Gonzalez-Pinto, MD, PhDa

anapinto@telefonica.net

Maria A. Oquendo, MD, PhDb

Barbara Stanley, PhDb

Iris de la Rosa, MDa,b

Gemma Garcia, MDa,b

Shang-Min Liu, MSb

Carlos Blanco, MD, PhDb

aHospital Universitario de Alava—Santiago, CIBERSAM, EHU, Vitoria, Spain

bNew York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York

Potential conflicts of interest: Refer to original article [J Clin Psychiatry 2017;78(8):e994-e999].

Funding/support: None.

J Clin Psychiatry 2018;79(2):17lr11919a

To cite: Gonzalez-Pinto A, Oquendo MA, Stanley B, et al. Dr Gonzalez-Pinto and colleagues reply. J Clin Psychiatry. 2018;79(2):17lr11919a.

To share: https://doi.org/10.4088/JCP.17lr11919a

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