Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.
BMC Psychiatry. 2024 Nov 25;24(1):846. doi: 10.1186/s12888-024-06297-8.
Differentiation of borderline personality disorder (BPD) and bipolar I disorder (BD) has been challenging. The assessment of shared symptoms in the context of the overall personality functioning, the patient's sense of self, and the quality of his object (interpersonal) relations is proposed to be valuable for the differential diagnosis of these disorders.
We empirically investigated the level of personality organization (PO), identity integration, and quality of object relations in patients suffering from BD or BPD using the Structured Interview of Personality Organization (STIPO) and the Level of Personality Functioning Scale (LPFS) in 34 BPD and 28 BD patients as well as 27 healthy control persons. Group comparisons and a logistic regression model were calculated to analyze group differences.
The BPD group showed significantly greater impairment in several domains of personality functioning, namely "identity", and "self- and other-directed aggression", while showing lower impairment in "moral values". The overall level of PO in the BPD group was significantly lower when excluding not only BPD but any personality disorder (PD) in the BD sample. Severity of impaired personality structure had a major impact on symptom load independent of the main diagnosis BD or BPD.
Our data show greater impairment in personality functioning in BPD than in BD patients. BD patients present with varying levels of PO, whereas in BPD severe deficits in PO are pathognomonic. The level of PO has a significant impact on symptom severity in both BD and BPD patients. Therefore, careful assessment of PO should be considered for differential diagnosis and adequate treatment planning.
边缘型人格障碍（BPD）和双相 I 障碍（BD）的区分一直具有挑战性。在整体人格功能、患者自我意识和客体（人际）关系的质量背景下评估共享症状，被认为对这些障碍的鉴别诊断具有价值。
我们使用人格组织结构访谈（STIPO）和人格功能水平量表（LPFS），对 34 名 BPD 患者和 28 名 BD 患者以及 27 名健康对照者进行了实证研究，以评估他们的人格组织水平（PO）、身份整合和客体关系质量。我们计算了组间比较和逻辑回归模型，以分析组间差异。
BPD 组在几个人格功能领域，如“身份”和“自我及他人指向的攻击”，表现出明显更大的损害，而在“道德价值观”方面表现出较小的损害。当排除 BD 样本中的任何人格障碍（PD）时，BPD 组的总体 PO 水平明显较低。人格结构受损的严重程度对症状负荷有重大影响，与主要诊断 BD 或 BPD 无关。
我们的数据显示，BPD 患者的人格功能障碍比 BD 患者更严重。BD 患者表现出不同程度的 PO，而 BPD 患者则存在严重的 PO 缺陷。PO 水平对 BD 和 BPD 患者的症状严重程度都有显著影响。因此，在鉴别诊断和适当的治疗计划中，应考虑仔细评估 PO。
