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Clinical Features, Neuropsychology and Neuroimaging in Bipolar and Borderline Personality Disorder: a Systematic Review of Cross-Diagnostic Studies

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Clinical Features, Neuropsychology and Neuroimaging in Bipolar and Borderline Personality Disorder: a Systematic Review of Cross-Diagnostic Studies SYSTEMATIC REVIEW published: 09 June 2021 doi: 10.3389/fpsyt.2021.681876 Clinical Features, Neuropsychology and Neuroimaging in Bipolar and Borderline Personality Disorder: A Systematic Review of Cross-Diagnostic Studies Anna Massó Rodriguez 1,2†, Bridget Hogg 3,4,5†, Itxaso Gardoki-Souto 3,4,5, Alicia Valiente-Gómez 1,3,4,6, Amira Trabsa 1,3,5, Dolores Mosquera 7, Aitana García-Estela 4,6, Francesc Colom 1,4,6,8, Victor Pérez 1,4,6, Frank Padberg 9, Ana Moreno-Alcázar 3,4,6 and Benedikt Lorenz Amann 1,3,4,6,10* 1 Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain, 2 Centro Salud Mental Infanto-Juvenil, Parc de Salut Mar, Barcelona, Spain, 3 Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction, Parc de Edited by: Salut Mar, Barcelona, Spain, 4 Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Maj Vinberg, Spain, 5 PhD Progamme, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, University Hospital of Spain, 6 Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain, 7 Instituto de Investigación y Tratamiento Copenhagen, Denmark del Trauma y los Trastornos de la Personalidad (INTRA-TP) Center, A Coruña, Spain, 8 Departament of Basic, Evolutive and Reviewed by: Education Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain, 9 Department of Psychiatry and Joel Paris, Psychotherapy, Klinikum der Universität München, Munich, Germany, 10 Department of Psychiatry and Forensic Medicine, McGill University, Canada Universitat Autònoma de Barcelona, Barcelona, Spain Steven Marwaha, University of Birmingham, United Kingdom Background: Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) have *Correspondence: clinically been evolving as separate disorders, though there is still debate on the Benedikt Lorenz Amann nosological valence of both conditions, their interaction in terms of co-morbidity or [email protected] disorder spectrum and their distinct pathophysiology. †These authors have contributed equally to this work and share first Objective: The objective of this review is to summarize evidence regarding authorship clinical features, neuropsychological performance and neuroimaging findings from cross-diagnostic studies comparing BD and BPD, to further caracterize their Specialty section: This article was submitted to complex interplay. Mood and Anxiety Disorders, Methods: Using PubMed, PsycINFO and TripDataBase, we conducted a systematic a section of the journal Frontiers in Psychiatry literature search based on PRISMA guidelines of studies published from January 1980 Received: 17 March 2021 to September 2019 which directly compared BD and BPD. Accepted: 14 May 2021 Results: A total of 28 studies comparing BD and BPD were included: 19 compared Published: 09 June 2021 clinical features, 6 neuropsychological performance and three neuroimaging Citation: Massó Rodriguez A, Hogg B, abnormalities. Depressive symptoms have an earlier onset in BPD than BD. BD Gardoki-Souto I, Valiente-Gómez A, patients present more mixed or manic symptoms, with BD-I differing from BPD Trabsa A, Mosquera D, García-Estela A, Colom F, Pérez V, in manic phases. BPD patients show more negative attitudes toward others Padberg F, Moreno-Alcázar A and and self, more conflictive interpersonal relationships, and more maladaptive Amann BL (2021) Clinical Features, regulation strategies in affective instability with separate pathways. Impulsivity Neuropsychology and Neuroimaging in Bipolar and Borderline Personality seems more a trait in BPD rather than a state as in BD. Otherwise, BD and Disorder: A Systematic Review of BPD overlap in depressive and anxious symptoms, dysphoria, various abnormal Cross-Diagnostic Studies. Front. Psychiatry 12:681876. temperamental traits, suicidal ideation, and childhood trauma. Both disorders doi: 10.3389/fpsyt.2021.681876 differ and share deficits in neuropsychological and neuroimaging findings. Frontiers in Psychiatry | www.frontiersin.org 1 June 2021 | Volume 12 | Article 681876 Massó Rodriguez et al. Borderline Personality Disorder Bipolar Disorder Conclusion: Clinical data provide evidence of overlapping features in both disorders, with most of those shared symptoms being more persistent and intense in BPD. Thus, categorical classifications should be compared to dimensional approaches in transdiagnostic studies investigating BPD features in BD regarding their respective explanatory power for individual trajectories. Systematic Review Registration: The search strategy was pre-registered in PROSPERO: CRD42018100268. Keywords: bipolar disorder, borderline personality disorder, clinical features, cognitive functions, neuroimaging, affective continuum INTRODUCTION Medicine (Medical Subject Heading Terms, MeSH) and the American Psychological Association (Psychological Index A recent meta-analysis of 42 studies (1) found that 21.6% Terms) and included the terms “borderline personality disorder,” of patients suffering from Bipolar Disorder (BD) fulfilled also “BPD,” “bipolar disorder,” “BD,” “mania,” “hypomania,” “clinical diagnostic criteria for Borderline Personality Disorder (BPD), features,” “clinical symptoms,” “emotional dysregulation,” ∗ and conversely, 18.5% of BPD patients for BD. However, these “instability,” “temperament,” “mood,” “neuropsycho ,” ∗ ∗ data may not reflect true comorbidity given the overlap of their “neurocognit ,” “cogniti ,” “impairment,” “deficit,” “functioning,” phenomenological features (2–4). Of note, researchers have also “cognitive function,” “executive function,” “attention,” “memory,” documented considerable rates of co-occurrence between BPD “working memory,” “neuroimaging,” “neuroimage.” The final and Major Depressive Disorder (MDD) or BD ranging from search equation was defined using the Boolean connectors as low as 3% to as high as 48% in clinical samples (5–8). The “AND” and “OR.” high frequency of diagnostic co-occurrence and resemblance of The automatic search was later completed with a manual phenomenological features has led some authors to suggest that search of the reference list of previous reviews and meta-analysis. BPD is part of the bipolar spectrum (9–13). Other experts in the Titles, abstract, methods and results of the articles identified field have clearly opposed this notion (6, 14–17). Furthermore, were screened for pertinent information. The search did not in the latter line, recent narrative reviews concluded that both include any subheadings or tags (i.e., search fields “All fields”). are distinct pathologies, even though they can be difficult In accordance with Cochrane Handbook guidelines, due to the to distinguish due to a considerable overlap between both significant heterogeneity and small number of the studies, a conditions (3, 18). Differentiating BPD from BD-I appears formal quantitative synthesis (i.e., meta-analysis review) was not relatively straightforward, reflecting the common presence of possible to conduct (21), therefore a systematic literature review severe manic episodes, frequently with psychotic features, in was conducted. BD-I. By contrast, BD-II (alternating depressive and hypomanic The Newcastle-Ottawa Scale for assessing the quality of episodes) and BPD are frequently less precisely diagnosed, as non-randomized studies (22) was applied to each study BD-II patients do not present with psychotic symptoms and separately by AMR and BH. Discrepancies were resolved by a both share common clinical features, especially impulsivity third researcher, IGS. The completed PRISMA 2009 checklist and emotional dysregulation (19). Furthermore, in BD-II there (20) and the Newcastle-Ottawa Scale (22) are included in is frequently subthreshold symptomatology between episodes Supplementary Tables 1, 2. instead of full remission. Therefore, misdiagnosis in both directions is common due to the uncertain boundaries between both disorders (13) and shared “transdiagnostic” features (3). Inclusion Criteria and Exclusion Criteria The main objective of this systematic review is to synthesize The selection of the articles was carried out using the following the evidence of whether clinical features, neuropsychological inclusion criteria: (i) observational studies published in peer- and neuroimaging data comparing both conditions point toward reviewed journals, (ii) human studies, (iii) adult populations two distinct clinical entities or to them both belonging on a (over 18 years), (iv) comparisons of a non-comorbid BD continuum within the affective spectrum. and non-comorbid BPD group in terms of (v) clinical features, (vi) neuropsychological functions or (vii) neuroimaging MATERIALS AND METHODS performance. The criteria for exclusion were: (i) articles that did not contain original research (i.e., reviews and meta- Study Design analyses), (ii) controlled studies, (iii) qualitative designs, (iv) Using PubMed, PsycINFO and TripDataBase, we conducted a empirical studies with quasi-experimental or single-case designs, systematic literature search of studies published from January (v) unpublished studies, (vi) in youth and child population, 1980 to September 2019 based on PRISMA guidelines (20) (vii) examined only pharmacological treatment trials. AMR which compared clinical features, neuropsychological functions and BH conducted the first literature search and selected the and neuroimaging between BD and BPD. The search terms articles in an independent way. Discrepancies were resolved by were selected from the thesaurus of the National
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