Differences between depression and borderline personality disorder

Introduction:

Connection between borderline personality, dysthymia and depression. On the face of it, there is no doubt about links between both of them. A Koenigsberg study hypothesize that the psychosocial sequella of each can contribute to the development of the other. You will find on the last part of this document our vision which we hope comprehensive and listening to the suffering

* Zanarini MC, Frankenburg FR, Hennen J,... - McLean Hospital, Belmont, USA.
Am J Psychiatry. 2OO4 - Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission.
OBJECTIVE: The purpose of this study was to assess the prevalence of axis I disorders among patients with borderline personality disorder over 6 years of prospective follow-up.
METHOD: A semistructured interview of demonstrated reliability was used to assess presence or absence of comorbid axis I disorders in 290 patients who met Revised Diagnostic Interview for Borderlines criteria
Follow-Up 2 years: 68.7% of major depression experienced by Patients With Borderline Personality Disorder

* Koenigsberg HW, Anwunah I, New AS, ... - Mood and Personality Disorders Program, Mount Sinai, New York, USA
1999 Depress Anxiety - Relationship between depression and borderline personality disorder.
The frequent occurrence of depressive symptoms in patients with borderline personality disorder has generated considerable interest in the nature of the relationship between borderline personality disorder and the depressive disorders.
In reviewing the more recent findings, we propose the less parsimonious hypothesis that the disorders co-occur, both because they share some common biological features and because the psychosocial sequella of each can contribute to the development of the other.

* Rogers JH, Widiger TA, Krupp A. - Department of Psychology, University of Kentucky, Lexington
1995 Am J Psychiatry - Aspects of depression associated with borderline personality disorder.
OBJECTIVE: The purpose of this study was to empirically identify aspects of depression most associated with borderline personality disorder.
RESULTS: The aspects of depression most associated with borderline personality disorder were self-condemnation, emptiness, abandonment fears, self-destructiveness, and hopelessness; boredom and somatic complaints exhibited no association. CONCLUSIONS: Depression associated with borderline pathology appears to be in some respects unique, as well as distinct from nonborderline depression. The study's implications delineate the importance of considering the phenomenological aspects of depression in borderline personality disorder.

* Ionescu R, Popescu C. -
1989 Neurol Psychiatr (Bucur) - Personality disorders in students with depressive pathology.
In a group of 111 students with depressive disorders, 70% presented a concurrent personality disorder
The patients with personality disorders had: an earlier age of affective illness onset, a more marked depression severity, a higher frequency of recurrent and nonreactive depression forms

* Russell JM, Kornstein SG, Shea MT, ... - Department of Psychiatry and Behavioral Sciences, The University of Texas Galveston
2OO3 J Clin Psychiatry - Chronic depression and comorbid personality disorders
635 patients diagnosed with DSM-III-R chronic major depression or "double depression" (dysthymia with concurrent major depression) were randomized to 12 weeks of double-blind treatment.
RESULTS: 46% of patients met criteria for at least 1 comorbid Axis II personality disorder

* Fava M, Farabaugh AH, Sickinger AH, Wright E,... - Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston USA.
2OO2 Psychol Med - Personality disorders and depression.
Method: Three hundred and eighty-four (384) out-patients (55% women - 45% men) with major depressive disorder
RESULTS: A significant proportion, 64% of our depressed out-patients met criteria for at least one co-morbid personality disorder

* Mulder RT, Joyce PR, Luty - Dept. of Psychological Medicine, Christchurch School of Medicine, New Zealand
2OO3 J Clin Psychiatry. - The relationship of personality disorders to ...outcome in depressed outpatients.
Method: Subjects with DSM-III-R major depression were recruited...
Results: Of the 183 patients who completed the personality disorder assessment, 45% had at least 1 comorbid personality disorder

* Rossi A, Marinangeli MG, Butti G, Scinto A, ... - Dept. of Experimental Medicine, University of L'Aquila, Italy
2OO1 J Affect Disord.- Personality disorders in bipolar and depressive disorders.
The association of mood disorders with personality disorders (PDs) is relevant from a clinical, therapeutic and prognostic point of view. To examine this issue, we compared the prevalence of DSM-III-R personality disorders in patients with depressive (n = 117) and bipolar (n = 71) disorders both recovered from a major depressive index episode that needed hospital admission. PDs prevalence and comorbidity with axis I were calculated. Avoidant PD (31.6%), borderline PD (30.8%) and obsessive-compulsive PD (30.8%) were the most prevalent axis II diagnoses among patients with depressive disorder.

* Joyce PR, Mulder RT, Luty SE, ... - Dept. of Psychological Medicine, Christchurch School of Medicine, New Zealand
2OO3 Compr Psychiatry. 2OO3 - Borderline personality disorder in major depression:
Among 183 depressed patients participating in a randomized long-term treatment trial of fluoxetine and nortriptyline, 30 patients (16%) had borderline personality disorder (BPD) ...
The borderline depressed patients had earlier age of onset of their depressions, more chronic depressions, more alcohol and cannabis comorbidity, and were more likely to have histories of suicide attempts and of self-mutilation...

* Corruble E, Ginestet D, Guelfi JD. - Service de Psychiatrie, Hopital Paul Brousse, Villejuif, France
1996 J Affect Disord. 1996 - Comorbidity of personality disorders and major depression: a review.
The association of major depressive disorders with personality disorders is relevant in terms of clinical, therapeutic and prognostic aspects.
It could be estimated from this review that 20% to 50% of inpatients and 50% to 85% of out-patients with a current major depressive disorder have an associated personality disorder.
Cluster B personality disorders, in particular borderline (10-30%), histrionic (2-20%) and antisocial (0-10%), seem to be overrepresented.

* Tedlow J, Leslie V, Keefe BR... - Depression Clinical and Research Program, Massachusetts General Hospital, Boston
1999 J Affect Disord. - Axis I and Axis II disorder comorbidity in unipolar depression with anger attacks.
OBJECTIVE: We evaluated whether anger attacks in patients with major depressive disorder (MDD) are associated with higher rates of panic or other Axis I or II comorbid disorders.
Mehods: 306 out-patients  with MDD were administered
Results. Consistent with previous studies, we have also found that depressed patients with anger attacks had significantly higher rates of dependent, avoidant, narcissistic, borderline, and antisocial personality disorders than those without anger attacks
Conclusion: Anger attacks do not appear to be associated with any specific pattern of Axis I comorbidity, but they are certainly linked with certain personality disorders.

Please read other data

"Differentiation from other illnesses.  Depression does not involve the instability and impulsiveness of behavior" (Daniel C Claiborn)

"In major depressive disorder there is less affective lability and less impulsivity and often more stable relationships" (Bpd sancturay)

"While a person with depression typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression and anxiety that may last only hours, or at most a day" (Psychology today)

"Depression and borderline personality disorder are two different illnesses.
- In Borderline Personality Disorder the sufferer may present with mood swings, impulsive behavior (spending sprees, substance abuse), self mutilating or suicidal behavior, difficulty maintaining longterm relationships, alternating between extremes of idealization and devaluation, feelings of emptiness similar to depression.
The symptoms are part of the patient's character or personality.
- In depression the sufferer may present with depressed mood, disturbed sleep, decreased motivation and other symptoms.
The patient doesn't necessarily suffer from the mood swings or impulsivity. It represents the patient's mood, not personality." (Medhelp org)

Here is our feeling

Are depression and borderline disorder, two distinct disorders ?
Yes, it is possible to have a depression without having a borderline disorder and vice versa

Is it possible to have both, a borderline disorder AND a depression ?
Yes, of course, a borderline people has a tendancy make depressions throughout her all life. That don't seem surprising, the borderline disorder functioning a little like an amplifier of emotions (in "up" but also in "down")

Is there a strong relationship between Depressive disorder and personality disorder ?
Yes.Several studies conduct in different countries have the same conlusion. About 45% of depressive people have a comorbid personality disorder. This could go up 70% for example in depressive students.

Can a depression mask a borderline disorder ?
Yes, of course, we need then to verify that you can't see the wood for the trees. In that case, treat only the depression is an open invitation to treatment failure. About 10 to 30% of people with depressive disorder have a comorbid borderline personality disorder

"Since he/she is treated for its depression, he / she is much better!"
This is not surprising, the antidepressant appear effective for the depression treatment but also for the borderline disorder.
It is thus impossible to say "he / she goes better with its treatment, that proves that he / she had a depression and not a borderline disorder"

Is is possible to know if it is "only" a depression or a depression lived by a borderline people ?
Really, yes, we are not without tips

• An "only" depressive person theoretically did not have recurring problems before this depression whereas the borderline person (except in a total denial) gives the image of recurring personal and in particular relational problems.
• Repeated depressions are the sign that there is "another thing" (not inevitably a borderline disorder besides)
• A borderline person apart from periods of major depression has euphoric and dysphoric episodes. She often suffer of dysthymia
• The borderline disorder implies emotional instability, sudden changes of mood, unstable self-image, impulsivity, black and white thinking and very often self-destructive behaviors and or suicide attempts...