title: Antisocial personality disorder and borderline symptoms are differentially related to impulsivity and course of illness in bipolar disorder.
abstract: BACKGROUND
  Interactions between characteristics of bipolar and Axis II cluster B disorders are clinically and diagnostically challenging. Characteristics associated with personality disorders may be dimensional aspects of bipolar disorder. We investigated relationships among antisocial personality disorder (ASPD) or borderline personality disorder symptoms, impulsivity, and course of illness in bipolar disorder.
  
  
  METHODS
  Subjects with bipolar disorder were recruited from the community. Diagnosis was by structured clinical interview for DSM-IV (SCID-I and -II), psychiatric symptom assessment by the change version of the schedule for affective disorders and schizophrenia (SADS-C), severity of Axis II symptoms by ASPD and borderline personality disorder SCID-II symptoms, and impulsivity by the Barratt impulsiveness scale (BIS-11).
  
  
  RESULTS
  ASPD and borderline symptoms were not related to clinical state or affective symptoms. Borderline symptoms correlated with BIS-11 impulsivity scores, and predicted history of suicide attempts independently of the relationship to impulsivity. ASPD symptoms were more strongly related to course of illness, including early onset, frequent episodes, and substance-related disorders. These effects persisted after allowance for gender and substance-use disorder history.
  
  
  CONCLUSIONS
  Personality disorder symptoms appear to be dimensional, trait-like characteristics of bipolar disorder. ASPD and Borderline symptoms are differentially related to impulsivity and course of illness.
authors: Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA. Alan.C.Swann@uth.tmc.edu
authors: Alan C
authors: AC
authors: Swann
authors: Marijn
authors: M
authors: Lijffijt
authors: Scott D
authors: SD
authors: Lane
authors: Joel L
authors: JL
authors: Steinberg
authors: F Gerard
authors: FG
authors: Moeller
mesh_terms: D000328:Adult; D000342:Affective Symptoms; D017668:Age of Onset; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000523:psychology*; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology*; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology*; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000175:diagnosis / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D019966:Substance-Related Disorders