title: Significance of borderline personality-spectrum symptoms among adolescents with bipolar disorder.
abstract: BACKGROUND
  Little is known regarding correlates of borderline personality-spectrum symptoms (BPSS) among adolescents with bipolar disorder (BP).
  
  
  METHODS
  Participants were 90 adolescents, 13-19 years of age, who fulfilled DSM-IV-TR criteria for BP using semi-structured diagnostic interviews. BPSS status was ascertained using the Life Problems Inventory which assessed identity confusion, interpersonal problems, impulsivity, and emotional lability. Analyses compared adolescents with "high" versus "low" BPSS based on a median split.
  
  
  RESULTS
  Participants with high, relative to low, BPSS were younger, and had greater current and past depressive episode severity, greater current hypo/manic episode severity, younger age of depression onset, and reduced global functioning. High BPSS participants were more likely to have BP-II, and had higher rates of social phobia, generalized anxiety disorder, conduct disorder, oppositional defiant disorder, homicidal ideation, assault of others, non-suicidal self-injury, suicidal ideation, and physical abuse. Despite greater illness burden, high BPSS participants reported lower rates of lithium use. The most robust independent predictors of high BPSS, identified in multivariate analyses, included lifetime social phobia, non-suicidal self-injury, reduced global functioning, and conduct and/or oppositional defiant disorder.
  
  
  CONCLUSIONS
  The study design is cross-sectional and cannot determine causality.
  
  
  CONCLUSIONS
  High BPSS were associated with greater mood symptom burden and functional impairment. Presence of high BPSS among BP adolescents may suggest the need to modify clinical monitoring and treatment practices. Future prospective studies are needed to examine the direction of observed associations, the effect of treatment on BPSS, and the effect of BPSS as a moderator or predictor of treatment response.
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Trehani M
authors.initials: TM
authors.lastname: Fonseka
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Swampillai
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Timmins
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Antonette
authors.initials: A
authors.lastname: Scavone
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: Mitchell
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Katelyn A
authors.initials: KA
authors.lastname: Collinger
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. Electronic address: benjamin.goldstein@sunnybrook.ca.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology*; D001883:Borderline Personality Disorder / Q000150:complications / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D063189:Symptom Assessment; D055815:Young Adult
keywords: Adolescent; Bipolar; Borderline; Personality disorder