title: Borderline personality disorder in transition age youth with bipolar disorder.
abstract: OBJECTIVE
  To determine the longitudinal impact of borderline personality disorder (BPD) on the course and outcome of bipolar disorder (BP) in a pediatric BP sample.
  
  
  METHODS
  Participants (N = 271) and parents from the Course and Outcome of Bipolar Youth (COBY) study were administered structured clinical interviews and self-reports on average every 8.7 months over a mean of 93 months starting at age 13.0 ± 3.1 years. The structured interview for DSM-IV personality disorders (SIDP-IV) was administered at the first follow-up after age 18 to assess for symptoms of BPD. BPD operationalized at the disorder, factor, and symptom level, was examined as a predictor of poor clinical course of BP using all years of follow-up data.
  
  
  RESULTS
  The number of BPD symptoms was significantly associated with poor clinical course of BP, above and beyond BP characteristics. Affective dysregulation was most strongly associated with poor course at the factor level; the individual symptoms most strongly associated with poor course were dissociation/stress-related paranoid ideation, impulsivity, and affective instability.
  
  
  CONCLUSIONS
  BPD severity adds significantly to the burden of BP illness and is significantly associated with a more chronic and severe course and outcome beyond what can be attributable to BP characteristics.
authors: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.|Butler Hospital, Providence, RI, USA.
authors: S
authors: S
authors: Yen
authors: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.|Emma Pendleton Bradley Hospital, East Providence, RI, USA.
authors: E
authors: E
authors: Frazier
authors: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
authors: H
authors: H
authors: Hower
authors: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.|Butler Hospital, Providence, RI, USA.
authors: L M
authors: LM
authors: Weinstock
authors: VA Boston Healthcare System, Harvard Medical School, Cambridge, MA, USA.
authors: D R
authors: DR
authors: Topor
authors: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.|Emma Pendleton Bradley Hospital, East Providence, RI, USA.
authors: J
authors: J
authors: Hunt
authors: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: T R
authors: TR
authors: Goldstein
authors: Department of Child Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Medical Center, Toronto, ON, Canada.
authors: B I
authors: BI
authors: Goldstein
authors: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: M K
authors: MK
authors: Gill
authors: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: N D
authors: ND
authors: Ryan
authors: Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors: M
authors: M
authors: Strober
authors: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: B
authors: B
authors: Birmaher
authors: Butler Hospital, Providence, RI, USA.
authors: M B
authors: MB
authors: Keller
mesh_terms: D000293:Adolescent; D000342:Affective Symptoms / Q000150:complications / Q000523:psychology; D000367:Age Factors; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D007406:Interview, Psychological / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies
keywords: bipolar disorder; borderline personality disorder; comorbidity; longitudinal