Cyclothymic temperament and/or borderline personality disorder

Many patients within the Bipolar spectrum, especially when recurrence is high and the inter-episodic period is not free of affective manifestations, may meet criteria for personality disorders. This is particularly true for cyclothymic patients, who are often misclassified as borderline personality disorder because of their extreme mood instability and reactivity. In patients with cyclothymic temperament, lifetime comorbidity with anxiety disorders, in particular panic disorder-agoraphobia, bulimia nervosa, body dysmorphic disorder, alcohol and substance abuse disorder and both cluster C (anxious) and cluster B (dramatic) personality disorders, is the rule rather than the exception [1]. In particular, a large proportion of these patients meet DSM-IV criteria for borderline personality disorders. Cyclothymic-bipolar II-borderline patients display a long-lasting "stable" hyper-reactivity to many psychological (i.e, rejection, separation) and physical (i.e., food, light, drugs) stimuli. This marked reactivity of mood could also explain the frequent concomitance of impulse control disorder and substances and alcohol abuse. An analysis of the explanatory power of affective temperaments and personality disorders for each of the criteria of BPD (Perugi et al., in press) revealed that the presence of cyclothymic temperament explains much of the relationship between bipolar II disorder and BPD. The diagnosis of BPD in these patients was favored by the coexistence of an affective cyclothymic temperamental dysregulation coexisting with anxious-dependent traits. We find no reason to separate bipolar II with cyclothymic instability from the stable instability of the borderline type, because mood lability is a common characteristic of both sets of disorders. Further, correlational analyses [2] indicate that in bipolar II atypical depressives mood reactivity and interpersonal sensitivity traits might be related constructs with a cyclothymic temperamental matrix.