Borderline patients have difficulties describing feelings; bipolar II patients describe difficult feelings. An alexithymia study.

alexithymia bipolar disorder borderline personality disorder differential diagnosis

Journal

Acta psychiatrica Scandinavica
ISSN: 1600-0447
Titre abrégé: Acta Psychiatr Scand
Pays: United States
ID NLM: 0370364

Informations de publication

Date de publication:
09 2020
Historique:
accepted: 22 06 2020
pubmed: 1 7 2020
medline: 19 8 2021
entrez: 29 6 2020
Statut: ppublish

Résumé

Apparent similarities between borderline personality disorder (BPD) and bipolar II disorder (BIP-II) contribute to clinical difficulties in distinguishing between the disorders. Here, we aimed to explore how subjective Difficulties with the Identification and Description of Feelings (DIDF), a major constituent of the alexithymia construct and assessed as a part of the Toronto Alexithymia Scale (TAS), are related to relationship problems and health complaints in these groups. Twenty-two patients with BPD; 22 patients with BIP-II; and 23 healthy controls (HC) completed TAS. Health complaints, including symptoms associated with mood swings, were assessed with the Giessener Subjective Complaints List (Giessener Beschwerdebogen-GBB), and relationship problems with the Health of the Nation Outcome scale, Relationship item (HoNOSR). Bivariate correlations were run. Both patient groups had high DIDF and GBB scores. In BPD only, there was a significant positive correlation between DIDF and HoNOSR. In BIP-II only, there was a significant positive correlation between DIDF and GBB total score. In BIP-II, DIDF correlated highly with those GBB subscales assessing symptoms typically occurring during bipolar mood swings (cardiovascular and gastrointestinal symptoms, exhaustion). Our results suggest that in BPD, high DIDF scores represent genuine problems with identifying and describing emotions which are expected to correlate with relationship problems. In BIP-II, high DIDF scores could potentially represent difficulties with understanding the unpredictable symptoms of bipolar mood swings. The findings suggest that difficulties with identifying and describing feelings in patients should be carefully explored to increase the validity of the diagnostic evaluation.

Identifiants

pubmed: 32594515
doi: 10.1111/acps.13204
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

203-214

Informations de copyright

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Références

Bayes A, Parker G, Paris J. Differential diagnosis of bipolar II disorder and borderline personality disorder. Curr Psychiatry Rep2020;21:125.
AMERICAN PSYCHIATRIC A. Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association; 2013.
Lazarus SA, Cheavens JS, Festa F, Zachary Rosenthal M. Interpersonal functioning in borderline personality disorder: a systematic review of behavioral and laboratory-based assessments. Clin Psychol Rev 2014;34:193-205.
Gunderson JG. Disturbed relationships as a phenotype for borderline personality disorder. Am J Psychiatry 2007;164:1637-1640.
Roepke S, Vater A, Preissler S, Heekeren HR, Dziobek I. Social cognition in borderline personality disorder. Front Neurosci 2012;6:195.
Jeung H, Herpertz SC. Impairments of interpersonal functioning: empathy and intimacy in borderline personality disorder. Psychopathology 2014;47:220-234.
Sharp C. Current trends in BPD research as indicative of a broader sea-change in psychiatric nosology. Personal Disord. 2016;7:334-343.
Euler S, Nolte T, Constantinou M et al. Interpersonal problems in borderline personality disorder: associations with mentalizing, emotion regulation, and impulsiveness. J Pers Disord. 2019;1-17.
Lewis M, Scott J, Frangou S. Impulsivity, personality and bipolar disorder. Eur Psychiatry 2009;24:464-469.
Strakowski SM, Fleck DE, Delbello MP et al. Impulsivity across the course of bipolar disorder. Bipolar Disord 2010;12:285-297.
Boen E, Hummelen B, Elvsashagen T et al. Different impulsivity profiles in borderline personality disorder and bipolar II disorder. J Affect Disord 2015;170:104-111.
Goodwin FK, Jamison KR, Ghaemi SN. Manic-depressive illness: bipolar disorders and recurrent depression. Oxford; New York: Oxford University Press; 2007.
Casper RC, Redmond DE, Katz MM, Schaffer CB, Davis JM, Koslow SH Somatic symptoms in primary affective disorder. Presence and relationship to the classification of depression. Arch Gen Psychiatry. 1985;42:1098-1094.
Judd LL, Akiskal HS, Schettler PJ et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003;60:261-269.
Renaud S, Corbalan F, Beaulieu S. Differential diagnosis of bipolar affective disorder type II and borderline personality disorder: analysis of the affective dimension. Compr Psychiatry. 2012;53:952-961.
Maletic V, Raison C. Integrated neurobiology of bipolar disorder. Front Psychiatry 2014;5:98.
Geoffroy PA, Bellivier F, Scott J, Etain B. Seasonality and bipolar disorder: a systematic review, from admission rates to seasonality of symptoms. J Affect Disord 2014;168:210-223.
Arciszewska A, Siwek M, Dudek D. Dyadic adjustment among healthy spouses of bipolar I and II disorder patients. Psychiatr Danub 2017;29:322-329.
Siqueira DE, Beraldi GH, Okawa Belizario G, Lafer B. Impaired social cognition in bipolar disorder: A meta-analysis of Theory of Mind in euthymic patients. Australian New Zealand J Psychiatry 2020. https://doi.org/10.1177/0004867420924109
Bora E, Bartholomeusz C, Pantelis C. Meta-analysis of Theory of Mind (ToM) impairment in bipolar disorder. Psychol Med 2016;46:253-264.
Lee J, Altshuler L, Glahn DC, Miklowitz DJ, Ochsner K, Green MF. Social and nonsocial cognition in bipolar disorder and schizophrenia: relative levels of impairment. Am J Psychiatry 2013;170:334-341.
Caletti E, Paoli RA, Fiorentini A et al. Neuropsychology, social cognition and global functioning among bipolar, schizophrenic patients and healthy controls: preliminary data. Front Hum Neurosci 2013;7:661.
Torrent C, Martínez-Arán A, Daban C et al. Cognitive impairment in bipolar II disorder. Br J Psychiatry 2006;189:254-259.
Bayes A, Graham RK, Parker GB, McCraw S. Is 'subthreshold' bipolar II disorder more difficult to differentiate from borderline personality disorder than formal bipolar II disorder? Psychiatry Res 2018;264:416-420.
Paris J, Gunderson J, Weinberg I. The interface between borderline personality disorder and bipolar spectrum disorders. Compr Psychiatry 2007;48:145-154.
Sifneos PE. The prevalence of 'alexithymic' characteristics in psychosomatic patients. Psychother Psychosom 1973;22:255-262.
Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994;38:23-32.
Landstra JM, Ciarrochi J, Deane FP, Hillman RJ. Identifying and describing feelings and psychological flexibility predict mental health in men with HIV. Br J Health Psychol 2013;18:844-857.
Vanheule S, Desmet M, Meganck R, Bogaerts S. Alexithymia and interpersonal problems. J Clin Psychol 2007;63:109-117.
Lane RD, Sechrest L, Reidel R, Weldon V, Kaszniak A, Schwartz GE. Impaired verbal and nonverbal emotion recognition in alexithymia. Psychosom Med 1996;58:203-210.
New AS, Rot M, Ripoll LHet al. Empathy and alexithymia in borderline personality disorder: clinical and laboratory measures. J Pers Disord. 2012;26:660-675.
Ospina LH, Shanahan M, Perez-Rodriguez MM, Chan CC, Clari R, Burdick KE. Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder. Psychiatry Res 2019;273:218-226.
Jonsson PD, Wijk H, Skarsater I, Danielson E. Persons living with bipolar disorder-their view of the illness and the future. Issues Ment Health Nurs 2008;29:1217-1236.
Fletcher K, Parker G, Bayes A, Paterson A, McClure G. Emotion regulation strategies in bipolar II disorder and borderline personality disorder: differences and relationships with perceived parental style. J Affect Disord 2014;157:52-59.
Sheehan DV, Lecrubier Y, Sheehan KH et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(Suppl 20):22-33;quiz 4-57.
First MB. User's guide for the structured clinical interview for DSM-IV axis II personality disorders: SCID-II. Washington, DC: American Psychiatric Press, Inc.; 1997.
Spitzer RL. Psychiatric diagnosis: are clinicians still necessary? Compr Psychiatry. 1983;24:399-411.
Hyler SE, Skodol AE, Oldham JM, Kellman HD, Doidge N. Validity of the personality diagnostic questionnaire-revised: a replication in an outpatient sample. Compr Psychiatry. 1992;33:73-77.
Suppes T, Leverich GS, Keck PE et al. The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. J Affect Disord 2001;67:45-59.
Drake R, Mueser K, McHugo G. Clinical rating scales: Alcohol Use Scale (AUS), Drug Use Scale (DUS), and Substance Abuse Treatment Scale (SAYS). In: Sederer L, Dickey B, editors. Outcomes assessment in clinical practice. Maryland: Williams & Wilkins; 1996: pp 113-116.
Taylor GJ, Bagby RM, Parker JDA. Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge [u.a.]: Cambridge Univ. Press; 1997.
Watters CA, Taylor GJ, Bagby RM. Illuminating the theoretical components of alexithymia using bifactor modeling and network analysis. Psychol Assess. 2016;28:627-638.
Spangenberg L, Brahler E. [The Giessen-Test-new norm values in a representative German sample (14-92 years)]. Psychother Psychosom Med Psychol 2011;61:e15-e18.
Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A. Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry 1998;172:11-18.
Honkalampi K, Hintikka J, Laukkanen E, Lehtonen J, Viinamaki H. Alexithymia and depression: a prospective study of patients with major depressive disorder. Psychosomatics 2001;42:229-234.
Grynberg D, Chang B, Corneille O et al. Alexithymia and the processing of emotional facial expressions (EFEs): systematic review, unanswered questions and further perspectives. PLoS One 2012;7:e42429.
Montebarocci O, Surcinelli P, Rossi N, Baldaro B. Alexithymia, verbal ability and emotion recognition. Psychiatr Q. 2011;82:245-252.
Parker PD, Prkachin KM, Prkachin GC. Processing of facial expressions of negative emotion in alexithymia: the influence of temporal constraint. J Pers 2005;73:1087-1107.
Baughman HM, Schermer JA, Veselka L, Harris J, Vernon PA. A behavior genetic analysis of trait emotional intelligence and alexithymia: a replication. Twin Res Hum Genet 2013;16:554-559.
Lumley MA, Ovies T, Stettner L, Wehmer F, Lakey B. Alexithymia, social support and health problems. J Psychosom Res 1996;41:519-530.
Mattila AK, Kronholm E, Jula A et al. Alexithymia and somatization in general population. Psychosom Med. 2008;70:716-722.
Merikangas KR, Akiskal HS, Angst J et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry. 2007;64:543-552.
Mantere O, Isometsa E, Ketokivi M et al. A prospective latent analyses study of psychiatric comorbidity of DSM-IV bipolar I and II disorders. Bipolar Disord 2010;12:271-284.
Parker G. Diagnosing bipolar II disorder: some personal perspectives. Australas Psychiatry 2015;23:112-115.
Karling P, Maripuu M, Wikgren M, Adolfsson R, Norrback K-F. Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder. World J Gastroenterol. 2016;22:8540.
Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain 2003;102:167-178.
Niesten IJ, Karan E, Frankenburg FR, Fitzmaurice GM, Zanarini MC. Prevalence and risk factors for irritable bowel syndrome in recovered and non-recovered borderline patients over 10 years of prospective follow-up. Personality Mental Health 2014;8:14-23.
El-Gabalawy R, Katz LY, Sareen J. Comorbidity and associated severity of borderline personality disorder and physical health conditions in a nationally representative sample. Psychosom Med 2010;72:641-647.
Stanton K, Brown MFD, Bucher MA, Balling C, Samuel DB. Self-ratings of personality pathology: insights regarding their validity and treatment utility. Curr Treat Opt Psychiatry 2019;6:299-311.
Bagby RM, Taylor GJ, Parker JD, Dickens SE. The development of the Toronto Structured Interview for Alexithymia: item selection, factor structure, reliability and concurrent validity. Psychother Psychosom 2006;75:25-39.

Auteurs

E Bøen (E)

Psychosomatic and CL Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.

B Hummelen (B)

Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.

B Boye (B)

Psychosomatic and CL Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
Department of Behavioural Medicine, University of Oslo, Oslo, Norway.

T Elvsåshagen (T)

Norwegian Centre for Mental Disorders Research (NORMENT), KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Neurology, Oslo University Hospital, Oslo, Norway.

U F Malt (UF)

Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH