This study examined predictors of borderline personality features in 30 youth diagnosed with bipolar disorder. Higher scores on a measure of borderline personality features were associated with increased self-injurious behaviors, impulsive aggression, and decreased family cohesion. These findings suggest that youth with bipolar disorder exhibiting these characteristics may be at increased risk of developing borderline personality disorder. Larger, longitudinal studies are still needed to validate these predictors. The study aims to help clinicians identify at-risk youth earlier to improve outcomes through targeted psychotherapy interventions.

1. R.S. Kahlon, MD1,2, C.D. Verrico, PhD1,3, A. Shah, MD1,2, B.A. Syed, MD1,2, P.A. Amin, MD1,2,T. Vu-Sowers, MD1,2, K.P. Taslimi, PhD4, R.P. Arvind, MD1,2, L.E. Wood, LCSW2, C. Sharp, PhD1,5,6, U.
Ramamurthy, MBA, MS PhD4, X. Lu, MS4, O.O. Okusaga, MD, MScPHR7, L.L. Williams, DO1,2, K. Saxena, MD1,2
1Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, 2Psychiatry Service, Texas Children’s Hospital, Houston, TX, 3Department of Psychiatry, Michael E. DeBakey V.A. Medical Center, Houston, TX, 4 Psychology Section, Department of
Pediatrics, Texas Children’s Hospital, Houston, TX, 5The Menninger Clinic, Houston, TX, 6Department of Psychology, University of Houston, Houston, TX, 7UT Harris County Psychiatric Center, Houston, TX
Self-Injurious Behavior, Impulsive Aggression and Decreased Family Cohesion in
Bipolar Youth: Probable Determinants of Emerging Borderline Personality.
Objectives
• Borderline Personality Disorder (BPD)
and adult Bipolar Disorder (BD) are often
diagnosed as comorbid disorders in
adults and adolescents 1,2.
• These disorders furthermore share
common correlates and risk factors3.
• This study aims to examine the
predictors that may increase the
likelihood of borderline features in youth
with BD.
Conclusions
• The study results demonstrate that
higher BPFS scores are observed in youth
with BD, who exhibit increased self-
injurious behaviors, increased impulsive
aggression, and decreased family
cohesion.
• The significance of these findings lies in
assisting clinicians in recognizing youth
with BD, who may be on the trajectory of
developing BPD.
• This in turn, can aid clinicians in
implementing specific psychotherapeutic
interventions which might improve
outcomes. Further research examining
longitudinal data with larger samples is
needed to validate these findings.
.
Materials and Methods
• 30 participants (M:16, F:14), aged 7–17
years, inclusive (Mean Age 12.95 ± 3.08
years) were recruited in an outpatient
specialty mood disorders clinic.
• Participants met DSM-IV-TR criteria for
BD I (n=19) and BD II (n=3). Also, the
Course and Outcome of Bipolar Youth
(COBY) criteria was used to establish the
BD–Not Otherwise Specified diagnosis
(n=7).
References
Results
• Significant positive associations were seen
between total score of BPFS Child Version
and:
- Total score of the Buss Perry Aggression
Questionnaire (BPAQ) (β=0.35, p<0.01)
- All the individual subscale scores of
BPAQ.
• The Self-harm subscale of BPFS Child
Version showed a significant and positive
association with
-Total score of the BPAQ (β=0.12, p<0.01)
-All the individual subscale scores of
BPAQ.
• Perceived Family cohesion scores were
negatively associated with
- Total score (β=-0.21, p<0.03)
-Self-Harm component (β=-0.69, p<0.05)
of the BPFS Parent Version.
Materials and Methods
• A battery of validated measures,
including the 24-item self-report
Borderline Personality Features Scale
(BPFS) was administered to obtain
cross-sectional data from study
participants and their primary
caregiver4.
• Multivariable linear regression
analyses examined associations
between BPFS (total and sub-scale)
scores and various psychopathology-
related predictor variables, while
adjusting for age, race, primary BD
diagnosis and the interval between
completion of the BPFS and other
predictor variables.
Table 1: Demographics CASES
N 30
Gender
N of males 16
N of females 14
Age in years (mean ± SD) 12.95 ± 3.08
Race
N of White or Caucasian 25
N of Black or African 4
N of Other 1
Ethnicity
Non-Hispanic or Non-latino 25
Hispanic or Latino 5
Diagnosis
Bipolar 1 20
Bipolar 2 3
COBY Bipolar NOS 7
Mean Age(±SD)
Bipolar 1 13.3 ± 2.80
Bipolar 2 14.8 ± 0.290
COBY Bipolar NOS 12.8 ± 3.76
R² = 0.128
30
50
70
90
50 60 70 80 90 100 110
FACES-parent,FamilyCohesion
BPFS-parent, Score
R² = 0.5579
40
60
80
100
120
140
160
5 10 15 20 25 30 35
BPAQScore
BPFS-child, Self-Harm Subscale Score
Graph A (Below): Correlation between Self-Harm Subscale of BPFS-
C and Total Score of BPAQ
Graph B (Below): Correlation between Total Score of BPFS-P and
Family Cohesion Score of FACES II
1. Zimmerman M, Morgan TA. Problematic boundaries in the
diagnosis of bipolar disorder: the interface with borderline
personality disorder. Current psychiatry reports. 2013;15(12):1-
10.
2. Yen S, Frazier E, Hower H, et al. Borderline personality disorder in
transition age youth with bipolar disorder. Acta Psychiatrica
Scandinavica.2015;132(4):270-280.
3. Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month
prevalence of bipolar spectrum disorder in the National
Comorbidity Survey replication. Archives of general psychiatry.
2007;64(5):543-552.
4. Chang B, Sharp C, Ha C. The criterion validity of the Borderline
Personality Features Scale for Children in an adolescent inpatient
setting. Journal of Personality Disorders. 2011;25(4):492.
Disclosures:
Kirti Saxena, MD : Grant Support from John S. Dunn
Foundation
Carla Sharp, PhD: Grant Support from McNair Family
Foundation
Christopher D. Verrico, PhD: Grant Support from The
United States Department of Defense
No Disclosures to report from any other authors.
Poster ID:
27048