Using neuroimaging to differentiate between Bipolar Disorder and Borderline Personality Disorder

Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) are often confused and misdiagnosed. Both disorders involve dysregulation of emotional responses as key diagnostic criteria. BD is a mental illness involving a set of significant 'mood swings'. The most common form of Bipolar involves 'highs' (or mania) and 'lows' (depression). BPD is a type of personality disorder, or a set of long-standing traits and behaviours associated with significant distress or disability. A key feature of BPD is affective liability, meaning that people with BPD have difficulty stabilising their moods and therefore can demonstrate erratic mood swings. They are also prone to depression. More information about both disorders can be found on the website of the Black Dog Institute.

As it is personality based BDP tends to be a long-term disorder, whereas BD can come and go and with the right treatment can be cured or well managed. Appropriate treatment and management requires proper diagnosis. Unfortunately until now there have been no biological markers for psychiatric disorders.

However, some promising new research has found that there may be a way to differentiate between BD and BPD at a biological level. Professor Gin Malhi from the Sydney University has found biological differences in the brains between people with the two conditions. Professor Malhi and colleagues scanned the brains of people with BD (who were not depressed at the time of the study), BPD and controls with no mental illness while they undertook a task that focuses on emotional responses and is cognitively taxing (the emotional Stroop task). They found a significant difference in the response of the emotional circuits in the brain of the two patient groups and between the patients and controls during the task.

Individuals with BP drew more on the dorsomedial prefrontal cortex of the brain, whilst people with BPD showed heightened activity in the amygdala, a lower level part of the brain which coordinates emotional responses and processes negative emotions such as fear. Professor Malhi reported that people with BPD were not able to regulate this "key node in the lower part of the brain that co-ordinates emotional understanding". In contrast, people with BP were able to function quite normally when well, and just needed to expend more effort in the brain than controls.

While the results are very promising, Prfessor Malhi stresses the need for replication of the study.

He concluded: "for the first time in the past two decades we have the technology to see the brain functioning [but] these insights and understanding have to be translated into clinical practice."

Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V)

The DSM is the 'bible' for mental health practitioners around the world. It is used to diagnose disorders affecting mood, personality, identity, development and cognition. It has recently undergone a major revision from the previous edition, the DSM-IV (released in 1994), and is set to be released in May 2013.

There have been many significant changes from the previous edition. Keep reading to find out about some of the most important changes.

New or amended diagnoses
Autism Spectrum Disorder (ASD)
This is one of the most important changes, given the prevalence and severity of ASD in the community. ASD is characterised by communication deficits, difficulties interpreting nonverbal communication, social difficulties, issues coping with change to routines, and intense focus or obsessions with inappropriate items. Some symptoms must be shown from early childhood. The symptoms fall on a continuum, with some individuals showing mild symptoms and others having much more severe symptoms. ASD is a single umbrella disorder which incorporates four separate disorders from the DSM-IV: autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.Researchers from the DSM-V workgroup found that these separate diagnoses were not consistently applied across different clinics and treatment centres, and that a single disorder improves diagnosis of ASD.

Disruptive Mood Dysregulation Disorder
This is characterised by severe outbursts or tantrums and prolonged irritable mood in children. It was included to capture children who display these characteristics and are misdiagnosed with Bipolar Disorder and/or Attention Deficit Hyperactivity Disorder.

Hoarding Disorder
Public interest in hoarding, the compulsive collection of possessions that may or may not have monetary value, is demonstrated by the popularity of reality television shows and docu-dramas dealing with this issue. Hoarding will now be listed as a separate condition from obssessive compulsive disorder in recognition of its unique symptoms and effects.

Structure
The complex multiaxial system with five 'levels' or axes of disorders will be removed. The DSM-V will instead present a simplified list of 20 chapters by grouping related disorders.

Rejected diagnoses
A number of proposed diagnoses were subsequently rejected and will not be included as separate disorders in the DSM-V. These include: Anxiety Depressive-Syndrome, Attenuated Psychosis, Hypersexual Disorder, Parental Alienation Syndrome and Sensory Processing Disorder.

Certain specifics of the DSM-V will not be made public until its release. However, more details about what has been publicly released can be found at the DSM-V development website.

While various websites publish diagnostic criteria from the DSM-IV (and likely the DSM-V once its released), a trained, experienced psychologist, neuropsychologist or psychiatrist is the best person to help you clarify or confirm a diagnosis of a psychological disorder. If you would like more information about our neuropsychological services, please contact us.

Right brain/left brain

If further proof was needed that the human brain is a fascinating organ, because of the way our brains are organised, there is a slight but discernible difference between the left and right sides of our faces.

Our brains are composed of approximately 100 billion neurons (nerve cells), with 50 billion neurons in each half. However, only approximately 250 million neurons join the two halves, meaning that our left and right brains are mostly unconnected and work separately. One result of this is our faces are unsymmetrical.

Many actors and other famous people (such as David Caruso, pictured) are known for having a 'good side' - preferring to be photographed on one side of their face than the other. Research shows support for the assertion that the different sides of our faces are different and one side is actually considered to be more attractive than the other.

Professors Kelsey Blackburn and James Schirillo from the University of Wake Forest asked undergraduate university psychology students to rate the attractiveness of 20 volunteers who had been photographed on both their left and right sides, about 37 degrees from the centre on each side. Some photographs were untouched, while other photos has been Photoshopped so that they were mirror-reversed so the left side looked like the right and vice versa.

As well as asking them about their preferences, the researchers examined the students' pupils. The size of one's pupil is related to the intensity of our emotional response to stimuli. In general, the students preferred the left face of the both men and women — regardless of whether they were shown the untouched left face, or a left face which had been mirror-reversed to look like a right face. This was regardless of the gender of the person in the photo, and the gender of the person doing the judging. And the pupils of the volunteers opened larger when they rated the faces more attractive.

The echoism app, developed by artist Julian Wolkenstein shows a combined image of two photos of either the left or right side of people's faces, with most of these photos posted on line being very different from the people's actual image. This indicates that 'symmetrical' faces don't look quite right. Judge for yourself whether you think the right or left images are more attractive.