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."

Mental health care for Newton

Successful treatment for Matthew Newton

After a string of assaults and alleged assaults, including domestic violence incidents involving two ex- partners, punching a taxi driver in Sydney and attacking a hotel receptionist in the US, Matthew Newton has recently been released from a high care mental health facility for treatment for bipolar disorder and obsessive compulsive disorder. He previously spent time in a mental health facility in Sydney in late 2010.
His latest treatment has reportedly been a resounding success, with Newton currently free of medication and 'unrecognisable' according to his lawyer, since spending 84 days at the clinic, when he appeared in the Downing Centre Local Court to face charges over the taxi driver assault. His lawyer, Chris Murphy is making a second application to have the matter dealt with under the Mental Health Act, given his diagnoses. An application made earlier this year was rejected.

Section 32 of the Mental Health Act diverts people suffering from mental illness who have been charged with a crime from the criminal justice system and imposes a treatment plan. Charges can be dismissed with the condition that the individual undergo treatment.

Serious psychiatric conditions such as bipolar disorder are known to be associated with higher rates of violence, particularly when an individual is in a manic state.

ABC News Photo Illustration

While this is certainly no excuse for violent behaviour, having a diagnosed mental health condition can help to explain Matthew Newton's actions and can be taken into account as an extenuating circumstance in legal matters. Section 32 of the Mental Health Act exists in part, to help ensure that people who have a mental health condition and engage in criminal behaviour undergo appropriate treatment, which benefits both the individual and the wider community.

As his lawyer made the point via Twitter, you "can't cure mental illness with 'You stop that!'".

With appropriate diagnosis and treatment, most people with mental health conditions can lead happy, safe and fulfilling lives.