This test may help you understand where on that spectrum your depression falls. So you must interpret your results carefully, by learning a lot about subtle bipolarity. At some point you may see a mental health professional, either a skilled therapist like an MSW, or Ph. If they give you a diagnostic opinion that differs from your self-educated impression, you can discuss the differences in your points of view.
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Toshihiko Nagata: pj. I Received Jul 31; Accepted Feb This article has been cited by other articles in PMC. This study examined the accuracy of these scales for detecting bipolar disorder among patients referred for eating disorders and explored the possibility of simultaneous assessment of co-morbid borderline personality disorder.
Methods Participants were 78 consecutive female patients who were referred for evaluation of an eating disorder. Conclusions Among patients being evaluated for eating disorders, the MDQ and BSDS show promise as screening questionnaires for both bipolar disorder and borderline personality disorder.
Keywords: Bipolar disorder, Borderline personality disorder, Eating disorder, Comorbidity, Screening scale Background As bipolar disorders are serious mental disorders that can cause severe lifelong functional impairment, early recognition of the diagnosis and early introduction of mood stabilizers are crucial for improvement of outcomes [ 1 ].
Nonetheless, most patients with bipolar disorder go years before receiving an appropriate diagnosis and starting mood stabilizers [ 1 ]. Borderline personality disorder is the most common personality disorder in clinical settings, and causes marked distress and impairment in social, occupational, and role functioning [ 2 ]. Yet, similar to bipolar disorder, borderline personality disorder is often incorrectly diagnosed or underdiagnosed in clinical practice [ 2 ]. Both bipolar and borderline personality disorders are associated with high rates of completed suicide [ 1 , 2 ] and are common among patients with mood disorders [ 1 , 2 ] and eating disorders [ 3 , 4 ].
Recently, the boundary of these disorders has been a focus of debate [ 5 - 9 ]. There are two viewpoints about the relationship between bipolar disorder, especially bipolar II disorder, and borderline personality disorder. The first one is that underlying cyclothymic temperament can explain the relationship, and borderline personality disorder [ 9 ] as well as bulimia nervosa [ 8 ] are variants of bipolar disorders. These instruments show good psychometric properties to detect bipolarity among patients with unipolar depression and are recommended as screening tools for bipolar disorders among patients with unipolar depression [ 1 ].
However, Zimmerman et al. Patients diagnosed with bipolar disorder by previous doctors were significantly more likely to be diagnosed with borderline personality disorder compared to patients who were not diagnosed with bipolar disorder Viewed another way, these results suggest the possibility that both bipolar and borderline personality disorders can be simultaneously detected by these scales.
To the best of our knowledge, the MDQ and BSDS have never been used to detect bipolar disorders or borderline personality disorder among eating disorder patients, despite the relatively high comorbidity rates of these disorders [ 3 , 4 ]. In contrast to common attention towards impulsivity and borderline personality disorder among eating disorder patients [ 4 ], the presence of comorbid bipolar disorder has rarely received attention of eating disorder specialists [ 15 ].
However, some evidence suggests increased prevalence of bipolar II disorder [ 16 ], ego-syntonic hypomania may escape clinical detection, and comorbid bipolar disorder requires special therapeutic considerations [ 3 ].
Thus, screening scales for bipolar disorder might be more important than eating disorder specialists traditionally thought. The aim of the current study was to examine the diagnostic accuracy including sensitivity and specificity of the MDQ and BSDS to detect bipolar disorders among patients that were referred for evaluation of an eating disorder. We also explored the possibility that the two scales can detect borderline personality disorder among this population.
We hypothesized that the diagnostic accuracy of the two screening tests MDQ and BSDS for borderline personality disorder might be similar to that for bipolar disorders. The patients with eating disorder not otherwise specified EDNOS were not excluded as prior research has shown these patients often are referred for eating disorder treatment and may have comorbid bipolar or borderline personality disorder [ 17 ].
Of the ninety patients who were screened, seventy-eight patients enrolled in the study, and all enrollees completed the study.
Of the twelve patients that did not participate in the study, six deemed their psychiatric problem minor and opted to cope with the difficulty, four were reluctant to undergo detailed psychiatric assessment, and two declined to participate for unknown reasons. As part of routine clinical care, patients received cognitive behavioral therapy, dialectical behavioral therapy, or medication management depending on the results of their assessment, even when their provisional primary diagnosis defined as the disorder most influencing their global functioning was other than an eating disorder.
All patients provided written informed consent before entering the study. This study was approved by the institutional review committee of the Osaka City University Graduate School of Medicine.
The symptom questions are followed by a single question about whether the symptoms clustered during the same period. The final question evaluates the level of impairment resulting from the symptoms on a 4-point scale no, minor, moderate, or serious problems.
In a Japanese study of unipolar depressive patients, a lower cut-off of more than 5 with minor or greater problems was proposed [ 19 ]. The BSDS consists of two parts: first, a paragraph containing 19 statements describing many of the symptoms of bipolar disorder, and, second, a single multiple-choice question asking respondents how well the paragraph describes them. The total score ranges from 0 to A score of 13 for the original version [ 11 ], 12 for the Chinese version [ 20 ], and 11 for the Japanese version [ 19 ] have been proposed as cut-off points.
All participants underwent a direct face-to-face assessment conducted by T. To the best of our knowledge, no previous study has explored the possibility that the two scales might detect borderline or histrionic personality disorders.
Given this, we used the same cut-off point to detect the personality disorders as for bipolar disorder. All data were analyzed with SPSS A high level of functional impairment was suggested by the high rate of single participants around two-thirds , unemployment around half and chronicity around ten years.
Scoring the Bipolar Spectrum Diagnostic Scale
Bipolar Spectrum Diagnostic Scale (BSDS)