People diagnosed with bipolar disorder often experience overlapping symptoms of borderline personality disorder, and new research reveals how deeply ingrained negative beliefs can fuel these symptoms. Shared psychological conflict is strongly associated with feelings of shame, a strong fear of abandonment, and a lack of self-control. The results were published in the Journal of Affective Disorders.
Bipolar disorder is a mental illness characterized by extreme mood swings. Patients oscillate between high-energy manic or hypomanic states and deep depression. In addition to these mood changes, many patients experience unstable self-identity, troubled interpersonal relationships, and impulsive behavior.
These additional challenges are hallmarks of borderline personality disorder. Mental health professionals have observed that these two conditions often occur together. Some people with bipolar disorder exhibit borderline severe features, while others exhibit only mild features.
Psychologists use the concept of early maladaptive schemas to understand persistent psychological distress. These are deeply ingrained patterns of thinking and feeling about ourselves and others. These usually develop during childhood when a person’s core emotional needs are not met.
Once established, these belief systems act as negative filters through which people view themselves and the wider world. There are several different categories of these beliefs. Some revolve around disconnection and rejection, including expectations of abandonment and feelings of inner deficiency.
Other negative beliefs are related to impaired autonomy, such as feeling uniquely vulnerable to illness or doomed to failure. Repeatedly evaluating the world through these lenses can make psychological healing very difficult.
The team of researchers realized that these deeply ingrained belief systems may explain why borderline characteristics look different among different patients. Lead author Myung-geun Cho and principal investigator C. Hyung-geun Park, together with colleagues at Asan Medical Center in South Korea, decided to investigate this relationship in a clinical setting.
Researchers collected data from 557 adult psychiatric outpatients diagnosed with bipolar I or bipolar II disorder. They provided patients with a specific questionnaire designed to assess 18 different categories of deep-seated negative beliefs.
The study also measured the severity of four specific borderline personality traits. These characteristics include unstable mood, identity issues, negative relationships with others, and self-harm. Based on the findings, the team divided participants into two different categories.
One group consisted of patients with severe borderline features. The second group consisted of patients who had only mild or non-severe borderline symptoms. To understand the data, the team used a statistical tool known as network analysis.
This analytical method visually maps how different psychological symptoms and belief systems interact. In these visual maps, each symptom or belief acts as a node, similar to a city on a map. Connect these nodes with lines to indicate the strength of their association. This reveals which mental habits are most central to a person’s overall distress.
The researchers found that the severe group had higher overall levels of all negative beliefs compared to the non-severe group. This confirms previous clinical observations that people with severe borderline symptoms are often plagued by an overwhelming number of negative thought patterns.
Visual maps revealed several patterns common to both severe and nonsevere groups. Beliefs related to personal deficiencies, shame, and subjugation were central to both groups’ psychological networks. Submission refers to the habit of relinquishing control to another person to avoid conflict or punishment.
Because these shame-based beliefs are central to the symptom network, they can have a pervasive influence on other negative thoughts. Researchers suggest that treating patients’ internalized shame may be an effective starting point for therapy.
The researchers also found that identity conflicts and negative relationship patterns act as bridges to certain beliefs. In all patients, these symptoms were strongly associated with expectations of abandonment, abuse, and social isolation.
Another common characteristic included behavior that physically harmed oneself. In both the severe and non-severe groups, self-harm was directly related to beliefs that self-control and discipline were insufficient. Researchers suggest that if patients believe they are incapable of self-regulation, they may be more susceptible to impulsive self-harm.
The analysis map also revealed clear differences between the two patient groups. For the group with severe borderline traits, having unstable relationships was more tightly woven into their overall web of negative beliefs.
In patients with mild symptoms, the deterioration of relationships may be primarily due to the social influence of manic or depressive mood swings. For severe groups, relationship instability appears to be rooted in chronic psychological beliefs about themselves and those around them.
The two groups also showed different patterns regarding unstable mood. In the severe group, sudden mood changes were associated with an increased likelihood of self-harm. Conversely, in the non-severe group, mood instability was associated with feelings of disintegration of self-identity.
This specific difference suggests that in severe cases, unstable emotions tend to cause external behavior, but in mild cases, they tend to cause internal turmoil. These distinctions can help mental health professionals tailor treatment plans. Clinicians treating borderline characteristics of bipolar disorder may adapt specific psychotherapies based on these symptom maps.
This study is based on observational data collected at one point in time. Because the design is cross-cutting, a direct chain of cause and effect cannot be established from the results. Rather than beliefs causing traits, it is still possible that borderline psychological traits cause the formation of these negative beliefs.
This study was also conducted at a single medical center in South Korea. This particular patient population may not reflect the experiences of diverse groups in other cultural or clinical settings. The authors note that the study did not take into account different medication status or the exact current mood state, which may have influenced survey responses.
Future studies would benefit from long-term follow-up of patients. Longitudinal data will allow researchers to see which psychological habits form first. Examining these associations in more diverse cultural contexts would test the broader applicability of the results. Researchers could also test whether psychological interventions targeting shame and abandonment are successful in reducing borderline traits in patients with bipolar disorder.
The study, “Levels and associations of borderline personality traits and early maladaptive schemas in bipolar disorder: A comparative network analysis of patients with and without severe borderline personality traits,” was authored by Myangkeun Cho, Chanhee Park, Eunbyeol Lee, and C. Hyung Keun Park.
