The temperamental borders of affective disorders


Hagop S. Akiskal, MD, Department of Psychiatry, University of California at San Diego, 9500 Gilman Drive, 2072-BSB, La Jolla, CA 92093–0603, USA


Depending on the population studied, anywhere from half to two-thirds of DSM-III borderline disorders seem to represent subaffective expressions, principally on the border of bipolar disorder. “Borderland” may actually be a better characterization of this large temperamentally unstable terrain with a population prevalence of 4–6% (as compared with 1% for classical bipolar disorder). The temperaments include the dysthymic, irritable, and cyclothymic types which, respectively, coexist with “double depressive”, mixed bipolar, and bipolar II disorders; others conform to an anxious-sensitive temperament in continuum with hysteroid dysphoric and atypical depressive disorders. Borderline “stable instability” in these patients appears secondary to affective temperamental dysregulation, which has exacerbated into a protracted emotional storm during a difficult maturational phase in the biigraphy of a given patient.