Comorbid atypical depression in borderline personality disorder is common and correlated with anxiety-related psychopathology Daniela Gremaud-Heitz a,b, ⁎ , Anke Riemenschneider a , Marc Walter a , Daniel Sollberger a , Joachim Küchenhoff a,c , Gerhard Dammann a,b a Psychiatric Hospital, University of Basel, Basel, Switzerland b Psychiatric Hospital, Münsterlingen, Switzerland c Psychiatric Hospital, Liestal, Switzerland Abstract Background: The core features of borderline personality disorder (BPD) are affective instability, unstable relationships and identity disturbance. Axis I comorbidities are frequent, in particular affective disorders. The concept of atypical depression is complex and often underestimated. The purpose of the study was to investigate the comorbidity of atypical depression in borderline patients regarding anxiety- related psychopathology and interpersonal problems. Methods: Sixty patients with BPD were assessed with the Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID I, SCID II) as well as the Atypical Depression Diagnostic Scale (ADDS). Additionally, patients completed a questionnaire (SCL-90-R, BDI, STAI, STAXI, IIP-C). Results: Forty-five BPD patients (81.8%) had a comorbid affective disorder of which 15 (27.3%) were diagnosed with an atypical depression. In comparison to patients with major depressive disorder or no comorbid depression, patients with atypical depression showed significant higher scores in psychopathological symptoms regarding anxiety and global severity as well as interpersonal problems. Conclusions: The presence of atypical depression in borderline patients is correlated with psychopathology, anxiety, and interpersonal problems and seems to be of clinical importance for personalized treatment decisions. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Borderline is one of the most common personality disorders that affects about 1% to 2% of the general population, around 10% psychiatric outpatients and 20% psychiatric inpatients. The diagnosis is more common in women (75%) than in men [1,2]. BPD was included in 1980 in the DSM-III classification [3]. The main characteristics include affective instability, unstable relationship patterns, disturbed identity and impul- sivity. DSM-IV-TR defines affective instability as intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days, due to a marked reactivity of mood [4]. BPD is considered both psychologically [5] and biolog- ically [6] as a heterogeneous disorder and is associated with high comorbidity [7]. Biological vulnerability and develop- mental insults combined determine the presentation of BPD. The diagnostic criteria of BPD can be organized into four sectors of psychopathology: affective, cognitive, behavioural and interpersonal criteria [8]. Patients vary widely in their severity of manifestation of these factors and even do not need to be impaired in all four factors. There are 126 different possibilities (clusters) to fulfil the diagnostic criteria for BPD (at least 5 of 9 different criteria) [9]. These dissimilarities can lead to alternate courses of the disorder [10] as well as different treatment responses. The disorder of affectivity in borderline disorder is conceptualized in different ways. Psychiatrists emphasize either the disorder of affect regulation with difficulty of personality-conditioned affect control [11,12], or the emotional dysregulation due to elevated biological vulner- ability [13]. Available online at www.sciencedirect.com ScienceDirect Comprehensive Psychiatry 55 (2014) 650 – 656 www.elsevier.com/locate/comppsych ⁎ Corresponding author at: Psychiatric Hospital Münsterlingen, CH-8596 Münsterlingen, Switzerland. Tel.: + 41 71 686 40 21; fax: + 41 71 686 40 35. E-mail address: daniela.gremaud@stgag.ch (D. Gremaud-Heitz). 0010-440X/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.comppsych.2013.11.021