Early Life Stress, Neuroendocrine Function Analysis Differentiates Borderline Personality Disorder From Bipolar Disorder

cortisol test tube
cortisol test tube
Analysis of early life stress and neuroendocrine function may help clinicians differentiate between borderline personality disorder and bipolar disorder.

Along with understanding of a patient’s history of early life stress, neuroendocrine biomarkers may help clinicians differentiate borderline personality disorder (BPD) from bipolar disorder (BD), according to a study published in Behavioural Brain Research.

The study sought to assess history of early life stress subtypes (including emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and their association to other psychiatric symptoms, including neuroendocrine function, in developing better diagnostic criteria to differentiate BPD from BD.

The study population included 51 women: 20 diagnosed with BPD, 16 diagnosed with BD, and a healthy control group of 15. Diagnoses were confirmed according to the DSM-IV and psychiatric symptoms were evaluated using various Beck Scales. The Childhood Trauma Questionnaire was used to score the history of early life stress according to subtypes, and cortisol levels were used to measure the functioning of the hypothalamic pituitary adrenal axis.

History of early life stress was significantly prevalent among individuals diagnosed with BPD (80%) and BD (56%), but was not present in the control group. Both diagnostic-related groups with a history of early life stress had significantly lower cortisol levels than that of the control group, suggesting a general impairment in neuroendocrine function.

Additionally, cortisol levels exposed the variations in neuroendocrine function in which individuals with BPD typically demonstrate more severe distress associated with a history of early life stress than those with BD.

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The results of this study support the value of identifying different stressor subtypes and the relevance of neuroendocrine function in forming a differential diagnosis between BPD and BD. For example, history of sexual abuse and cortisol levels showed a positive correlation among patients with BPD and a negative correlation in patients with BD, suggesting a different inhibitory response for each disorder.

Limitations of this study were a small study population and cortisol samples that were taken only once, which could affect the ability to establish an accurate baseline.

BPD and BD are commonly misdiagnosed as they share many clinical symptoms; in order to accurately form a differential diagnosis a more thorough analysis of neuroendocrine function in association with a history of early life stressors is required. 


Mazer AK, Cleare AJ, Young AH, Juruena MF. Bipolar affective disorder and borderline personality disorder: differentiation based on the history of early life stress and psychoneuroendocrine measures [published online April 24, 2018]. Behav Brain Res. doi: 10.1016/j.bbr.2018.04.015