Deep-seated feelings of shame and abandonment fuel borderline traits in bipolar patients

People diagnosed with bipolar disorder frequently experience overlapping symptoms of borderline personality disorder, and new research maps out how deeply ingrained negative beliefs might fuel these conditions. Shared psychological struggles are strongly linked to feelings of shame, an intense fear of abandonment, and a perceived lack of self-control. The results were published in the Journal of Affective Disorders.

Bipolar disorder is a psychiatric condition characterized by extreme mood swings. Patients oscillate between high-energy manic or hypomanic phases and deep depressive lows. Alongside these mood changes, many patients experience unstable self-identity, stormy interpersonal relationships, and impulsive behaviors.

These additional challenges are the hallmark traits of borderline personality disorder. Mental health professionals often observe that these two conditions frequently occur together. Some patients with bipolar disorder show severe borderline traits, while others only exhibit mild characteristics.

Psychologists use the concept of early maladaptive schemas to understand persistent psychological distress. These are deeply entrenched patterns of thinking and feeling regarding oneself and others. They usually develop during childhood when a person’s core emotional needs go unmet.

Once established, these belief systems act as a negative filter through which people view themselves and the broader world. There are several distinct categories of these beliefs. Some revolve around disconnection and rejection, which includes the anticipation of abandonment and feelings of inner defectiveness.

Other negative beliefs relate to impaired autonomy, such as feeling uniquely vulnerable to illness or destined to fail. Evaluating the world through these lenses repeatedly can make psychological healing very difficult.

A team of researchers recognized that these deeply ingrained belief systems might explain why borderline traits look different across varying patients. Lead author Myeongkeun Cho and principal investigator C. Hyung Keun Park, along with colleagues from the Asan Medical Center in the Republic of Korea, decided to investigate this relationship in a clinical setting.

The researchers gathered data from 557 adult psychiatric outpatients diagnosed with either bipolar I or bipolar II disorder. They provided the patients with specific questionnaires designed to evaluate 18 different categories of ingrained negative beliefs.

The surveys also measured the severity of four specific borderline personality traits. These traits included unstable moods, identity problems, negative relationships with others, and self-harming behaviors. Based on the survey results, the team separated the participants into two distinct categories.

One group consisted of patients exhibiting severe borderline traits. The second group consisted of patients who only exhibited mild or non-severe borderline symptoms. To make sense of the data, the team used a statistical tool known as network analysis.

This analytical method visually maps out how different psychological symptoms and belief systems interact with one another. In these visual maps, each symptom or belief acts as a node, similar to a city on a map. Lines connect these nodes to show 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 showed higher overall levels of every single negative belief compared to the non-severe group. This supports previous clinical observations that people with severe borderline symptoms often grapple with an overwhelming number of negative thought patterns.

The visual maps revealed several shared patterns across both the severe and non-severe groups. Beliefs related to personal defectiveness, shame, and subjugation were centrally located in the psychological networks of both groups. Subjugation refers to the habit of surrendering control to others to avoid conflict or punishment.

Because these shame-based beliefs sit at the center of the symptom network, they likely exert a broad influence on other negative thoughts. The researchers suggest that treating a patient’s internalized shame could be an effective starting point for therapy.

The team also noticed that identity struggles and negative relationship patterns acted as bridges connecting to specific beliefs. Across all patients, these symptoms were strongly tied to expectations of being abandoned, abused, or socially isolated.

Another shared trait involved behaviors that physically harm oneself. In both the severe and non-severe groups, self-harm was directly associated with beliefs about having insufficient self-control and discipline. The researchers suggest that when a patient believes they lack the capacity for self-regulation, they might become more prone to impulsive acts of self-injury.

The analytical maps also revealed distinct differences between the two patient groups. In the group with severe borderline traits, having turbulent relationships was more tightly woven into their overall web of negative beliefs.

For patients with mild symptoms, bad relationships might largely stem from the social fallout of their manic or depressive mood swings. For the severe group, relationship instability appears rooted in chronic psychological beliefs about themselves and the people around them.

The two groups also displayed different patterns regarding unstable moods. For the severe group, sudden mood shifts were associated with an increased likelihood of self-harm. Conversely, for the non-severe group, mood instability was linked to feelings of a fractured self-identity.

This specific difference suggests that unstable emotions tend to trigger external behaviors in severe cases, but internal confusion in milder cases. These distinctions can help mental health professionals tailor their treatment plans. Clinicians treating borderline traits in bipolar disorder might adapt specific psychological therapies based on these symptom maps.

The study relies on observational data gathered at a single point in time. Because the design was cross-sectional, the results cannot establish a direct chain of cause and effect. It remains possible that borderline psychological traits cause these negative beliefs to form, rather than the beliefs causing the traits.

The research also took place at a single medical center in the Republic of Korea. This specific patient population might not reflect the experiences of diverse groups in other cultural or clinical environments. The authors note that the study did not account for varying medication statuses or exact current mood states, which might have influenced the questionnaire responses.

Future studies would benefit from tracking patients over long periods. Longitudinal data would allow researchers to see which psychological habits develop first. Examining these associations in a wider variety of cultural contexts would test the broader applicability of the findings. Researchers could also test whether psychological interventions targeting shame and abandonment successfully reduce borderline traits in bipolar patients.

The study, “Levels and associations of borderline personality features and early maladaptive schemas in bipolar disorder: A comparative network analysis of patients with and without severe borderline personality features,” was authored by Myeongkeun Cho, Chanhee Park, Eunbyeol Lee, and C. Hyung Keun Park.