Tokyo psychiatrist, Dr. Douglas Berger, comments on “Borderline or Bipolar: Objective Data Support a Difference” by James Phelps, MD, July 11, 2016 issue of the Psychiatric Times:

Dr. Phelps is going too far too fast in concluding these results are valid or objective.

The study he references here

studied 20 subjects with Borderline personality disorder (BPD) and 20 with euthymic bipolar disorder (BD)

1. The numbers are really too small to make any conclusive statements.

2. The results would mean that if we had 100 of each group, 25 of the BD and 50 of the BP would not cooperate in the paradigm i.e., 75/200. In addition to the the diagnostic uncertainty of these disorders, especially BPD, it’s a study with lots of variance (=standard error) in entry criteria and in the results. Even Dr. Phelps admits that separation between the groups was far from 100%.

3. The subjects are unblind to the question being asked and as such could reply for any number of reasons, so its not truly an objective finding, i.e., it is still a psychosocial finding, not a biological or physical parameter that can be clearly measured like stroke incidence, tumor size, or death rate, etc.

4. The diagnosis of BPD is still subject to considerable subjective interpretation and overlaps considerably with ADHD and MDD, and BD (even Dr Phelps says it’s 90% overlap).

5. The authors state themselves, “Our data support the differentiation of BPD from BD”. They only use the word “support”, they do not (and can not) conclude the results are clearly validated by this small study, nor are they objective in any way that can be measured with minimal error.

We need to be more humble in our conclusions about mental health research with large variance in disorder validation, variable results, unblinded studies with semi-subjective endpoints, and small numbers of subjects.

The research study described is an interesting description of a psychosocial challenge to persons with a psychiatric history, but not really conclusive about anything at this time.

Doug Berger, M.D., Ph.D.
US Board Certified Psychiatrist
Tokyo, Japan

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