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GENERAL ANNOUNCEMENT

This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question.

Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board.

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Author Topic: DIFFERENCES|COMORBIDITY: Borderline PD and BiPolar Disorder  (Read 11576 times)
SLO
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« on: January 14, 2008, 05:29:15 PM »

Can someone list the differences between BPD and Bipolar? I have found a couple sites on Bipolar, but kind of need it separated for me. Reading the Walking on Eggshells and all I've learned here my "whatever" almost perfectly fits BPD to the T. His brother (psychologist) thinks he is Bipolar...but I know that BPD is "understudied". It really doesn't matter what he has...I am just real curious at the differences. Thanks.
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« Reply #1 on: January 14, 2008, 05:52:49 PM »

BPD (Borderline Personality Disorder) is a an Axis 2 classifications. BPD is a "Behavioral Disorder". It is a disorder based upon how a person thinks and feels. They cannot process and control their emotions and feelings. It is not "curable" per-se, but can be controlled through a few processes DBT/CBT in which the afflicted learn to accept and understand their thought (so to speak) and learn how to react and respond to them and to others. Medicines may be used with BPD to help them get into a "better place" so they can start to face their thoughts/feelings.

Bi-Polar is a Mood disorder and can be considered a "tangible medical matter". It is often generally affected with chemistry & transmitters. It has hereditary allowances. It may often be treated with some medications (to "control" the moods) and has been noted to be improved with special diets and herbs. Bi-Polar can be very difficult to treat and control. There are my types of Bi-Polar. It too is to be considered not-curable. Medicines are the primary approach to Bi-Polar with therapy coming is as support (after the meds).

Here is a link that may shed some more light:
http://www.psycheducation.org/depression/borderline.htm

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« Reply #2 on: January 14, 2008, 08:23:19 PM »

  The bipolar disorder includes either mania or hypomania which is a period of at least several days where the mood is euphoric, the individual feels on top of the world and invincible, has lots of energy and sleeps very little, maybe a few hours a night.  It can include out of control behavior including anger and sexually inappropriate behavior that they would not normally do.
   The mood changes of a borderline are less predictable and can change several times in one day.  It is not a predictable cycle.  They usually feel empty and have self-loathing although it may not be apparent to others as some hide it well.

   Although the generally accepted thinking has been that BPD is not a chemical problem but purely behavioral, there are others who are in disagreement.  New research is showing more and more, the prominence of biology playing a role in BPD.  It has also found to be hereditary, although it is believed to be a combination of a hereditary predisposition and environmental factors that cause the BPD to develop.
   Our doctor strongly believes that BPD is a malfunctioning of the limbic system, similar to a type of epileptic seizure.  He has researched every medical study on the BPD and has found medications and treatment to manage the disorder.  Therapy is needed to change lifetime negative thinking and poor defense mechanisms, but without the proper medication, therapy will not be very effective.
   He has successfully helped thousands of individuals suffering from the borderline disorder, which includes my husband, daughter, neighbor's daughter, two friends and several acquaintances of mine that I personally know.  Patients with the borderline disorder have come from all over the world to see him.  My husband says he owes his life and his mental health to this doctor.  (And prior to this doctor, he thought all doctors were morons or jerks)

  Abigail
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« Reply #3 on: January 18, 2008, 08:20:02 PM »

When asking differential questions about multiple personality disorders, it is important to understand why you are asking the question and how you intend to use the information. Without this perspective and focus, the data may be overwhelming, confusing and misleading.  For example...

~ if your child is not responding to therapy, it makes sense to look more carefully into the possibility that the wrong illness was diagnosed or whether there are comorbid (multiple) personality disorders at play. Bipolar and Major Depressive Disorder, for example, are far more responsive to pharmaceutical therapy than Borderline Personality.

~ If you are trying to get along better with your wife, it's not as important to precisely pinpoint the specific disorder or analyze the comorbidity as it is to recognize and fully understand the problem behaviors and how to constructively deal with them.  

~ If you are recovering from a failed relationship, the important thing is often to understand which behaviors were pathologic (mental illness) and which were just the normal run of the mill problems common to failing/failed relationships - there is often a bias to assign too much to the "pathology" and not enough to common relationship problems, or the issues we created by our own behaviors.

It's important to know that the distinctions are not all that neat and tidy. In a 2008 study, comorbidity with another personality disorder was very high at 74% (77% for men, 72% for women).  This is one reason why there is controversy around the DSM classifications of Personality Disorders - there is so much overlap it is confusing even to professionals - personality disorders are real, but they are not easily or neatly defined.
More info

In the study, comorbidity with mood disorders was also very high at 75% as was anxiety disorders 74%.

Mood/Anxiety Comorbidities ----
Anxiety Disorder
-Posttraumatic stress
-Panic with agoraphobia
-Panic w/o agoraphobia
-Social phobia
-Specific phobia
-General anxiety
Mood Disorder
-Major depressive
-Dysthymia
-Bipolar I
-Bipolar II

More info
Men---------
-
30%
8%
16%
25%
27%
27%
-
27%
7%
31%
7%
Women------
-
47%
15%
21%
33%
47%
42%
-
37%
12%
33%
9%

Some helpful hints for sorting through this.

  • General and Specific There are definitions for "personality disorder" as a category and then there are definitions for the subcategories (i.e., borderline, narcissistic, antisocial, etc.).  Start with the broader definition first.  Keep in mind that to be a personality disorder, symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder - - the history of symptoms can be traced back to adolescence or at least early adulthood - - the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control

  • Spectrum Disorders  An extremely important aspect of understanding mental disorders is understanding that there is a spectrum of severity. A spectrum is comprised of relatively "severe" mental disorders as well as relatively "mild and nonclinical deficits".  Some people with BPD traits cannot work, are hospitalized or incarcerated, and even kill themselves.  On the other hand, some fall below the threshold for clinical diagnosis and are simply very immature and self centered and difficult in intimate relationships.

  • Comorbidity Borderline patients often present for evaluation or treatment with one or more comorbid axis I disorders (e.g.,depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa). It is not unusual for symptoms of these other disorders to mask the underlying borderline psychopathology, impeding accurate diagnosis and making treatment planning difficult. In some cases, it isn’t until treatment for other disorders fails that BPD is diagnosed.  Complicating this, additional axis I disorders may also develop over time.  Because of the frequency with which these clinically difficult situations occur, a substantial amount of research concerning the axis I comorbidity of borderline personality disorder has been conducted. A lot is based on small sample sizes so the numbers vary.  Be careful to look at the sample in any study -- comorbidity rates can differ significantly depending on whether the study population is treatment seeking individuals or random individuals in the community.  Also be aware that comorbidity rates  are generally lower in less severe cases of borderline personality disorder.
  • Multi-axial Diagnosis  In the DSM-IV-TR system, technically, an individual should be diagnosed on all five different domains, or "axes." The clinician looks across a large number of afflictions and tries to find the best fit.  Using a single axis approach, which we often do as laymen, can be misleading -- looking at 1 or 2 metal illness and saying "that's it" -- if you look at 20 of these things, you may find yourself saying "thats it" a lot.   smiley  A note in the DSM-IV-TR states that appropriate use of the diagnostic criteria is said to require extensive clinical training, and its contents “cannot simply be applied in a cookbook fashion”.

  • Don't become an Amateur Psychologist or Neurosurgeon  While awareness is a very good thing, if one suspects a mental disorder in the family it is best to see a mental health professional for an informed opinion and for some direction - even more so if you are emotionally distressed yourself and not at the top of your game. 

I hope this helps keep it in perspective.   smiley

Skippy



DIFFERENCES|COMORBIDITY: Overview of Comorbidity

Additional discussions...

Personality Disorders
Borderline and Paranoid Personality Disorder
Borderline and Schzoid/Schizotypal Personality Disorder
Borderline and Antisocial Personality Disorder
Borderline and Histrionic Personality Disorder
Borderline and Narcissistic Personality Disorder
Borderline and Avoidant Personality Disorder
Borderline and Dependent Personality Disorder
Borderline and Obsessive Compulsive Personality Disorder
Borderline and Depressive Personality Disorder
Borderline and Passive Aggressive Personality Disorder
Borderline and Sadistic Personality Disorder
Borderline and Self Defeating Personality Disorder

Other
Borderline PD and Alcohol Dependence
Borderline PD and Aspergers
Borderline PD and Attention Deficit Hyperactivity Disorder
Borderline PD and BiPolar Disorder
Borderline PD and Dissociative Identity Disorder
Borderline PD and P.T.S.D.
Borderline PD and Reactive Attachment Disorder (RAD)
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« Reply #4 on: January 18, 2008, 08:58:59 PM »

I believe that the acid test is treating for bipolar and looking at the leftover symptoms.
I found this board after 14 years of ex being treated for his bipolar and not being symptom free.

Also as a side note: The seasons usually have a lot to do with depression and mania in bipolar disorder. Suicides, murder, and creativity are also charted according to the seasons.
Winter depression and May mania.

Kay Redfield Jamieson wrote a book on creative types and charted their creativity according to the seasons, and their subsequent depressions and suicides.
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« Reply #5 on: March 04, 2008, 07:21:03 AM »

Quote
I believe that the acid test is treating for bipolar and looking at the leftover symptoms.
I found this board after 14 years of ex being treated for his bipolar and not being symptom free.

From what I read over the years,
psychiatrist will first treat "possible bipolar" with anti-psychotic meds and see how the patient evolves...
Anti-psychotic meds don't help PD... so if the patient doesn't inprove it's a personality disorder.
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« Reply #6 on: June 26, 2008, 05:36:38 PM »

Hi All -

This is a question that frequently comes up on this board and I found a very interesting article about it today that I thought might be useful.

http://www.medicalnewstoday.com/articles/46236.php
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Randi Kreger
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« Reply #7 on: June 27, 2008, 12:46:58 PM »

When I was writing my new book, the psychiatrist whom I spoke with most often was just spitting mad at this article/study (don't remember which it is). He didn't agree with it.

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Author, The Essential Family Guide to Borderline Personality Disorder, Stop Walking on Eggshells, and the SWOE Workbook. Coauthor, Splitting: Protecting Yourself While Divorcing Someone with Borderline or Narcissistic Personality Disorder.  www.BPDCentral.com
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« Reply #8 on: June 27, 2008, 05:37:15 PM »

When I was writing my new book, the psychiatrist whom I spoke with most often was just spitting mad at this article/study (don't remember which it is). He didn't agree with it.



I thought it was really interesting, and I agree that the co occurance of bipolar and BPD are way over diagnosed.  I think that doctors diagnose BPD patients with bipolar so that they can get better insurance coverage, and that doctors diganose Bipolar patients with BPD because they can look very BPD when they are in an episode. 

For the bipolar advocacy community, this can present a huge problem because bipolar folks are not getting the correct dx, treatment or understanding of their illness, which is distinctly different from borderline personality disorder, even though people with bipolar can manifest many of the same symptoms.  Doc sees a bipolar cutting and says "borderline" immediately.  This is often  not the case.  Doc sees rage and says "borderline" despite the fact that rage is a huge symptom of a mixed bipolar mania.  Same with substance abuse, hypersexuality etc.

When you work with both populations, you do see some who definately have both, but for the most part they really don't.  There are some major differences that you get a feel for over time.  For me, I don't see the amount of overlap that is being dxd and I don't see much response to bipolar meds such as lamictal etc., when given to borderlines.  I do see a good rate of remission, but I have seen it come from group and individual therapy. The meds that I have seen work are APs like seroquel and anti depressants.
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« Reply #9 on: October 07, 2008, 04:41:06 PM »

It's been awhile since anyone posted, but for closure I wanted to add this. This is from my new book, the Essential Family Guide to Borderline Personality Disorder, out in November 2008:

Both people with BPD and those with bipolar disorder experience dramatic mood swings. But there are three crucial differences:

1. People with BPD cycle much more quickly, often several times a day.
2. The mood swings with BPD are more specific: all emotions are affected (fear, anger, sadness) while people with bipolar either have mania (intensely high) or major depression.
3. The moods in people with BPD are more dependent, either positively or negatively, on what’s going on in their life at the moment.



Randi Kreger
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« Reply #10 on: October 07, 2008, 04:51:33 PM »

Thanks for this topic. My BPD gf has been misdiagnosed with Bipolar disorder three times now. I myself have bipolar affective disorder(BP II) and i know the illness inside out. They are very very different. If you have any questions about bipolar disorder, feel free to ask me. I love discussing my illness.
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« Reply #11 on: October 17, 2008, 04:28:41 PM »

Thanks for this topic. My BPD gf has been misdiagnosed with Bipolar disorder three times now. I myself have bipolar affective disorder(BP II) and i know the illness inside out. They are very very different. If you have any questions about bipolar disorder, feel free to ask me. I love discussing my illness.

i agree with you, they are very different. i was diagnosed bipolar over ten years ago, and have been working on maintaining balance since. it's been an interesting ride, and i haven't always been someone that's easy to be around (i usually recognize it and pull back in attempt not to affect others), but never have entered into some of the behaviors that i'm learning are typical of a BP. i have felt a growing fear-based stigma toward bipolar individuals over the last several years, and i was wondering if perhaps you've noticed anything, pop-culturally or even in the psychiatric arena, that would reflect what i consider to be a gross misunderstanding of what a bipolar individual really deals with? if so, do you think the stigma is exasperated by this trend to diagnose BP's as bipolar?
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« Reply #12 on: January 24, 2009, 01:15:32 PM »

Hi

I thought that this was an interesting article comparing and contrastin bipolar and BPD

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=4185
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« Reply #13 on: January 26, 2009, 11:29:16 AM »

Thank you so much for posting this. I actually was going to ask the question today about what the difference is.   cheesy
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« Reply #14 on: March 14, 2010, 09:17:53 PM »

It's been awhile since anyone posted, but for closure I wanted to add this. This is from my new book, the Essential Family Guide to Borderline Personality Disorder, out in November 2008:

Both people with BPD and those with bipolar disorder experience dramatic mood swings. But there are three crucial differences:

1. People with BPD cycle much more quickly, often several times a day.
2. The mood swings with BPD are more specific: all emotions are affected (fear, anger, sadness) while people with bipolar either have mania (intensely high) or major depression.
3. The moods in people with BPD are more dependent, either positively or negatively, on what’s going on in their life at the moment.



Randi Kreger
BPDCentral.com
Welcome to Oz Community Owner
Stop Walking on Eggshells and the SWOE Workbook
The Essential Family Guide to BPD




Hi

Since this came back up again, I wanted to adress your points.  I respectfully disagree on a few.

1. People with BPD cycle much more quickly, often several times a day. - People with ultra radian rapid cycling bipolar can go through multiple mood dwings in a single day.

2. The mood swings with BPD are more specific: all emotions are affected (fear, anger, sadness) while people with bipolar either have mania (intensely high) or major depression. - People can present with a variety of moods when in mania or depression.  Mania is also much more than an intense high.  In bipolar type 2 it can be a mild high.  Or, a person with any form of bipolar disorder can suffer from what is known as dysphoric mania, which is a very nasty, irritable, angry high that is also referred to as a mixed epsiode.  In terms of depression, the sadness associated with a bipolar depression is brutal.  Lastly, a person with symptoms of the schizoaffective end can most certainly suffer from feelings of fear and paranoia during an episode.  

3. The moods in people with BPD are more dependent, either positively or negatively, on what’s going on in their life at the moment. - I am 50-50 on this one.  I agree that people with bipolar do not experience the intense and transient symptoms that can come on like lightning for people with borderline, but life circumstances and stress have an affect on all mental health conditions.

The difference to me is level of insight and the way people with bipolar treat others.  Most people with bipolar diisorder know that they are sick.  They might have a hard time with med compliance, but they know that they hv a problem.  They also generally do no manipulate and treat other people like crap the way that borderlines do.  Also, I have noticed that if something does go on during an episode that damages a relationship, they are generally sincerely remorseful.

Just my observations.
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« Reply #15 on: June 17, 2010, 08:17:25 PM »

Skip, thanks for the statistics on how often this occurs.  I knew it happened a lot but I didn't know any actual numbers on this.  
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« Reply #16 on: June 17, 2010, 09:11:42 PM »

These 3 links are summarizing the same recent study info, but each includes a few details that the other doesn't.  Says that "nearly 40 percent (20 of 52) of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder."

Personality Disorders Misdiagnosed As Bipolar | Psych Central News    http://psychcentral.com/news/2009/07/30/personality-disorders-misdiagnosed-as-bipolar/7439.html

Some conditions misdiagnosed as bipolar disorder | Reuters      http://www.reuters.com/article/idUSTRE57C4SZ20090813

Bipolar over-diagnosis associated with personality disorder       http://www.masspsy.com/leading/11.09_bipolar.html


In case you're interested, a few links I read over when I was researching the difference between bipolar and BPD:
What's the difference between BPD and bipolar?-(this is full of info, I found it very interesting)     http://www.psycheducation.org/depression/borderline.htm

Difference Between Bipolar and Borderline Personality Disorder - Bipolar Disorder Center - Everyday Health-    http://www.everydayhealth.com/bipolar/specialists/difference-between-bipolar-and-borderline-personality-disorder.aspx

Three Easy Ways to Differentiate Bipolar and Borderline Disorders | Psychology Today-   
http://www.psychologytoday.com/blog/stop-walking-eggshells/201003/three-easy-ways-differentiate-bipolar-and-borderline-disorders


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« Reply #17 on: June 18, 2010, 05:44:16 PM »

Almost every borderline that I have known or have heard about by others, has been diagnosed AT LEAST ONCE as being bipolar. It is hugely misdiagnosed. Somewhere in my archives of posts I have ranted about this and the reasons why, I will have to dig it up...

This is actually one of my goals to "blow the lid off" when I finish my psychology degree. Last spring semester I was working on a project comparing the two illnesses and seeing how many of the general population of the school knew about bipolar disorder and how many knew about borderline personality disorder. The results didn't surprise me. Almost everyone has heard of bipolar disorder, and only a select few have heard of borderline - or any PD for that matter. When I asked some of the people to describe bipolar disorder, a lot of them did give me an accurate description... of borderline personality disorder... -sigh.
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« Reply #18 on: June 24, 2010, 12:30:21 PM »

There are no stats on this.

Randi Kreger
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The Essential Family Guide to BPD
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« Reply #19 on: June 27, 2010, 11:36:28 PM »

My wife is currently diagnosed with Bipolar.  She has tried most bipolar medications: Paxil, Prozac, Zoloft, etc.  They help some, irritate other parts of her life, and generally fail to work in the long term.

She clearly exhibits black/white thinking and crazy-making behaviors.  She also cycles incredibly quickly... too quickly for bipolar in my (non-professional opinion).  I can be a god one moment, garbage the next, and back to wonderful later that evening.

I think that having a non-BPD learn how to deal with some of the behaviors is the most helpful with dealing with the BPD behaviors.  This is essentially behavioral therapy for the BPD partner.

However, I think some mood stabilizers can have some helpful effects in making some of the BPD behaviors less accute and perhaps more manageable by the couple.  My wife is currently taking a low dose of Seroquil.  I've notice that during this time we've been much more successful in working with the behaviors.  The behaviors are still there, they just tend to be less intense.  So instead of fearing for my physical safety, many times it's just my feelings that get hurt.  It also seems the frequency of the behaviors is reduced.

I'm still struggling with how to broach the subject with her about the possibility of her being BPD instead of Bipolar... but for now, I'm finding it helpful that at least this mood stabilizer seems to help somewhat for dealing with the behaviors.
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