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Author Topic: DIFFERENCES|COMORBIDITY: Borderline PD and BiPolar Disorder  (Read 13515 times)
PotentiallyKevin
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« Reply #40 on: August 06, 2010, 07:14:13 PM »

To break bipolar disorder down, Bipolar I = at least 1 manic episode. Bipolar II = no full blown manic episodes, but reoccurring hypo-mania, which is a milder form of mania - no "psychotic breaks."

Bipolar III is widely used differently depending on who is your source. Most accounts refer bp3 as cyclothymia, which has both mild depression and hypo-mania. It also tends to cycle more frequently than Bipolar I and Bipolar II.

More interesting facts: One study showed that people with Bipolar II disorder have a 50+% co-morbidity with seasonal affective disorder. Only about 25% of BP I reported SAD. Most BP II have a fairly predictable mood cycle pattern. They also experience more "normal" times than BP I. BP I tends to have the longest durations of cycles, cycles often lasting years. Most historical accounts of bipolar disorder were BP I. Untreated Bipolar Disorder (especially type I) can be very devastating to the person and anyone associated to them - BUT - the love/hate, black and white thinking, splitting, projective identification issues - are the halmark traits of borderline personality disorder and is generally not associated with bipolar disorder.

A person with bipolar disorder who is manic, is extremely INTERNALIZED, meaning, that they exist and no one else really does. It is a feeling of grandiosity, immortality, exuberance, and endless energy. Ideas flood the mind very rapidly - everything is possible. Most inventors, poets, composers, and artists in history are suspected to have been suffering from bipolar disorder. During their manias they often were inspired to their greatest achievements.

During depression, a person with bipolar disorder withdrawals from society. The will go days without eating, sleep many hours, and feel lethargic and useless. Everything seems to be a huge chore.

Suicide is also remarkably different. Many borderline personality disorder suicides have been ruled "accidental" or meaning their was no absolute intention of committing suicide. Reckless driving, overdosing on pills, self-mutilation taken too far, are the most common forms of borderline suicide. Most borderline suicides are done in the presence of others - whereas bipolar disorder is seldom done in the presence of others. A majority of bipolar suicides are done with little cry for help or warnings. The person appears days before as just fine - a lot of the times, bipolar suicides will make sure they have everything in order. My friend (who had extreme bipolar I) cleaned his entire house, gave away his motorcycle, wrote a note to his family explaining that it wasn't their fault, he was tired of bieng depressed and couldn't take it any longer...he had planned his suicide while they were on vacation, so they wouldn't interfere nor have to deal with directly with it. He left a note to the police, letting them know exactly where to find his body, and went to a remote place so no one would have to stumble upon it... when my exbpdgf was suicidal, it was much more reactionary - spur of the moment, and she let the whole world know that they better rescue her... one of my friend's wife, who I suspect is BPD, called him as she was overdosing on her pills, and said "well honey, I just took a bottle of pills, you better come home..."

I have mentioned several times that the symptoms of these two illnesses, are very similar, but the core issues are completely different. Read my other posts on this subject.

Kay Redfield Jamison has written three amazing books about bipolar disorder.

An unquiet mind - which outlines her struggle with bipolar disorder as well as does an excellent job explaining everything about bipolar disorder

Touched with Fire - In which she explores the connection with heightened creativity and bipolar disorder

and The Night Falls Fast - In which she explores the causes of suicide and societies outlook on suicide, she even mentions the borderline personality disorder in this book, and in my opinion, makes an excellent comparison.

Read these books if you want to know more about bipolar disorder. There is no one who knows more or has researched more about bipolar disorder than Mrs. Jamison.
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po·ten·tial  adj.
1. Capable of being but not yet in existence; latent: a potential greatness.
2. Having possibility, capability, or power.
3. The inherent ability or capacity for growth, development, or coming into being.
4. Something possessing the capacity for growth or development.


Unreal
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« Reply #41 on: August 18, 2010, 09:26:45 AM »

Quote
Unreal,
   For example, my neighbor's daughter had been diagnosed as bipolar when she was a teenager but the meds for bipolar disorder did not help, there was no mania and when she found out about the criteria for BPD, she, her mother and a doctor agreed that she was borderline.  In addition, the treatment for BPD helped her tremendously.
   My husband's therapist had insisted he was bipolar even though he met 8 out of the 9 criteria for BPD, and never once in the 26 years we have been married, ever had mania.
   My nephew is bipolar and a friend of mine has both bipolar and the borderline personality disorder.

There are many types of bipolar disorder/cyclic disorders. . . bipolar I, bipolar II, cylcothymia.  Check out this:

http://www.mayoclinic.com/health/cyclothymia/DS00729/DSECTION=symptoms

tell me if it doesn't sound familiar. 

That the treatment didn't work doesn't mean the diagnosis was wrong.  That a treatment does work in some fashion doesn't mean the diagnosis was correct.

There are a lot of problems with overlap/co-morbiditity among some categories of mental illness, and our understanding of how these symptoms develop, what impacts them is continually advancing,  hence the need for another DSM. 
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Salut
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« Reply #42 on: January 12, 2011, 04:04:34 PM »

Because of the mood cycling, it seems like in some cases BPD and bipolar could be easily confused.  Are these related, and if they are different problems do they need to be treated differently?
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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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« Reply #43 on: February 15, 2011, 12:39:10 PM »

I was looking around this morning and found this. My now exBPDf has been diagnosed at one time or another with both. Hope this helps some of you.

Borderline and Bipolar are closely related. Depression and mood swings are high in bipolar, as a person can be manic (one pole) and depressive (the other polarity) the next.

This switching back and forth is called rapid cycling.

Bipolar has three different forms:

Bipolar I--where the person experiences one or more manic episodes with or without major depressive episodes.

Bipolar II

Bipolar II--where the person has hypomanic episodes as well as at least one major depressive episode. Hypomanic episodes do not go to the extremes of mania (i.e. do not cause social or occupational impairment, and without psychotic features), and a history of at least one major depressive episode. Bipolar II is much more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing depression.

Cyclothymia

Cyclothymia--involves presence or history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes.

Borderline Personality Disorder:

It involves this Mnemonic (using the word PRAISE)

A commonly used mnemonic to remember some features of borderline personality disorder is PRAISE:

P - Paranoid ideas

R - Relationship instability

A - Angry outbursts, affective instability, abandonment fears

I - Impulsive behavior, identity disturbance

S - Suicidal behavior

E - Emptiness

Read this information from wikipedia: Differential diagnosis

Borderline personality disorder often co-occurs with mood disorders. Some features of borderline personality disorder may overlap with those of mood disorders, complicating the differential diagnostic assessment.

Both diagnoses involve symptoms commonly known as "mood swings". In bipolar disorder, the term refers to the marked lability and reactivity of mood defined as emotional dysregulation. The behavior is typically in response to external psychosocial and intrapsychic stressors, and may arise or subside, or both, suddenly and dramatically and last for seconds, minutes, hours or days.

Bipolar depression is generally more pervasive with sleep and appetite disturbances, as well as a marked nonreactivity of mood, whereas mood with respect to borderline personality and co-occurring dysthymia remains markedly reactive and sleep disturbance not acute.

The relationship between bipolar disorder and borderline personality disorder has been debated. Some hold that the latter represents a sub threshold form of affective disorder, while others maintain the distinctness between the disorders, noting they often co-occur.

Some findings suggest that BPD may lie on a bipolar spectrum, with a number of points of phenomenological and biological overlap between the affective lability criterion of borderline personality disorder and the extremely rapid cycling bipolar disorders. Some findings suggest that the DSM-IV BPD diagnosis mixes up two sets of unrelated items and an affective instability dimension related to Bipolar-II, and an impulsivity dimension not related to Bipolar-II.

This was a real eye opener for me and really helped me understand my BPD/Bipolar ii now exBPDf . This was someone who had been told they were both types answer.

I had a therapist who knew me quite well, and was 100% sure I have bipolar disorder. A doc I saw in the hospital tried to tell me I had borderline personality disorder. I was SO confused. When I brought this up to the therapist, he said in no way did I have BPD and I was bipolar all the way.

I asked him how he was so certain, and his basic explanation was I do not have trouble holding an interpersonal relationship. It may have turmoil due to my mood swings (rapid cycle bipolar), however, I can maintain the relationship. With BPD, there is a problem interacting with others because your personality, not just your mood, can shift rapidly.

  Much love to you all I have been painted black and left once again.



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twister329
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« Reply #44 on: December 18, 2012, 02:18:53 PM »

Bipolar disorder? I asked my teacher about her opinion on it, and she said it's not as extreme as Bipolar disorder. My mother has BPD, and I find it very difficult to believe there's a disorder worse than this! Except maybe sociopaths and the like, but bipolar? I thought BPD and Bipolar had a lot of similarities. Maybe I'm wrong? huh
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« Reply #45 on: January 07, 2013, 04:00:39 PM »

I was wondering how frequently people with BPD get misdiagnosed. My roommate/closest friend thinks she might have it (this is after a very long, turbulent period of us having no idea what's going on/why she's having so much interpersonal difficulty) and originally she was tentatively diagnosed with Bipolar II by a fairly desperate doctor who, according to her parents, basically didn't know what else to say. My friend has lived for about 10 years under the assumption that she had a mood disorder, then Bipolar Disorder. I went with her to see a T the other week (she's looking for one now) and the T observed that she doesn't seem to show any of the signs that specifically point to Bipolar Disorder (at least these days). Now, the possibility of BPD is coming up and it seems to be changing her entire approach to things. I was wondering how often people diagnosed with Bipolar Disorder end up actually having BPD.
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« Reply #46 on: January 08, 2013, 02:23:40 AM »

losingconfidence misdiagnosis, or cormorbid diagnoses, or alternative diagnoses are not uncommon.  It's a difficult disorder to diagnose.  Sometimes there are more than one diagnosis going on and sometimes the medical professionals are reluctant to diagnose for BPD for insurance or patient rejecting therapy.

Here is a link and an excerpt to a thread that has a little more info:
It is a significant challenge to determine if someone in your life has Borderline Personality Disorder or any personality disorder. We often do not have a formal diagnosis to rely upon.  

The American Psychiatric Association cautions us against using the DSM criteria for making amateur "cookbook" diagnoses as they are often inaccurate. For our own sake and for the sake of others,  we want to be responsible and constructive in assessing the mental health of others in our life.  First and foremost, these designations were created to help people and families, not label and blame.

When we encounter high conflict and destructive relationship behaviors in others, our first priority could be to triage our situation. Write down the difficult behaviors that we have observed.

  • If any are dangerous (e.g., domestic violence, suicidal ideation, or criminal) or fatal to the relationship (e.g., serial adultery, ruinousness spending), it makes sense to immediately start planning for safety.

  • For all the others, we should do everything we can to reduce the conflict in the immediate term. This may not be not easy for us.  It usually involves giving in to the other person and providing them space and listening to/validating them. At the same time, we should force ourselves to step back from the conflict and process the hurt or resentment that we are feeling.  This requires a great deal of maturity.  We have tools for neutralizing the situation (stop the bleeding) and we have tools for taking a step backward (rebalancing ourselves). As difficult as it may be, starting here is usually in the best interest of ourselves and our children.

Once the situation is defused as best it can be, we can then start investigating what is going on so that we can make informed decisions.  When we encounter high conflict people with destructive relationship behaviors it is important for us to know that the problems can be caused by a large range of things from immaturity,  short term mental illness (e.g. depression), substance induced illness (e.g. alcoholism), a mood disorder (e.g., bipolar), an anxiety disorder (e.g. PTSD), a personality disorder (e.g., BPD, NPD), or even a learning disability (e.g. Aspergers) and "any combination of the above" (i.e., co-morbidity). It will likely take some digging to sort it out.

The behaviors exhibited during a relationship for all of these afflictions can look somewhat alike but the driving forces and the implications can be very different.  For example, was that lying predatory (as in ASPD), ego driven (as in NPD), defensive (as in BPD), a result of being out of control (as in alcoholism), or ineptitude (as in Aspergers).  Was it situational, episodic (bipolar), or has it been chronic. Yes, all lying is bad, but the prognosis for the future is not that same in all situations. For example, depression and bipolar disorder (mood disorders) are very responsive to drug therapy -- substance abuse often requires intervention and inpatient detoxification -- personality disorders require multi-year re-learning therapies (e.g. DBT, Schema) --  Aspergers is often considered a long term disability.  Chronic bad behavior and situational bad behavior are very different.

It is probably best to resist the temptation to immediately latch onto one of the personality disorder symptoms lists as the magic formula. Doing this may make the situation appear more hopeless and more one-sided than it actually is, and it may send us in a wrong or unhealthy direction.  

Getting back to the subject in the title "What is BPD?" -- personality disorders, per se', are lifelong afflictions -- anyone can act "borderline" in a particular situation. To be a PD, symptoms must have been present for an extended period of time, be inflexible and pervasive, and not a result of alcohol or drugs or another psychiatric disorder -- the history of symptoms should be traceable 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.

"Present for an extended period of time" doesn't mean constantly and obviously present.  Many people with this disorder, especially as they get older, learn to adapt and control or isolate the worst of the disordered actions except when stress pushes them past their ability to control and manage.  This is why the disorder is more visible to the family and close friends. "Present for an extended period of time" means that there have been indications of the disorder at different times dating all the way back to the teen years.

It is also worth noting that personality disorders are spectrum disorders - meaning that there is a broad range of severity.  At the lower end, it is not necessarily a personality disorder at all - people can have personality style like a BPD or NPD.  Surely you know someone that is pretty narcissistic, but not mentally ill.  People with BPD can range all the way from "very sensitive with somewhat nonconstructive ways of coping and avoiding hurt" (BPD personailty style) all the way to social dysfunction (e.g., unable to hold a job) and potentially life threatening behavior (e.g. severe BPD).

Whether it is BPD or BPD personalty style, Bipolar Disorder, or simple depression, etc, you are welcomed and encouraged to work with the members here at BPDFamily.

A high conflict, emotionally abusive parent, child, relationship partner or spouse, regardless of the causation, is a challenge and we need to take appropriate steps for our own wellbeing and that of our family.  And hopefully you want to learn how to rise above and manage your interface with the difficult person in a constructive, mature and healthy way.  It's our very next step to a constructive, mature and healthy future for ourselves.

Tall order, I know.  I had a loved one with this disorder, too.   Empathy

Skippy
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« Reply #47 on: February 15, 2013, 01:23:48 AM »

One of the biggest differences, according to my psyD whom I was seeing, is the greater tendency and even ability for people with bipolar disorder to be self aware and to be able to help themselves through their cycles and one of the reasons attributed is the simple fact that bipolar disorder is a -mood- disorder and not a disorder where a person's way of thinking/mode of operations is where the disorder is coming from.

Where a person with bipolar disorder can sense a 'cycle' about to start - for example, a depressive or a manic phase - and are able to tell themselves - and the people around them, "this is just the bipolar acting up; hang on" and cope with it this way and not let it affect themselves or the people around them to the degree that a BPD's episode might, that sort of self-awareness is something that is not as prevalent amongst people who struggle with BPD and is, in fact, a much greater struggle for people with BPD.

Also, where the triggers for a pwBPD might be almost all emotion-related and situational-related, the trigger for people with bipolar disorder is oftentimes nothing particularly tangible.  It happens - with no probable cause (can't blame a bad conversation with whoever, etc, nothing traumatic happened, it isn't because of a conflict in a relationship) save for bad weather (for those who are affected by seasons) or certain other non-interpersonal-related situations.

A person with bipolar disorder can wake up and feel grumpy for absolutely no reason whatsoever aside from the bipolar...   and acknowledge and realize it.  This same person at some other point in time can feel suddenly euphoric...   and also with no particular cause or trigger...   and acknowledge it and realize it.

Basically, most everyone has had an experience where they suddenly felt the blues for no particular reason, right?  And most people, if they realize they ARE having the blues, could probably communicate this with their loved ones.  "Hey, I'm not feeling too hot today, so I'm going to go out for a walk."

For people with bipolar disorder, these 'blues for no reason' and 'highs for no reason' is what characterizes their disorder the most and they go in cycles for episodic periods of time - lows, highs, and periods of more 'normal' and less extreme moods.

This doesn't mean that people with bipolar disorder can't exhibit characteristics of BPD because they surely can - in the same way even nBPD people can, depending on situation and circumstances.  This also doesn't mean that people with bipolar disorder can't also be pwBPD because they can.  However, for people who are bipolar only, exhibiting behaviors of pwBPD is not their main mode of operations.

They may become destabilized during an episode because of the abrupt change in moods and how they are feeling - going from suddenly feeling fine to suddenly feeling like &%#$ can be a bit jarring.

They may become suicidal because they are desperate about their cyclical situation - a mood disorder where you feel like %$#@ one day and fantastic another for absolutely no particular reason.  Less likely is it because of an emotional reactions such as, "My SO dumped me and now I want to kill myself because nobody loves me!"

They may become withdrawn because their mood disorder affects their ability to function - being too depressed to take care of themselves or being too sky-high and euphoric and feeling invulnerable and being more willing to take risks with their risk-taking behavior generating unwanted results.

Their relationships may suffer owing to the side effects of these episodes of mood imbalances, but it is not characterized by something like, "I hate you, don't leave me".

Another thing, too, is where the treating of unipolar depression can be aided by medications such as SSRI antidepressants, people with bipolar disorder have a tendency to have their mood 'poles' switched over if they are treated with antidepressants alone.

Instead of simply 'feeling better' and 'feeling normal again' which is more characteristic of unipolar depression, they get booted into the realm of feeling the extreme 'high' which can either be mania-mania or mixed mania.

Ever watch those commercials for antidepressants?  That's what some of those warnings - especially about experiencing suicidal ideations while on the meds - are for.

Anyhow, I'm no professional, but I just thought I would share what was shared with me.

Basically, it all seems to boil down to what, exactly, is being affected and how, exactly is the person with whatever disorder acting and reacting, and their understanding and ability to understand and manage according the whys and wherefores.
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« Reply #48 on: March 21, 2013, 04:20:44 PM »

So my ex gf was just now at 21 years old pronounced to not have BPD but bipolar 1. I know there are some similarities between the two but i have questions about them. I do know my xgf has apandament issues as well as reckless behaviors. But do BPD people not have manic episodes. Our break up i beleive was cause by her going into mania, once she went into depression she called me right away. This manic episode last almost 3 weeks. So is it same to say BPD episodes last hours not weeks. Do the actions and lack of thinking about concequences lye in both bipolar and BPD? and insite would help i have done allot of research and really cant find the answers im looking for.
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« Reply #49 on: March 22, 2013, 01:59:36 AM »

I cam only give my experience.  My father is bipolar.  My ex BPD. 

My father has had some years were he has cycled thru both mania and mania many times to years where he has had very few episodes.  His overall well being isn't usually driven by outside interaction, with the exception of his depression on the few occasions where there has been a death of a close loved one.  Usually his cycles as I've seen them are where one day he wakes up and the upward cycles starts to build.  He becomes very active to which accelerates in his "projects".  I've seen him remodeled a kitchen in two weeks, record a music album, create a bunch of culinary sauces and bottle them thinking he will start a business, and reorganize his workshop to rebuild a 1960's Ford Ranch wagon in a matter of a month.  He has grandiose and scattered thinking.  He's going so fast and his "take" on the world is overwhelming in its intensity.  Then he crashes and will spend a month or two in depression which usually culminates in him crying when he hears certain songs or if god forbid he decides to dig thru old pictures.  He's not emotionally manipulative and he doesn't have abandonment issues.  He's brilliantly creative but very unstable.  He's had suicidal ideation with his depression but didn't mention it until he was manic and it wasn't a big deal.  And he readily admits he has a problem.  Yet he refuses medication...   the highs are worth the lows to him and this is his normal.  It's taken him a long time to learn to how to reign in the most destructive parts of his disorder. 

My ex on the other hand had wildly varying moods.  Most of his mood swings were daily and influenced by his perceptions of external stimuli-someones actions or words.  It caused a cascade effect.  On a whole the overall perception and thinking of the world was threatening or negative.  The threshold for disappointment was almost non existent and the needs were profound.  When they weren't up to the idealized expectation the overall effect on himself and others was destructive and extreme.  This could happen in a single day.
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