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Author Topic: DIFFERENCES|COMORBIDITY: Borderline PD and BiPolar Disorder  (Read 11623 times)
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« Reply #20 on: June 28, 2010, 01:43:29 AM »


My wife is currently diagnosed with Bipolar.  She has tried most bipolar medications: Paxil, Prozac, Zoloft, etc. 


I think the Seroquel is the med for the bipolar diagnosis.  The others -- Paxil, Prozac and Zoloft -- are antidepressants and I don't believe they're meds commonly prescribed for bipolar.



I'm still struggling with how to broach the subject with her about the possibility of her being BPD instead of Bipolar...


You'll find reference material on this site that suggests it's not entirely a good idea to share that idea with someone you suspect has BPD.  You should read that before considering sharing your thoughts with her about this particular diagnosis.  It could help you out tremendously.
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« Reply #21 on: June 28, 2010, 06:47:36 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.



A good indication that her psychiatrist doesn't actually believe she is bipolar, is by prescribing Prozac. Prozac is the preferred staple drug for Borderline Personality Disorder. Prozac is also the worst nightmare for pwBipolar Disorder - if prescribed alone (without a mood stabilizer) it will induce mania faster than an alcoholic binge...

Bipolar disorder is usually treated with mood stabilizers such as Lithium, Depakote or a combination drugs such as Zyprexa, along with an anti-psychotic or tranquilizer such as Xanax.

From what I have read, Borderlines seem to do OK on mood stabilizers - but I have read that Zyprexa has poor results - and Xanax seems to be a borderlines Kryptonite...I have read several accounts of Xanax having horrible results with BPD.  My ex was on Xanax and her rages increased 10 fold while she was on it - same with her dissociation...

Psychiatrists prefer to "officially" diagnose a patient as bipolar rather than borderline for three main reasons.

#1 No drama with the insurance company. Bipolar is considered highly treatable - and usually fully supported by insurance companies.

#2 Many psychiatrists feel that if they diagnose as borderline - the patient will be "shunned" by future therapist/psychiatrists. They consider it almost "blacklisting" the patient. I had a therapist admit to me that she almost always diagnoses bipolar rather than borderline - because if she diagnoses borderline, the person won't get the help they need. In her words "Any therapy is better than NO therapy" and "Treatment for the two are basically the same."

This really pissed me off, but I guess if it kinda makes sense. Most people have multiple therapists/psychiatrists before they recover, and having a rapsheet of being borderline, might be the difference between getting help and getting discharged... like I said, most therapists I know either A: Refuse to treat borderlines (saying they aren't qualified) or B: will only accept 2-3 borderlines at a time. My uncle, who specializes in treating sexually abused women and children, says he can only "handle" two borderlines at a time, that they are that taxing and emotionally draining...

#3 Many psychiatrists aren't familiar enough to properly distinguish between Bipolar Disorder and Borderline Personality Disorder. Unfortunately, this seems to be the #1 problem. Bipolar disorder and Borderline Personality Disorder have a lot of the same characteristics (Grandiose/Magical Thinking, Impulsiveness, Hyper-sexuality, Recklessness on the "high" side, Extreme Depression, Anxiety, Panic attacks, Loss of interest/appetite on the Low Side), The root of the problem, however, is very different.

It takes a keen eye, and someone familiar with BPD to see what is exactly triggering the "mood swings." Bipolar disorder is a more Mania/Depression chemical cycle, a lot of the times, with no "triggers" or the triggers are very predictable, like sleep disruption, alcohol abuse, moving to a different time zone, etc etc etc - all of which are mostly "physical changes."

Borderline Personality Disorder - as with all PDs - seems to be triggers associated with interpersonal problems. Also, the "cycles" tend to last minutes/days/hours compared to weeks/months as with Bipolar. With borderline, the pwBPD can literally split a person within seconds, and also go from elated, to horribly depressed in the same time. I watched this happen numerous times.

This subject is near and dear to me. Having successfully managed my Bipolar II disorder , and also witnessing my exBPDgf, I can tell you that the illnesses are very different from one another. My struggles seemed to be more internal than external. Sure I was a royal pain in the ass to those around me - especially my parents. They had to bail me out of some tight spots... Gambling Addictions, Grandiose thinking, months where I would literally sleep for 18 hours a day, etc etc etc... but I never did take it out on them, or "split" them like what is so common for a borderline. My support system was easily accepted by me, and I knew I had a problem (although convincing me in a manic episode was quite the challenge because I felt like GOD). Also. I was never abusive. When I was manic, I would get extremely frustrated at people not "keeping up with me" or telling me to slow down or that I was "acting crazy", but I never ever split them black nor idolized them. In short, Bipolar disorder is like being on speed. During a manic phase, everything was colorful and exciting, I felt like I could run a marathon or take a bullet... I was immortal. When the high ended, a horrible withdrawal like feeling entrapped me. I was sluggish, the most simple tasks FELT like running a marathon, no motivation whatsoever...sleep sleep sleep and sleep some more... I was that drained.

After witnessing my borderline girlfriend for three years. I never once saw a manic phase. Sure she would rotate from being extremely Narcissistic to extremely self-loathing - but this was so different from the endless energy to bed-ridden depression.  Also, EVERY one of her shifts seemed to be related to some interpersonal trigger, like getting fired from a Job or me not living up to her never-ending, unobtainable demands and expectations... I do think that borderline personality disorder has a strong chemical component, but in my experience, it has a lot more to do with relating to people than bipolar disorder does.

Also - the biggest difference between a person with Borderline Personality Disorder and Bipolar disorder is that A LOT of the times, Bipolar disorder is neither on a Manic Phase nor a Depression Phase - and the person is completely normal, can hold a job just fine, and is every bit as functioning as everyone else.

pwBorderlinePD don't seem to have these long durations of calm. Their lives seem to be a never-ending cycle of dysregulation. After a while, Its a horribly predictable pattern observed by those who are close to them.

Hope this helps.
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« Reply #22 on: June 28, 2010, 06:56:49 PM »

I'm diagnosed bipolar II because I've never had a manic episode. My depression didn't respond to Prozac alone but when they added lithium I started feeling better.

I'm in emdr therapy right now.

Pwbpd don't often seek treatment on their own do they? Do people with bipolar (either kind)?
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« Reply #23 on: June 28, 2010, 07:00:47 PM »

Oh I asked my pdoc the difference. She said "you've had a mixed episode. Imagine that ALL the time. That's how pwbpd feel. They have different reasons and motivations too."

That make sense to anyone else? I know the one mixed episode I had was awful. I was depressed but not apathetic. High energy unease and anxiety and sadness. I can't imagine feeling that way again...I know a lot of people with bipolar have mixed episodes more often than that. But thinking of it that way I can understand how crappy pwbpd must be feeling, to act the way they do.

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« Reply #24 on: June 28, 2010, 07:30:12 PM »

Oh I asked my pdoc the difference. She said "you've had a mixed episode. Imagine that ALL the time. That's how pwbpd feel. They have different reasons and motivations too."

That make sense to anyone else? I know the one mixed episode I had was awful. I was depressed but not apathetic. High energy unease and anxiety and sadness. I can't imagine feeling that way again...I know a lot of people with bipolar have mixed episodes more often than that. But thinking of it that way I can understand how crappy pwbpd must be feeling, to act the way they do.



From my own experience, the worst mixed episode I had almost ended my life. There is no worse feeling in the entire world. When I was depressed, I was fine. I didn't have the energy to do anything about it, basically it sucked, but eventually blew over. When I was manic, life was great, nothing could stop me... but  he mixed episode was horrible. I couldn't sit still, couldn't sleep, was anxious as all hell, had loads of energy, but instead of the grandiose thinking, it was extreme anxiety... I couldn't eat, I would just throw everything up... it was a living hell. If borderlines do in fact, experience a feeling like a mixed episode, I pity them... there is no worse feeling in the entire world...
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« Reply #25 on: June 28, 2010, 07:32:58 PM »

That was what she said. Like the high anxiety and sadness along with plenty of energy...

That's how their disregulation feels. She told me to look up "dysphoria"; I haven't had time yet.
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« Reply #26 on: June 28, 2010, 07:34:35 PM »

By the way, Mixed episodes are also the time of the highest suicide rate in people with Bipolar disorder. Mixed episodes usually happen in the spring time. Kay Redfield Jamison has a theory that during spring, with the increased sunlight, the energy comes back, but the winter blues haven't quite worn off, creating a horrible combination. Suicides happen more during March and April more than any other month, which doesn't make any sense... you would think December or January... but maybe the mixed episodes seem to be why?

Anker, do you happen to suffer from Seasonal Affective Disorder? Most BPIIs (50%) suffer from SAD. I still get it bad. I have light that I use during the winter time.
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« Reply #27 on: June 28, 2010, 07:42:16 PM »


Pwbpd don't often seek treatment on their own do they? Do people with bipolar (either kind)?


From Wikipedia:
Quote

Egosyntonic is a psychological term referring to behaviors, values, feelings, which are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image. It is studied in detail in abnormal psychology. Many personality disorders  are considered egosyntonic and are therefore difficult to treat. Anorexia Nervosa, a difficult-to-treat Axis I disorder, is also considered egosyntonic because many of its sufferers deny that they have a problem.

It is the opposite of egodystonic. Obsessive compulsive disorder is considered to be an egodystonic disorder, as the thoughts and compulsions experienced or expressed are not consistent with the individual's self-perception, meaning the patient realizes the obsessions are not reasonable. However obsessive compulsive personality disorder (OCPD) is egosyntonic, as it is consistent with the way the patient thinks.


Well, PDs are considered Egosyntonic, so usually the borderline doesn't believe they have a problem... and if they do, its more of a poor me, I am broken, deal with it, mentality.

To my understanding (barring a manic phase, which is probably egosyntonic) bipolar disorder is considered egodystonic. At a young age,  I realized and even wrote journal entries about my mood swings. I knew something was wrong with me. I desperately wanted to not have mood swings, and wanted to be like everyone else... constantly happy. When I was diagnosed as bipolar, at first, it felt like a death sentence, but later I was finally relieved to have a diagnosis that described exactly what I was going through. I sought help on my own, because I couldn't stand being controlled by my mood swings.
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« Reply #28 on: June 28, 2010, 07:47:27 PM »

A good indication that her psychiatrist doesn't actually believe she is bipolar, is by prescribing Prozac. Prozac is the preferred staple drug for Borderline Personality Disorder. Prozac is also the worst nightmare for pwBipolar Disorder - if prescribed alone (without a mood stabilizer) it will induce mania faster than an alcoholic binge...


It is not unusual to prescribe antidepressants to someone with bipolar disorder and antidepressants are well accepted tools for helping manage the disorder.  In some people with bipolar disorder, antidepressants can trigger manic episodes (very true) but may be OK if taken along with a mood stabilizer. 

Many of the drugs used have potential negative outcomes - it is why we want to stay close to the clinician and report any concerns promptly.

Psychiatrists prefer to "officially" diagnose a patient as bipolar rather than borderline for three main reasons.

#1 No drama with the insurance company. Bipolar is considered highly treatable - and usually fully supported by insurance companies.

#2 Many psychiatrists feel that if they diagnose as borderline - the patient will be "shunned" by future therapist/psychiatrists. They consider it almost "blacklisting" the patient. I had a therapist admit to me that she almost always diagnoses bipolar rather than borderline - because if she diagnoses borderline, the person won't get the help they need.

#3 Many psychiatrists aren't familiar enough to properly distinguish between Bipolar Disorder and Borderline Personality Disorder. Unfortunately, this seems to be the #1 problem. Bipolar disorder and Borderline Personality Disorder have a lot of the same characteristics (Grandiose/Magical Thinking, Impulsiveness, Hyper-sexuality, Recklessness on the "high" side, Extreme Depression, Anxiety, Panic attacks, Loss of interest/appetite on the Low Side), The root of the problem, however, is very different.


These are all valid points. 

But it is also important to consider that psychiatrists, whom don't have the equivalent of low cost technical tools like blood tests and x-rays to diagnose patients, are limited to what the patient tells them.  This communication is a function of time (appointments are under an hour), communication skills of the patient (remember, people often see a therapists when they are in crisis), patient self awareness and honesty, and patient follow up (coming in for additional appointments, reporting progress).

My understanding is that many clinicians work through a process of elimination - treating the more episodic, pharmaceutical responsive, and lower cost conditions first.  Many of the Axis I disorders fall into this category.  The process is a little like pealing back an onion and dealing with each new layer.  If the patients stop coming in, the pealing process stops.

Axis II disorders are far more expensive, complex treatments for conditions that are often buried below other comorbid conditions.

In a hospital setting, there is more time to analyze and diagnose a patient.  Outpatient treatment, however, is often very time limited.





http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=treatments-and-drugs
Medications
A number of medications are used to treat bipolar disorder. If one doesn't work well for you, there are a number of others to try. Your doctor may suggest combining medications for maximum effect. Medications for bipolar disorder include those that prevent the extreme highs and lows that can occur with bipolar disorder (mood stabilizers) and medications that help with depression or anxiety.

Medications for bipolar disorder include:

Lithium. Lithium (Lithobid, others) is effective at stabilizing mood and preventing the extreme highs and lows of certain categories of bipolar disorder and has been used for many years. Periodic blood tests are required, since lithium can cause thyroid and kidney problems. Common side effects include restlessness, dry mouth and digestive issues.

Anticonvulsants. These mood-stabilizing medications include valproic acid (Depakene, Stavzor), divalproex (Depakote) and lamotrigine (Lamictal). The medication asenapine (Saphris) may be helpful in treating mixed episodes. Depending on the medication you take, side effects can vary. Common side effects include weight gain, dizziness and drowsiness. Rarely, certain anticonvulsants cause more serious problems, such as skin rashes, blood disorders or liver problems.

Antipsychotics. Certain antipsychotic medications, such as aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), may help people who don't benefit from anticonvulsants. The only antipsychotic that's specifically approved by the U.S. Food and Drug Administration (FDA) for treating bipolar disorder is quetiapine. However, doctors can still prescribe other medications for bipolar disorder. This is known as off-label use. Side effects depend on the medication, but can include weight gain, sleepiness, tremors, blurred vision and rapid heartbeat. Weight gain in children is a significant concern. Antipsychotic use may also affect memory and attention and cause involuntary facial or body movements.

Antidepressants. Depending on your symptoms, your doctor may recommend you take an antidepressant. In some people with bipolar disorder, antidepressants can trigger manic episodes, but may be OK if taken along with a mood stabilizer. The most common antidepressant side effects include reduced sexual desire and problems reaching orgasm. Older antidepressants, which include tricyclics and MAO inhibitors, can cause a number of potentially dangerous side effects and require careful monitoring.

Symbyax. This medication combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the FDA specifically for the treatment of bipolar disorder. Side effects can include weight gain, drowsiness and increased appetite. This medication may also cause sexual problems similar to those caused by antidepressants.

Benzodiazepines. These anti-anxiety medications may help with anxiety and improve sleep. Examples include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax). Benzodiazepines are generally used for relieving anxiety only on a short-term basis. Side effects can include drowsiness, reduced muscle coordination, and problems with balance and memory.

Finding the right medication

Finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. This can take months or longer, and medications may need to be adjusted as your symptoms change. Side effects improve as you find the right medications and doses that work for you, and your body adjusts to the medications.

Medications and pregnancy

A number of medications for bipolar disorder can be associated with birth defects.

Psychotherapy

Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful. These include:

Cognitive behavioral therapy. This is a common form of individual therapy for bipolar disorder. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.

Psychoeducation. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. Knowing what's going on can help you get the best support and treatment, and help you and your loved ones recognize warning signs of mood swings.

Family therapy. Family therapy involves seeing a psychologist or other mental health provider along with your family members. Family therapy can help identify and reduce stress within your family. It can help your family learn how to communicate better, solve problems and resolve conflicts.

Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship skills.

Other therapies. Other therapies that have been studied with some evidence of success include early identification and therapy for worsening symptoms (prodrome detection) and therapy to identify and resolve problems with your daily routine and interpersonal relationships (interpersonal and social rhythm therapy). Ask your doctor if any of these options may be appropriate for you.

Transcranial magnetic stimulation

This treatment applies rapid pulses of a magnetic field to the head. It's not clear exactly how this helps, but it appears to have an antidepressant effect. However, not everyone is helped by this therapy, and it's not yet clear who is a good candidate for this type of treatment. More research is needed. The most serious potential side effect is a seizure.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy can be effective for people who have episodes of severe depression or feel suicidal or people who haven't seen improvements in their symptoms despite other treatment. With ECT, electrical currents are passed through your brain. Researchers don't fully understand how ECT works. But it's thought that the electric shock causes changes in brain chemistry that leads to improvements in your mood. ECT may be an option if you have mania or severe depression when you're pregnant and cannot take your regular medications. ECT can cause temporary memory loss and confusion.

Hospitalization

In some cases, people with bipolar disorder benefit from hospitalization. Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic episode or a deep depression. Partial hospitalization or day treatment programs also are options to consider. These programs provide the support and counseling you need while you get symptoms under control.
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« Reply #29 on: June 29, 2010, 05:15:42 PM »

That was what she said. Like the high anxiety and sadness along with plenty of energy...

That's how their disregulation feels. She told me to look up "dysphoria"; I haven't had time yet.

Borderlines experience dysphoria which is a combination of anxiety, rage, depression and despair.  It does not include the endless energy or grandiose thinking associated with bipolar disorder.  But it is a horrible, awful feeling.  The opposite of euphoria.  Many times, after a rage, or when extremely dysphoric, they will simply go to bed and stay there. 

One therapist told me she thought my husband was bipolar because of the rages.  I told her that he never once had mania the entire 23 years I had been married to him at the time.  When dysphoric, he could sleep 24/7.  If he didn't get enough sleep, it was due to insomnia, not endless energy.

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« Reply #30 on: June 29, 2010, 05:28:20 PM »


From what I have read, Borderlines seem to do OK on mood stabilizers - but I have read that Zyprexa has poor results - and Xanax seems to be a borderlines Kryptonite...I have read several accounts of Xanax having horrible results with BPD.  My ex was on Xanax and her rages increased 10 fold while she was on it - same with her dissociation...

Several studies have shown that those with BPD do worse on Xanax.  Interestingly, some types of epilepsy that have a behavioral dyscontrol syndrome as well, have epileptic fits of rage that are triggerred or worsened by Xanax.

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« Reply #31 on: July 01, 2010, 02:10:33 AM »

Mania is only part of a bpI diagnosis, people with bpII don't get manic.
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« Reply #32 on: July 31, 2010, 11:16:03 PM »

Yes Bi-polar individuals will benefit from mood stabilizers and anti-depressants, it is believed to involve chemical imbalance in the brain leading to the symptoms. Personality disorders are believed to be non chemically based. They are dysfunctions and distortions in the persons personality traits. These are learned and developed behaviors. Medication would only be useful to treat co-morbid symptoms such as the depression.
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« Reply #33 on: August 01, 2010, 11:40:14 AM »

Really good overview,Skip. Thanks.

My experience in the difference between BI-Polar and BPD lead me to believe that there is a significant difference between the two...A BI-Polar individual cycles at a far different rate than a BPD...a BI Polar individual when they shift..can stay in a certain mode for months and even possibly years,  before things fall apart...and shift into another mode, that likewise can last for months or years...and in the case of BI-Polar individuals, medication can be very effective in promoting stability for them...my experience with BPD...is that they cycle in days or even hours between various states...at the risk of sounding rude...BPD makes BI-Polars look stable...this is all just my un-educated opinion based on observations of both types of people...take care all
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« Reply #34 on: August 01, 2010, 03:30:14 PM »

I have also read that people with BPD are often mis diagnosed as bi polar. My ex said he was bi polar but I really think he is just BPD. I have a friend who is bi polar and her mood swings take sometimes years where as my ex would litterally be minutes. I was loved one day and hated the next and I did nothing.
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« Reply #35 on: August 02, 2010, 12:00:12 AM »

Skip, thanks for the stats about co-morbidity of the two and the explanation for why bi-polar is more typically the first diagnosis.
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« Reply #36 on: August 02, 2010, 05:14:10 AM »

My ex is bi polar, adhd and bpd - it's possible to have all 3. The chemical imbalance is hereditary - my D has inherited bi polar but not the others and is not bpd.  There are environmental impacts on both bi polar and schizophrenia and varying degrees of the illness as well.  There are also a number of types of bi polar including rapid cycling and ultra rapid cycling types - common in young people. My D was ultra rapid cycling as a young teenager.

Bi polar does respond to medication although there are variations there like with all things.

The thinking is that bpd may be a coping mechanism by people with bi polar, or a response to an abusive situation, or both. Reality is no one really knows although it appears to be a learned behaviour rather than a genetic chemical imbalance. Bear in mind that a child with this tendency, being raised in a family where untreated bi polar and other conditions exist, rarely has the structure in place to deal with the illness appropriately.

Having said that, I have seen people with various degrees of bi polar cope very well with life, or not at all, have other personality disorders, abuse drugs or alcohol which makes the situation worse - a lot depends on the individual, their willingness to work with the illness and whatever else might be going on - no different to anyone else really. 

BPD has some crossover symptoms. Of course BPD has some crossover symptoms common to all of us if we are honest about it - it's the degree of difficulty and impact on life and others that makes it a disorder.

There is also a group with BPD who have suffered severe abuse as children - again, is it learned, or a coping mechanism? My H's ex was severely abused but in hindsight there is also more going on in the family than bpd. Paranoid schizophrenia for one.

I have for years thought there might be two distinct causes for bpd - severe childhood abuse or learned behaviour coupled with bi polar - symptoms similar.  There has also been some information suggesting that some medications that work for bi polar also have some effect in bpd - perhaps other things going on there. My psych textbook is unclear about causes, but more informative about bi polar. The interesting thing is that this illness can be triggered by external stimuli - ie drug use, stress, or be noticeable from a very young age like in my D's case. A lot depends on how many genes are implicated. The more that is found out the more it is realised there is really no such thing as "classic bi polar". Everyone is an individual.

Hope this helps - many years of research has gone into the above, but there is no clear cause really.  Take care, Rose

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« Reply #37 on: August 02, 2010, 10:27:32 AM »

This is all great information, And input.

I just have been struggling with this, as her mom is paronoia schizo , and my estranged wife's T gave me the book, stop walking on eggshells. and also that my T believes she has BPD, and with all the whacked out hurtful push and pull i been thru, I do have my doubts.

She thinks she has bi-polar, and is self medicating with ,amino acids, and various alternative approaches while not being supervised.

She has been gone for almost a year now, and wants to reconcile, but our phone conversations, go from 1 step forward to 3 steps backward in days, at times even minutes,

I hurt, and just want to know i am doing all i can do to save my marriage and do the right thing.. its so confusing, and i feel she can be very manipulative..
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« Reply #38 on: August 02, 2010, 01:34:43 PM »

This is all great information, And input.

I just have been struggling with this, as her mom is paronoia schizo , and my estranged wife's T gave me the book, stop walking on eggshells. and also that my T believes she has BPD, and with all the whacked out hurtful push and pull i been thru, I do have my doubts.

She thinks she has bi-polar, and is self medicating with ,amino acids, and various alternative approaches while not being supervised.

She has been gone for almost a year now, and wants to reconcile, but our phone conversations, go from 1 step forward to 3 steps backward in days, at times even minutes,

I hurt, and just want to know i am doing all i can do to save my marriage and do the right thing.. its so confusing, and i feel she can be very manipulative..

Hi CVA

If she's as manipulative and into "push/pull" as you say, it's probably BPD (AXIS 2 Disorder).

Borderlines I, II and III (Axis 1 Disorders) typically display manic or hypomanic features.  

She could possibly have a mood disorder, too. It's been my experience that BPDs can sometimes fit the criteria for Cyclothymia (a long-term condition with fluctuating mood disturbance involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms - not to be confused with BPD w/narcisistic features).

Given the way they live and "love", how could BPDs not have some kind of mood disorder? It's a chicken and egg thing with the BPD causing the mood disorder.

Personality Disorders may not be the primary diagnosis because of whatcha gotta tell insurance companies. Insurance companies and SSI Disability don't pay for Axis 2 diagnoses, so you tend to see many personality disordered people diagnosed with with Axis 1 disorders.

Substance abuse rehabs are notorious for diagnosing clients with BPD with mood disorders. I've seen a huge increase in the diagnoses of Biploar Disorder in substance abusers since managed care took over. The overwhelming majority of people in drug treatment are on some sort of mood altering medication, anymore. But here's the thing... Biploar and Depressive Disorders disorders aren't suppose to go away just because you get clean and sober, though the rate of miraculous cures for my clients is nothing short of astounding. And BTW, 12 Step Programs are often BPD maintenance programs (in a good way).



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PotentiallyKevin
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« Reply #39 on: August 02, 2010, 05:37:22 PM »

To be honest, every person with borderline personality disorder I have ever met or heard a story about has at one point been diagnosed as having bipolar disorder. In my opinion, it is a wastebasket diagnosis.

Furthermore, I think one of the reasons why bipolar disorder is so negatively stigmatized is really because of  BORDERLINES who are improperly diagnosed as bipolar...

To a non-professional, and even many so called "professionals", it can be really confusing to distinguish between the two illnesses, which share common symptoms, (lack of self-control, impulsiveness, grandiose thinking, depression, promiscuity, alcoholism etc etc etc) but the core CAUSE of these symptoms (and the love/hate dynamics of borderline personality disorder) are really what separates the two.

For example, many people have digestive problems with similar symptoms. But many things can effect the digestive system. It could be your liver, stomach, diet, kidneys, intestines, colon, glands... etc etc etc, and without a trained professional's expertise and testing, it would all appear to be the same illness.   

Bipolar disorder is theorized and generally accepted  by the psychological community as being a mood disorder caused by chemical imbalance. The hereditary component of bipolar disorder is very strong. If a close relative has bipolar disorder or another mood disorder, the chances of having bipolar disorder skyrocket. Bipolar disorder does not discriminate. Emotionally Sound, happy, successful, healthy families have just as much a chance as having a child with bipolar disorder as any "dysfunctional" family.

This is not the case with BPD. The evidence suggesting borderline personality disorder is caused by a combination of a highly neurotic personality to begin with, and then being subject to an invalidating or smothering environment. Childhood trauma and abuse is extremely common in BPD. "Dysfunction" within the family, is also extremely common.

Can people be born with BPD? Possibly, but BPD seems to be more of a problem with interpersonal relationships than a chemical imbalance. There is plenty of evidence that suggests problems with brain structure and inherent mood - which further confuses psychologists, but it is not nearly as cut and dry as it is with bipolar disorder.

In my opinion - and please only take it as is - a person can be born with highly sensitive, erratic, or combative emotions, which then leads to early interpersonal relationship problems, such as not fitting it, not bonding with siblings and parents, and failing at attaining any personal/emotional growth. So in essence, a person CAN be born with a BPD-like nature to begin with. That is why we shouldn't be so fast on crucifying the parents. But, most borderlines that I have come in contact with, have been from extremely invalidating or abusive childhoods.

Bear in mind, that an extremely invalidating/abusive childhood environment DOES NOT guarantee a person developing BPD. That is why there seems to be two factors - environment and predisposition. 
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