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Author Topic: How could BPD be diagnosed as PMDD?  (Read 422 times)
bobcat2014
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« on: August 10, 2014, 05:15:04 PM »

My uBPDw is back into therapy. I couldnt be more happy that things a least moved in the right direction. However, it seems my wife is being treated for PMDD with prozac. Her mood swings have improved but she seems down. Is it common for a T to diagnose PMDD instead of BPD.

The T would have no idea of the gaslighting, rages etc. But still see the cycles within the clinical note taking?

Any thoughts? I feel like T dropped the ball with diagnosis.
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MaybeSo
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« Reply #1 on: August 10, 2014, 07:27:25 PM »

Bipolar and pmdd would have cycles.

BPd is triggered by relational issues and is not on a "cycle".

a person can have both, a mood disorder on a cycle that points to bio factors AND They could also have BPD or traits, too. BPD is often co morbid with anxiety and/or mood disoder. Very common.

my partner is dx cyclothymia (bi polar lite)  and has BPD features.

aspects of pmdd could look like BPD, or BPD features could be exacerbated by pmdd during a woman's cycle.
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bobcat2014
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« Reply #2 on: August 10, 2014, 08:13:33 PM »

BPd is triggered by relational issues and is not on a "cycle".

my partner is dx cyclothymia (bi polar lite)  and has BPD features.

Thanks for the reply.

So honeymoon phase, clinging and hating is not a cycle? How about the pathology they follow?

Just curious... .what was your partner diagnosed with and how did they treat it?

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MaybeSo
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« Reply #3 on: August 11, 2014, 01:30:33 AM »

BiPolar I disorder has certain distinct mood cycles that a person will go through, whether they are in a relationship or not; With bipolar I you have to have a marked manic phase.  This would be like a week of just off the charts mania…like not sleeping for an entire week. The manic phase would be followed by a serious depressive crash, the kind would likely have you end up in the hospital b/c you can’t get out of bed to eat.  Bipolar would be treated with a mood stabilizer drug and  as long as you were compliant with appropriate meds, you would not have anymore manic phases followed by depressive crashes. Between phases you could be quite normal…no one would necessarily find you terribly difficult or odd expect when in a manic/depressive phase.  Without meds…someone with bipolar would continue to cycle through manic phases that would always follow with a depressive crash phase.  Without meds, the more manic phases you have…and the worse they get.    

One of the diagnostic criteria used to determine if you are seeing bipolar or BPD…is to investigate if the moods are situationally triggered and happening all over the place …or do they follow a regular manic high/depressive crash cycle…and is the person pretty normal between phases, eg. when not cycling are they in stable r/s, not impulsive, regulate their moods okay,  not engaging gin impulsive behavior, not engaging in cognitive distortions etc. With BiPolar I…if the person is on meds…the extreme manic/depressive symptoms go away.

If you put a person with BPD on bipolar mood stabilizers…they may feel a bit more stable or not…but you will not clear up the cognitive distortions, and interpersonal chaos of BPD with a mood stabilizer alone.


Excerpt
So honeymoon phase, clinging and hating is not a cycle?

Not in the sense that like with bipolar…which has distinct manic/depressive episodes that follow a set pattern and is thought to be mostly a biological condition that responds well to meds... . 

Borderline is triggered by the relational environment, it is especially triggered primarily by and within close attachment relationships; it is thought of as an attachment disorder... .and the ups and downs and distorted thoughts and reactions that are triggered do not just go away with a mood stabilizer or any psyche medication alone (though med’s can sometimes help them to feel less reactive at least enough to maybe get some work done in therapy on the cognitive end of things).

I know a woman dx with BPD in her 20-30 that in her 40s stopped the constant dating romance merry go round and has just stayed single for the last 10 years…and when she is NOT in a romantic r/s…her life is nearly symptom free of BPD.   If she got involved again with someone…I suspect it would be difficult again.

To further complicate things…you could have BiPolar and BPD both.  You could have BPD and just about any anxiety or mood disorder concurrently.

Women’s symptoms could certainly get worse with hormonal fluctuations of the menstrual cycle.

My partner has been diagnosed with cyclothymia (less severe form of bipolar) and an ‘attachment disorder’  (code for BPD)... .(he does have distinct cycles of ups and downs that have been tracked and that is why he is dx with cyclothymia, though this is often code for BPD, too, by clinicians)…but he has symptoms of an attachment disorder for sure…meaning he clings and idealizes and withdraws and engages in black/white thinking, is impulsive, and has lots of ups and downs in his mood dependent on attachment interactions, unstable relationships, shaky sense of self, and has trouble regulating his emotions, etc.,

He has been in therapy for about 9 years…the last 5 years he has worked with a therapist who has training in DBT.  Compared to when he started therapy…he is like a different man.  But, he still struggles. His doctor has him on Lexapro to treat depression/anxiety.  When he goes off the Lexapro he usually gets worse (irritable depression/anxiety)  and has to go on it again.  

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« Reply #4 on: August 11, 2014, 08:07:24 AM »

In my xwife's long search for a diagnosis PMDD was one of the ones she got, just before bipolar type II (and eventually BPD).

The reason was that the foucus was on the acute anxiety attacks and aggressiveness, which seemed to happen monthly and end abruptly. No attention was paid to what the fighting was about, what went on in my wife's head between the episodes and wether her behavior towards me or other people was acceptable or not.

We both thought things were OK if we just could get rid of the most acute symtoms.

In hindsight the menstrual cycle propably affects her moods which in turns "triggers her to trigger". During some phases of her menstrual cycle reduces her patience and stress tolerance, but her BPD behavior is just as likely to be brought on by something else.
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« Reply #5 on: August 11, 2014, 08:44:39 AM »

A few months after dating my now-fiance, after her first major rage, she revealed to me she had been diagnosed BPD.  This was a few weeks after my therapist told me she likely had BPD based on the issues I described.  Her mom was also diagnosed BPD. 

But my fiance was also diagnosed ptsd, and a few other things that she tended to focus on rather than the BPD.  With PTSD, she can blame her behavior on something else, some past event, and excuse herself that way.  Or fribromyalgia or bone spurs in her back.  She will claim she acts the way she does because she is in so much pain all the time.  The reality here is, if you really listen to her complaints and know about BPD, it's pretty clear that BPD is the common denominator in all of them.  She easily meets all 9 diagnostic criteria.  That doesn't mean she doesn't have all of the above, too, it's just that I think many doctors would rather tackle those issues than the "untreatable" BPD. 

When she was in the hospital a year ago for suicidal thoughts, she was diagnosed bipolar.  I was pretty sure she was not bipolar, and a bipolar friend of mine told me she didn't sound bipolar to her, either.  I think she was diagnosed bipolar because that is the "in" thing right now, because it responds well to medication, and it's something insurance companies understand.  I seriously doubt she would have qualified for the services she did if she was simply diagnosed BPD.  But being "bipolar" she was declared seriously mentally ill, given free services, free medications, federal disability, and given access to other programs available to mentally ill persons.  I seriously think that is one reason why many doctors don't diagnose BPD, even thought they may strongly suspect it - that insurance companies like to see diagnoses that are treatable.  Notice how they will cover the costs of all kinds of drugs, but may cap the limit on psych visits at something like 12 per year?  After not really responding to mood stabilizers for 9 months, she went back to the doctor to be re-diagnosed, and they diagnosed her as just BPD, not bipolar. 

But I did learn something about bipolar through all this, and that is a person can be bipolar but not really have manic episodes.  There is a term for that that I can't remember.  My fiance would tell her doctors that she could not possibly be bipolar because she never has felt manic in her whole life, and the doctor tried to explain it that way to her.  Or, they tried to say that in some people manic episodes manifest themselves in different ways, and that for her, those periods of her life where she just up and decided to move and live in a foreign country for 6 months was a manic episode.  And that her dating someone for a few months then suddenly stopping were manic episodes, even thought she still felt miserable.  I think this wash the case of the doctors having a hypothesis driven conclusion (they already suspected she had bipolar and were looking for evidence to support it). 

That's probably the case with your wife.  They heard one thing that she said, formed a diagnosis, and after that everything else she says they try and fit into that initial diagnosis.  I think mis-diagnosis for BPD is probably extremely common.
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MaybeSo
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« Reply #6 on: August 11, 2014, 09:02:44 AM »

You can't dx bipolar 1 w/out a manic phase.

Then there is bipolar 2 and cyclothymia ... .Bi polar 1's less severe cousins.

Insurance traditionally doesn't cover axis ii personality disorders... .with the new DSM and Obama Care... .who knows... .

In the end, they will probably determine that so much of all of this is the result of chronic trauma anyway ... .BPD in my opinion is how less trauma resilient persons adapt over time  to chronic relational trauma. Much of the treatment for PTSD targets BPD symptoms.

giving a person a dx of PTSD for BPD is not a bad idea in terms of treatment. it makes more sense than Bipolar 1. They send folks to classes like Seeking Safety for PTSD... where you learn safe coping skills. With bipolar they often just just throw meds at you.

It's all interlaced anyway... .if you have BPD you are going to get traumatized... .over and over. Traumatized folks tend to get re traumatized. Those of us who try to relate to a pwBPD often get some PTSD symptoms over time, too. We haven't even touched on multi generational transmission. It's complicated.

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maxsterling
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« Reply #7 on: August 11, 2014, 10:20:03 AM »

It's all interlaced anyway... .if you have BPD you are going to get traumatized... .over and over. Traumatized folks tend to get re traumatized. Those of us who try to relate to a pwBPD often get some PTSD symptoms over time, too. We haven't even touched on multi generational transmission. It's complicated.

Yeah, it seems to be a negative reinforcement cycle, and BPD itself is classic chicken/egg.  While a few things lead me to believe there is a genetic component to BPD, I don't think it will truly blossom without some kind of trauma component.  In the example of my fiance, there are several traumatic experiences that are truly unfortunate events that have zero to do with her, such as an abusive mother.  And then there are the others that happened as part of BPD behaviors, but she is traumatized just the same (in her mind).  For example, boyfriends that just disappeared and went NC.  And PMDD is related to, because she associates her monthly cycle with trauma because of an abortion she had.  So every month where she is not pregnant she thinks about the baby she aborted a few years ago, gets in a foul mood, and takes it out on others (me).  But in reality, the abortion is BPD related, because she was sleeping around and not acting responsibly in a foreign country, got pregnant, expected the guy to man up, but raged at him, he probably freaked and took off.  So now every month, she thinks she blew her chance to be a mother, blames me for having not given her another chance at that yet, blames the man who got her pregnant... .

Man, just typing this out makes me realize how much work she has to to to even just be halfway stable.  And right now the past few days is the most stable and happy I have seen her in over a year. 
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« Reply #8 on: August 11, 2014, 10:55:55 AM »

Yes…it does get very layered and complicated.

Sigh.

This link is to a series of 17 clips where Dr. Allan Schore from UCLA discusses this.  It is truly fascinating and amazing.  What I take away from it is how important pregnancy and the first year of life is to the developing infant.  Trauma, and that means relational trauma where even a depressed mother who was simply not able to respond to the babies need for affect regulation, which is experienced as abandonment trauma by the way…impacts brain development, and can set up a trajectory of severe affect regulation problems that are biological in nature which will lead to environmentally more trauma experiences b/c of the maladaptive interaction with the environment and the dissociative states the body goes into in the absence of dyadic regulation (lack of connection). Well worth the time to view it.

www.psychalive.org/video-dr-allan-schore-psycho-biological-nature-suicidality/
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