BPDFamily.com

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.

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:

www.psycheducation.org/depression/borderline.htm

bumpy

  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

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 (https://bpdfamily.com/message_board/index.php?topic=58157.msg541921#msg541921)
 
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 (https://bpdfamily.com/message_board/index.php?topic=58157.msg541921#msg541921)

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 (http://www.psyweb.com/DSM_IV/jsp/dsm_iv.jsp), 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.   :)  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.   :)
 
Skippy
 

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DIFFERENCES|COMORBIDITY: Overview of Comorbidity (https://bpdfamily.com/message_board/index.php?topic=58157.0)
 
Additional discussions... .
 
Personality Disorders
 
Borderline and Paranoid Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=162162.0)
 
Borderline and Schzoid/Schizotypal Personality Disorder
 
Borderline and Antisocial Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=156878.0)
 
Borderline and Histrionic Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=61196.0)
 
Borderline and Narcissistic Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=90388.0)
 
Borderline and Avoidant Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=153546.0)
 
Borderline and Dependent Personality Disorder
 
Borderline and Obsessive Compulsive Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=82476.0)
 
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 (https://bpdfamily.com/message_board/index.php?topic=96965.0)
 
Borderline PD and Aspergers (https://bpdfamily.com/message_board/index.php?topic=21363.0)
 
Borderline PD and Attention Deficit Hyperactivity Disorder (https://bpdfamily.com/message_board/index.php?topic=147635.0)
 
Borderline PD and BiPolar Disorder (https://bpdfamily.com/message_board/index.php?topic=162165)
 
Borderline PD and Dissociative Identity Disorder (https://bpdfamily.com/message_board/index.php?topic=71454.0)
 
Borderline PD and P.T.S.D. (https://bpdfamily.com/message_board/index.php?topic=42598.0)
 
Borderline PD and Reactive Attachment Disorder (RAD) (https://bpdfamily.com/message_board/index.php?topic=150400.0)

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.

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.

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.

www.medicalnewstoday.com/articles/46236.php

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.

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 KregerWelcome to Oz Community OwnerStop Walking on Eggshells and the SWOE WorkbookThe Essential Family Guide to BPD

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?

Hi

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

www.mentalhelp.net/poc/view_doc.php?type=doc&id=4185

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.

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    www.psychcentral.com/news/2009/07/30/personality-disorders-misdiagnosed-as-bipolar/7439.html

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

Bipolar over-diagnosis associated with personality disorder       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)     www.psycheducation.org/depression/borderline.htm

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

Three Easy Ways to Differentiate Bipolar and Borderline Disorders | Psychology Today-   

www.psychologytoday.com/blog/stop-walking-eggshells/201003/three-easy-ways-differentiate-bipolar-and-borderline-disorders

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.

There are no stats on this.Randi KregerThe Essential Family Guide to BPD

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.

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.



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.

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.

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)?

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... .

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.

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.

From Wikipedia:
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.

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.


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.

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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.

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.

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.

Mania is only part of a bpI diagnosis, people with bpII don't get manic.

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.

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

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.

Skip, thanks for the stats about co-morbidity of the two and the explanation for why bi-polar is more typically the first diagnosis.

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

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).

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. ":)ysfunction" 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. 

I have a question and I think I know the answer but I want to here from others here that have a better knowledge of disorders in general.

The question is what the main differences between BPD and Bipolar I, II, III?

A number of the traits are very similar and I have heard that some people can have both.

I have talk to my T and they think she has Bipolar and a case of paranoia and may be some other issues too.

I had my physical today and told my doctor about how she’s acting and how it’s stressing me and think that’s probbaly the root to some of the problem sleeping and weight issues I have. I’m under wait not over. He said that he really want to talk to her and see just what is going on, he also said that it sound like Bipolar as well.

BPD "episodes" are almost always triggered by perceived rejection or abandonment (or fear thereof). Bipolar cycles have no obvious triggers (though self-care/lifestyle choices do have a significant influence). BPD issues show up due to relationships/interactions; Bipolar symptoms have no significant correlation to this.

Also, while anger may be part of a manic episode, its less commonly so, and is very rarely the dominant emotion. Most people with bipolar disorders genuinely enjoy the manic phases (though their loved ones clearly suffer), while this can't be typically said of BPD's. It's because they feel miserable that they want others to suffer as well.

Hope that helps.

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.

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

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. 

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?

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.

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?

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.

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:

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.

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.

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.

Hi all, I'm wondering what your thoughts are on this.

My ex was dxed with rapid cycling bipolar. However I think she was truly BPD. She has lupiterally every symptom except self injurt. Meds would seem to help for a short time but never really had lasting or noticable effects. I've read that rc bipolar and BPD are often misdiagnosed for one another, and I've also read that some psychiatrics won't reveal the "real" BPD diagnosis to the patient. Does anyone have a sense of how common this is and how it's recognized to be a misdiagnosis? Or how ommon it is to not know the dx?

It is possible there is a misdiagnosis involved with your ex.

This is a general statement from the NIH site: Unfortunately, borderline personality disorder is often underdiagnosed or misdiagnosed.*

I also found this one particular study posted on their site, regarding misdiagnosis and bipolar disorder:

Recent reports suggest bipolar disorder is not only under-diagnosed but may at times be over-diagnosed. Little is known about factors that increase the odds of such mistakes. The present work explores whether symptoms of borderline personality disorder increase the odds of a bipolar misdiagnosis. Psychiatric outpatients (n=610) presenting for treatment were administered the Structured Clinical Interview for DSM-IV (SCID) and the Structured Interview for DSM-IV Personality for DSM-IV axis II disorders (SIDP-IV), as well as a questionnaire asking if they had ever been diagnosed with bipolar disorder by a mental health care professional. Eighty-two patients who reported having been previously diagnosed with bipolar disorder but who did not have it according to the SCID were compared to 528 patients who had never been diagnosed with bipolar disorder. Patients with borderline personality disorder had significantly greater odds of a previous bipolar misdiagnosis, but no specific borderline criterion was unique in predicting this outcome. Patients with borderline personality disorder, regardless of how they meet criteria, may be at increased risk of being misdiagnosed with bipolar disorder.**

*www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtmlwww.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml

**www.ncbi.nlm.nih.gov/pubmed/19889426

A few months before my wife was diagnosed with BPD she received a bipolar diagnosis. This was based on the fact that she had a history of depressions and wild mood swings. However, after medicatiton had been tried out and her mood swings had been discussed in detail (the doctor intially didn't know that her "down"/suicidal phases were triggered by criticism or interpersonal conflict) the diagnosis was revised and her medication was changed earlier this summer.

The doctor was not very straight ahead with the new diagnosis, and she was rather discrete about the bipolarity being out of the picture. She told my wife (in my presence) "What you describe to me is not bipolarity, this is personailty-related". And that was it. My wife was sent to see a DBT therapist and has been going since.

But after the above mentioned meeting with doctor my wife has been very reluctant to discuss her illness with me. I have tried to talk about her situation but she doesn't want to talk about it. She continues to read her "bipolar mom" websites and doesn't care much for the DBT (she thinks the therapist is too demanding). I have also told my wife that the doctor meant to tell her that he's borderline (I think it just needs to be said) and that's why she's in DBT. My wife knows enough about psychiatry to know what it means. She says she knows this very well but doesn't want to talk about it because it makes her feel worthless.

Earlier this week - just as her menstruation was about to end - she got into the usual deep anxiety.   Apparently it was worse than usual. She was suicidal and she sought care and was hospitalized for a few days. What she was also very anxious about was a doctor's appointment - an appointment with the doctor that says she's not bipolar - whom she now hates.

When my wife came back from the hospital (yesterday) she told me that she had met a doctor there (at psych ER) how had talked to her and "heard her story", who had told her that she was a "classic case" of Bipolar type II. Said doctor took away all her medication, put her on Lithium + a new antidepressant + Immovane.

I asked my wife if she had told this doctor that her moodswings are usually triggered by criticism, quarrels or her menstrual cycle. The answer was no. She had described this "My mood's all over the place and there's there's no discernible pattern"-persona that she likes to paint up when she wants to be taken care of.

What people don't get it that the doctor can't "find" a diagnosis. All about how you describe yourself. A doctor that observers you over time can see and learn things, but a guy who reads a few journals and meets you once or twice only reflects what you tell him.

My wife can't take the idea of being "an incurable b*tch" (i e BPD) and therefore prefers to lie to herself about her own mental condition. She's even prepared to go on a heavy medication that I'm not sure if she will benefit from. But then again it's that BPD personality. It's not about the truth, it's about the feelings.

There's another thread on the subject "is a BPD diagnos important?" and I really think it is. Not changing doctors is very important. Everyone around a BPD person will become the enemy/the devil, including the doctor. A BPD has a fair chance of being misunderstod because they manipulate and they don't know it.

This is a fairly recent meta-study specifically focused on BPD-Bipolar co-morbidity. The numbers are not so far off from the previous shared numbers. For people interested in measuring the mind with numbers and the significant challenges to it may want to study the full text.

The relationship between borderline personality disorder and bipolar disorder

Mark Zimmerman, MD, Theresa A. Morgan, PhD

Dialogues Clin Neurosci. 2013 June; 15(2): 155–169.

Abstract:

It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum.

Link to full text: www.ncbi.nlm.nih.gov/pmc/articles/PMC3811087/

I used to think my ex was undiagnosed BPD. Now I found out that he had all kind of psychiatric tests e few years ago and that there exists a file of him. He sais that the psychiatrists doesn't want to tell their diagnose to their patients. So maybe they know that he's BPD but keep it to theirselves ?

I don't get this, so they just let him struggle on his own, causin' problems everywhere he goes ? 

recently my ex got himself together again: he's in a hospital right now to detox from his alcoholaddiction. He's in an introspective phase and he is diagnosing himself now as bipolar. From his point of view I get that, still I would say it's BPD: that makes much more sense.

but allready I'm glad that he made a new step in self awareness, maybe it doesn't matter how he is diagnosed, as long as he tries to do something about it... .

It's probably less painful to think you're bipolar than you' re BPD, which is more stigmatising in my eyes.

but suppose he will get some medication fror Bipolar?

he wants to ask his doctor for lithium, and allready he takes seroquel,

can't that be harmful: taking inappropriate medication ?  and I know him: he's always trying to increase the dose, or combining stuff, not to mention drinking on it... .

and what about therapy? IF he might consider that... .

what a mess... .  

Triss: Lithium is also used to used for treatment of BPD. I asked this question elsewhere on this forum and got a reply with a link and all. My wife has a combination of seroquel + lithium.

There has been some debate over wether my wife is bipolar or has BPD, but the meds she's one should be doing effect regardless of which.

thx hergestridge. currently my ex takes seroquel but to get lithium he needs to see a psychiatrist which he refuses at the moment.

also he was told by someone that taking lithium makes everything you eat taste different and smell strange   

can someone confirm this ?

My wife hasn't had that experience. The only thing she's had (and I've under that's common) is thirst and craving for sweet drinks.

Thing with mood stabilizers is that is makes you kind of dumb I think. Lithium has been effective in some ways but she's been even more prone to ignore her behavioral problems now.

I can speak from my experience.  I am diagnosed with bipolar I disorder and ADHD and sort of PTSD (it's agreed that it is there between my psych nurse).  My manias last several months and are followed by long periods of apathy.  I am consistent in my moods though.  I tend to feel like my body is running on adrenaline and some points and almost dead (yet still hyperactive out of sheer antsy urge, ADHD).  I can't wind down during some episodes.

I deal with delusions and hallucinations.  My whole system literally changes... . I can smell better, taste better, want to take on everything and love everyone, sometimes paranoia, like schizophrenia paranoia but they're consistent with me.

My mom and brother both have BPD, my brother is also addicted to a few things and not sober so his is different than hers.  With them, just based on my gut feeling, it was set off or emotive in nature.  It is like being possessed with me but it is almost like they are overburdened with emotion and want others to feel the way they do.  When I am manic and people try to tell me to calm down, I don't understand their problem and think they are jealous of me or they they are manic or something.  I find that I get argumentative but often with people that are more apt to feed into it not knowing that I won't stop and my mom and brother can seem to defuse and whatnot for some period.  One seems emotional.  If I take meds for bipolar I disorder (Lamictal and sometimes Klonopin) and ADHD (Dexedrine).  I stay stable for years as long as I stop myself at times and eat healthy and take meds but even then, I go off, sometimes due to conflict or a death or something or just because I need meds raised.

BPD and BiPD seem somewhat similar.  

The difference is there is a baseline of stable normative behavior in BiPD.  There are manic, depressive, mixed, and hypomanic episodes that last up to a week or a few days.  One of the episodes tend to follow another, for example a major depressive episode followed by a manic episode.  

Certain diagnoses of BiPD will be based on their latest episode. The periods of the cycling of the mood can be consistent, for example someone with BiPD can have seasonal manic episodes.  Essentially, it is a temporary spike in their mood and they will eventually go back to their baseline mood.  

On the other hand, with BPD there is no baseline. PwBPD have a persistent pattern of behavior.  A person with BPD can reflect instability with their mood but it tends to last a few hours and rarely less then a few days.  

There is an association between antidepressants and rapid cycling.  To my understanding, there has to be 4 periods of either manic, hypomanic, depression, or mixed episode within 12 months to be have a rapid-cycling specifier.