COMPARISON: BiPolar Disorder vs BPD

[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.

[SLO]

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.

[Bumpy Road]

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

[Abigail]

  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

[Skip]

When asking differential questions about multiple personality disorders, it is important to understand why you are asking the question and how you intend to use the information. Without this perspective and focus, the data may be overwhelming, confusing and misleading.  For example... .
 
~ if your child is not responding to therapy, it makes sense to look more carefully into the possibility that the wrong illness was diagnosed or whether there are comorbid (multiple) personality disorders at play. Bipolar and Major Depressive Disorder, for example, are far more responsive to pharmaceutical therapy than Borderline Personality.
 
~ If you are trying to get along better with your wife, it's not as important to precisely pinpoint the specific disorder or analyze the comorbidity as it is to recognize and fully understand the problem behaviors and how to constructively deal with them. 
 
~ If you are recovering from a failed relationship, the important thing is often to understand which behaviors were pathologic (mental illness) and which were just the normal run of the mill problems common to failing/failed relationships - there is often a bias to assign too much to the "pathology" and not enough to common relationship problems, or the issues we created by our own behaviors.
 
It's important to know that the distinctions are not all that neat and tidy. In a 2008 study, comorbidity with another personality disorder was very high at 74% (77% for men, 72% for women).  This is one reason why there is controversy around the DSM classifications of Personality Disorders - there is so much overlap it is confusing even to professionals - personality disorders are real, but they are not easily or neatly defined.
 
More info
 
In the study, comorbidity with mood disorders was also very high at 75% as was anxiety disorders 74%.
 

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

Men---------  - 30% 8% 16% 25% 27% 27% - 27% 7% 31% 7%

Women------ - 47% 15% 21% 33% 47% 42% - 37% 12% 33% 9%

Some helpful hints for sorting through this.
 

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

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

• Comorbidity Borderline patients often present for evaluation or treatment with one or more comorbid axis I disorders (e.g.,depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa). It is not unusual for symptoms of these other disorders to mask the underlying borderline psychopathology, impeding accurate diagnosis and making treatment planning difficult. In some cases, it isn’t until treatment for other disorders fails that BPD is diagnosed.  Complicating this, additional axis I disorders may also develop over time.  Because of the frequency with which these clinically difficult situations occur, a substantial amount of research concerning the axis I comorbidity of borderline personality disorder has been conducted. A lot is based on small sample sizes so the numbers vary.  Be careful to look at the sample in any study -- comorbidity rates can differ significantly depending on whether the study population is treatment seeking individuals or random individuals in the community.  Also be aware that comorbidity rates  are generally lower in less severe cases of borderline personality disorder.

• Multi-axial Diagnosis  In the DSM-IV-TR system, technically, an individual should be diagnosed on all five different domains, or "axes." The clinician looks across a large number of afflictions and tries to find the best fit.  Using a single axis approach, which we often do as laymen, can be misleading -- looking at 1 or 2 metal illness and saying "that's it" -- if you look at 20 of these things, you may find yourself saying "thats it" a lot.     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
 

DIFFERENCES|COMORBIDITY: Overview of Comorbidity
 
Additional discussions... .
 
Personality Disorders
 
Borderline and Paranoid Personality Disorder
 
Borderline and Schzoid/Schizotypal Personality Disorder
 
Borderline and Antisocial Personality Disorder
 
Borderline and Histrionic Personality Disorder
 
Borderline and Narcissistic Personality Disorder
 
Borderline and Avoidant Personality Disorder
 
Borderline and Dependent Personality Disorder
 
Borderline and Obsessive Compulsive Personality Disorder
 
Borderline and Depressive Personality Disorder
 
Borderline and Passive Aggressive Personality Disorder
 
Borderline and Sadistic Personality Disorder
 
Borderline and Self Defeating Personality Disorder
 
Other
 
Borderline PD and Alcohol Dependence
 
Borderline PD and Aspergers
 
Borderline PD and Attention Deficit Hyperactivity Disorder
 
Borderline PD and BiPolar Disorder
 
Borderline PD and Dissociative Identity Disorder
 
Borderline PD and P.T.S.D.
 
Borderline PD and Reactive Attachment Disorder (RAD)

[homemadecookie]

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.

[geroldmodel]

I believe that the acid test is treating for bipolar and looking at the leftover symptoms.

I found this board after 14 years of ex being treated for his bipolar and not being symptom free.

From what I read over the years,

psychiatrist will first treat "possible bipolar" with anti-psychotic meds and see how the patient evolves... .

Anti-psychotic meds don't help PD... .so if the patient doesn't inprove it's a personality disorder.

[GameGirl]

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

[Randi Kreger]

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.

[GameGirl]

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.

[Randi Kreger]

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

[PotentiallyKevin]

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.

[gradient]

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?

[GameGirl]

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

[GameGirl]

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

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

1. People with BPD cycle much more quickly, often several times a day.

2. The mood swings with BPD are more specific: all emotions are affected (fear, anger, sadness) while people with bipolar either have mania (intensely high) or major depression.

3. The moods in people with BPD are more dependent, either positively or negatively, on what’s going on in their life at the moment.



Randi Kreger

Welcome to Oz Community Owner

Stop Walking on Eggshells and the SWOE Workbook

The Essential Family Guide to BPD

Hi

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

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

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

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

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

Just my observations.

[Lizzie]

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

[PotentiallyKevin]

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.

[Randi Kreger]

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

[jeffreyd]

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.

[clean slate]

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

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

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

You'll find reference material on this site that suggests it's not entirely a good idea to share that idea with someone you suspect has BPD.  You should read that before considering sharing your thoughts with her about this particular diagnosis.  It could help you out tremendously.

[PotentiallyKevin]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hope this helps.

[anker]

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)?

[anker]

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.

[PotentiallyKevin]

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... .

[anker]

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.

[PotentiallyKevin]

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.

[PotentiallyKevin]

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

From Wikipedia:

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

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

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

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

[Skip]

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

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

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

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

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

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

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

These are all valid points. 

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

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

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

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





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.

[Abigail]

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

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

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

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

[Abigail]

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

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

[anker]

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