Important: how often is BPD diagnosed as bipolar disorder?

[Indifferent28]

I don't feel like going into all the details here but say a suspected BPD is diagnosed as bipolar. How often does this actually happen?  Wouldn't a doctor be more qualified to diagnose it than us self diagnosing?  But if so, why do so many things not match up with bipolar... .Such as the attachment/infatuation phases and such.

Isn't that strictly to do with BPD?

[Keef]

Hello Indifferent28

To start with, my uBPDX was diagnosed with bipolar type II a couple of years ago, and as far as I know she's still undiagnosed with BPD even though that seems a much more likely diagnose. They are also different kinds of illnesses as you probably know. If you're familiar with the bipolar subtypes you'll know that type II involves a less acute manic state, hypomania. Hypomania can quite easily seem more like a euphoric state of mind, it's from what I've read not as obvious as a proper manic state.

I've from what I understand never noticed hypomania in my ex gf's behaviour. To me, after she discarded me, I've come to see her actions only as consequences of proper emotional dysregulation. The mood swings were too many, too frequent.

I have read that some psychiatrists on purpose misdiagnose BPD as BP because BPD's apparently are so difficult to treat. I haven't got proper sources at hand but sadly this is imaginable.

I guess it only takes an unexperienced psychiatrist to misdiagnose. Or maybe a psychiatrist reluctant to treat a person with BPD/traits of BPD.

As for attachment and infatuation, these things would happen in any relationship, though not in such a strong sense as in the case of someone with BPD. Somebody going through a hypomanic period may as far as I'm concerned behave like a pwBPD heavily idealizing the other one.

My ex has just started taking meds for her bipolarity. I hope they're right for her. I think she's in great need of therapy (such as DBT) most of all. But she's not my problem anymore anyway...

[beggarsblanket]

I'm no statistician, but it looks to be common enough. Here's a table from a 2010 paper on the subject:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849890/table/T1/

Here's the paper itself, "Borderline Personality Disorder and the Misdiagnosis of Bipolar Disorder":

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849890/

[marvelless]

I have wondered this for a while as well. My ex had an official diagnosis of bipolar I. I think his descriptions of his feelings and behaviors were interpreted by his psychiatrist as manic and depressive episodes. Coupled with reckless behaviors and substance abuse it does sound a lot like bipolar. When I finally went with my ex to an appointment and described his behavior with specific examples, his doctor mentioned BPD before I even brought it up. Basically unless the doctors are actually observing their day to day behaviors or getting an accurate and detailed description of them they can only diagnose/treat what they are presented with.

[Confused108]

My ex was diagnose as Bipolar at the age of 14 in 1988. I strongly feel she was misdiagnosed and is BPD. Bpds mood swings are up and down very quickly maybe several times a day when a person with Bipolar is not. They may take a day or weeks with their mania. I was told and read that back in the early 1980s BPD was founded. But the Doctors still didn't know what they were dealing with. Kids / teens were diagnosed as being bipolar because the Drs felt they were still maturing mentally and that's why a lot of people got misdiagnosed.

[Sunfl0wer]

My sis was diagnosed some "rapid cycling Bipolar" or such similar. (My guess was that the whole rapid cycling crap was a gentle way to express BPD, idk tho) She does have episodes of hypomania, so I'd say she has both Bipolar and BPD.  Not uncommon to have both.  She is mostly a depressive Bipolar, the hypomania episodes are less common than depression ones.

[beggarsblanket]

Although it's true that bipolar mood cycles tend to be longer -- once every several months or years -- there are many exceptions. Some people with bipolar have "ultradian" cycling, in which cycles are minutes or hours long. This is a well known kind of bipolar "rapid cycling." It is not just a kind name for BPD.

I think the important distinction in people with BPD is not the rate of change of moods but their sensitivity to external stressors. Bipolar mood swings are "endogenous," caused from within the psyche. People with bipolar will be despondent or irritable or euphoric regardless of their conditions in life. BPD mood swings are "exogenous," or caused from outside the psyche. I gather that relational/attachment problems are among the major external causes of BPD mood swings.

Someone who knows more about BPD can correct me if I'm wrong. I've only been reading about it for a few months. I know much more about bipolar; I have it, and I've read a great deal about it in the several years since I was diagnosed.

[Sunfl0wer]

I certainly am not clear on my sis BPD and Bipolar thing.  When I have known her in what I see as hypomania, she is racing, doing something non stop huge like a move across the country. This state lasts months.  When she is depressed, it also lasts months.  Yet, she also has daily mood swings that are certainly BPD and related to idealizing a situation or person and devaluing it/them, she also has all other BPD symptoms. I really don't grasp where the doc decided she was "rapid cycling Bipolar." Idk about that diagnosis. I do however, know her Bipolar is comorbid with BPD. I just cannot distinguish the diff between what the doc is calling rapid cycling and BPD swings, cause honestly, I think he is wrong or being "gentle" or also equally likely, I just haven't known any rapid cycling Bipolar examples from which to compare. (In her case, the Bipolar meds do help a bit, not enough tho, she takes lithium I think) I do hear what you mean on the "exogenous" and her daily/min to min swings are certainly exogenous.  They are related to the situation as she feels triggered into a rage/dysregulation because the server brought the wrong thing or such. Where as the Bipolar switches seem to not be exogenous.  She simply is on top of the world or the bottom of it... .And well, she will relate it maybe to something external, (cause she does everything) but really doesn't seem to match the thing in any way.  Like her huge move happened just after a break up.  She just impulsively moved across country stating she had to right then and there, so did, without any planning at all really, her, kids and all.

[beggarsblanket]

I do however, know her Bipolar is comorbid with BPD.

Hi Sunfl0wer. I believe you. I speak with many other bipolar sufferers. BPD is a common comorbidity.

I'm glad that the endogenous/exogenous distinction is helpful. That's the main point that I wanted to contribute to the thread. I feel for patients who struggle with both ultradian cycling and BPD. Rapid cycling bipolar of any kind can be hard to treat medically. If it is not responsive to medication, the BPD may never be detected.

[Confused108]

Hey guys let me ask this. How are your exs outside in the real world? Mine is a very very High functioning one. She is an angel at work and everyone clients , friends , etc think she is wonderful. She doesn't pull any of her crap on them! Just when she gets into relationships or her family. Anyone else know how their exs / family members are outside with others?

[beggarsblanket]

Hey guys let me ask this. How are your exs outside in the real world? Mine is a very very High functioning one. She is an angel at work and everyone clients , friends , etc think she is wonderful. She doesn't pull any of her crap on them! Just when she gets into relationships or her family. Anyone else know how their exs / family members are outside with others?

This question may deserve a different thread, but I'll answer anyway.

She struggles, but it's for psychiatric reasons not connected to the BPD. I marvel at her adaptability given everything she struggles with. She takes my breath away with her self-awareness and her striving against her limitations.

It's reasoning like this that keeps me from losing all affection for her, but that's another issue.

[Indifferent28]

Thanks for the responses even though now I am more confused.

If they are bipolar, shouldn't the medication help them to get better?  If it was BPD, I suppose they wouldn't improve.

I guess this explains how they've seem to be doing so much better relatio ship wise these last few months

[Sunfl0wer]

Thanks for the responses even though now I am more confused.

If they are bipolar, shouldn't the medication help them to get better?  If it was BPD, I suppose they wouldn't improve.

I guess this explains how they've seem to be doing so much better relatio ship wise these last few months

I find it hard to help sort through what info you are seeking because I do not hear directness in the asking.

There are many reasons a person can "appear" to be doing well.

More details in OP may help remedy some confusion .

You may possibly trying to incorrectly generalize info, when situations may not be compatible to do such.  Hard to tell.

Some people do not improve with meds for a variety of reasons. ...
Hard to speculate here as I'm not hearing a clear question.

[marvelless]

Hey guys let me ask this. How are your exs outside in the real world? Mine is a very very High functioning one. She is an angel at work and everyone clients , friends , etc think she is wonderful. She doesn't pull any of her crap on them! Just when she gets into relationships or her family. Anyone else know how their exs / family members are outside with others?

Not well at all. He was previously on disability and recently had to go back to work. He cycles through "jobs" weekly. His idea of a career is a get rich quick scheme and he can't determine that an opportunity that sounds too good to be true is either a scam or misrepresented. His family has become extremely detached from him, particularly his parents.  Friends he will do well with for a short time while he idealizes them until they disappoint his impossibly high expectations at which point he lashes out very violently.

[Indifferent28]

Well Sunflower, basically I had suspected my ex to be BPD. That's how I found this board and such. I had no doubts she was BPD. Although her and her girlfriend have had a few day or two long break ups in the last year, I noticed that after their last very short few day break up, they had been doing much better the last few months.

It seemed mutual where as before it seemed like the replacement put in less effort than my ex. Now it seems their is a mutual closeness that hadn't been there before as much.

Well, I recently also found out that apparently my ex was just diagnosed as bipolar a few months ago and put on medication. I'm not sure what type of meds or how long she was really analyzed for. I just heard this through the grapevine.

So I'm sort of shell shocked. She used to tell me she believed she was bipolar. But never went and got diagnosed or treated. And now I'm hearing that it was concluded she is indeed bipolar.

It is confusing me, because if she is bipolar, it would change quite a few things. I know there are overlapping similarities between BPD and bipolar, but I don't know. I feel it would change a few things if she is bipolar.

And I say the improvement that seems to be occurring between her and the replacement may be due to the fact that she has been officially diagnosed, is now on meds, and maybe not having the usual mood ups and Downs.

If so, I'm glad she got help.
However, I am devastated if she was indeed bipolar and could've been getting better like this had she seeked help when we dated.

[Sunfl0wer]

It appears beggarsblanket actually supplied you with excellent info, the answer to your general question.(I'm darn it on my phone, or I'd paste)


No offense... .
I would not have replied to much on a story like that on the detaching board.

Reason is cause you are making observations based on third party people reporting to you or other observations from a distance that she is doing well or such.

My mom with BPD also had the appearance of doing well, as did my sis, yet in both instances, we're very much capable of killing their kids in a fit of rage.  

I can sympathize with your struggle... . that you wonder if your ex actually IS a different person and has actually done some healing.

I am sorry I cannot answer but only general stuff from my life experiences or refer to my own readings.  I also have not read more of your story.

Did you grasp the exogenous/endogenous difference mentioned here?

In my experiences, the pwBPD had severe abandonment issues and anxiety regarding painting people all black and all white even while at either end of the Bipolar spectrum.

Also, I had a friend with BPD and well, according to FB appears to be doing fine.  I have touched bases with her occasionally... . and have no reason to doubt she isn't doing well.  She literally does acknowledge her diagnosis acknowledge independently sought and worked very hard in treatment.  So while I believe she is doing well, it is also quite possible her or anyone else on my friends list is not.

I guess my point is, to know the outcome of your ex is really big speculation and grasping.  I wonder if you feel there is hope and interest on her part? Or is this more magical thinking on your part? And what can we do to help you through the stages of detaching? Have you begun lessons?

(Sorry, cannot check history)

[apollotech]

I think it is misdiagnosed as BP often. From the literature that I have read about BPD, BP is the most common misdiagnosis. My opinion is that a clinician in a clinical setting just cannot see the emotional attachment issues that drive the crazy push/pull mood swings, so BPD is misdiagnosed as something else.

There was a post on this tread that addressed this issue somewhat. To paraphrase, the poster doesn't (didn't) understand why individuals that are not emotionally intimate with the pwBPD cannot see the disorder. To those people, the pwBPD appears normal. The emotional attachment makes all the difference regarding which part of the pwBPD that you will meet. As far as I know, at least based on the friendships that I have with people that have been clinically diagnosed as BP, their mood swings have nothing to do with emotional attachments. As mentioned in other posts, BP seems to be an internal issue, not dependent upon outside influences, very much the opposite from someone suffering with BPD.

[heartandwhole]

Hi Indifferent,

In my understanding, BiPolar is a mood disorder that can often be treated with medication. BPD is a personality disorder that doesn't respond well to the same medication. The etiology of the two are assumed to be different as well.

Here is a very informative article on the subject of why professionals are often reluctant to diagnose BPD:

Why Psychiatrists are Reluctant to Diagnose Borderline Personality Disorder

This section deals with BPD and BiPolar:

BPD and the Bipolar Spectrum

It has been proposed that borderline pathology falls within the spectrum of bipolar illness,22 based on a wish to expand the narrower diagnostic construct of bipolar disorder into a much broader range of conditions termed the bipolar spectrum. In this model, the range of bipolar spectrum disorders would be extended to include bipolar III (antidepressant-induced hypomania), as well as bipolar IV (ultra-rapid-cycling bipolar disorder). The last category, bipolar IV, describes mood swings typical of BPD (i.e., rapid shifts over hours). This expanded definition might include many, if not most, patients with BPD.

The issue is whether the lability of mood seen in BPD is identical to phenomena observed in mood disorders, such as bipolar II.23 Hypomanic episodes have to last for at least four days, and this consistency of mood is rarely seen in BPD. Instead, affective instability (AI) is a characteristic feature that distinguishes BPD from classical bipolar disorder (as well as from other personality disorders). Emotion dysregulation is a similar concept.24

Other lines of evidence have also failed to support the idea that BPD and bipolar disorder reflect the same underlying psychopathology.25,26 To summarize, there is no evidence for a common etiology, family prevalence data shows that impulsive disorders are more common than mood disorders in the first-degree relatives of patients with BPD, the longitudinal course of BPD rarely shows evolution into bipolar disorder, and treatment studies have failed to show that mood stabilizers have anywhere near the same efficacy in BPD as they do in bipolar disorder.

The following case demonstrates some of the problems in differential diagnosis between BPD and bipolar disorder.

Case example—Patient 3. Lisa had been self-cutting since age 16 and presented to a clinic with chronic suicidal ideation, irritability, and rages. Lisa received a DIB-R score of 9/10.

Nonetheless, bipolar II disorder was diagnosed on the basis of Lisa’s mood swings, as well as repeated episodes in which she impulsively became involved with men—flying thousands of miles to meet them after an initial internet contact. At certain points of her illness, Lisa also showed quasipsychotic symptoms, such as an intense fantasy that she was Jesus’s sister who had been sent to earth with a mission. Yet lithium, prescribed for a full year in adequate doses, had no affect on her symptoms. Instead, all of these problems came under control within weeks once Lisa entered psychotherapy and formed a solid therapeutic alliance.

Hope it helps. 

heartandwhole

[SummerStorm]

My BPD friend was initially diagnosed as bipolar but was given the BPD diagnosis a year and a half ago, after her fourth suicide attempt.  As others have said, I'm sure it's hard for someone to give a BPD diagnosis because a lot of the symptoms only appear in intimate relationships.  At one point, before her diagnosis, my BPD friend did once say something like, "It's because I'm bipolar... .or whatever is wrong with me."  I think she knew that there was a lot more going on.  It doesn't mean that she's gone to therapy and has any intention of actually acknowledging that she has BPD, but she at least has moments when she realizes that she's not kind to people.  That being said, this is why I'm in a friendship with her, which I can back away from when she's on the warpath, and not a romantic relationship with her.

[Indifferent28]

Thank you once again for all of your replies. However, all of the information I am gathering makes it even harder to pinpoint whether it seems to be more BPD or bipolar behavior.

Sunflower, it is probably just wishful thinking on my part. You're right.

The only reason i'd have even wondered if she has BPD or bipolar is simply because it seems with BPD, they never genuinely loved their exes. They were just forms of attachment, where as it seems bipolars may have actually been in love with their exes. I don't know.

Probably wishful thinking on my part basically.
I mean i was also curious because if she is bipolar and happens to be doing better due to these meds, it just means my assumptions regarding her having BPD were wrong all along. I don't know. It is crazy and i feel crazy over this all.

Summerstorm, you are totally right about seeing someone in a totally different state when in a romantic relationship with them.  I felt like that with her. No one saw the crazy side of her like i did. But to be fair, no one really saw my crazy side like her either. I guess that can be BPD related or not. People tend to be somewhat different with their romantic partner but i guess with BPD, that is just intensified by a lot.

[Keef]

Indifferent28,
Thanks for bringing this topic to the board. I'm sorry for how you feel, I can really relate.

It's an interesting read, and also for me a sad one since my ex was diagnosed with bipolar II three years ago (started with meds just after she abandoned me in November) but it's most likely she is borderline too, I will probably never get to know since she left me just before a proper evaluation was under way.

I know exactly what you mean by this:

i was also curious because if she is bipolar and happens to be doing better due to these meds, it just means my assumptions regarding her having BPD were wrong all along. I don't know. It is crazy and i feel crazy over this all.

Crazy, isn't it? It scares me. It's as if I don't know what's real or not. I think we will have to rely on our memory. I was mostly treated badly during the r/s except for during the weeks leading up to the end, and it wasn't a fair treatment in any way. We need to remind ourselves of those things! I think my ex had made her mind up earlier on, she eventually chose to create a scene and leave me. She could maybe not handle knowing there might be another diagnosis round the corner. Too much responsibility for her or something :-(

Sorry for not keeping entirely to the topic, this has just brought some things into the light for me. Oh well :-/

Heartandwhole: Thanks for posting that link.