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Im So Confused...is Is BPD Or Bipolar?

Question:

Hello, I am 27 yrs old and have been having many symptoms that correlate almost exactly to both diagnosis of BPD and Bipolar disorder. I have mood swings, the highs and the lows, anxiety, suicidal thinking (and 2 attempts), sleep disturbance of always feeling tired to never feeling tired at all, i have always had relationship problems, i have an anger problem as well and spending problems. I did have an emotional and verbally abusive childhood as well. My mother and sister were both told they had Bipolar Disorder. But then told by someone else that they did not. My sister is currently in treatment for BPD. I’m not sure what to think, what to do, or how to control my anger, mood swings, racing thoughts,etc. I feel so out of control. please…can you give some insight on what you may think it could be? I would really appreciate it.

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Answer:

Bipolar disorder is traditionally thought of as a biological condition, and the primary and best treatments for that condition are medical. Mood stabilization medications such as lithium are generally offered, as may be anti-depressant medications and anti-anxiety medications. Sometimes anti-psychotic medications are offered as well. There is a role for psychotherapy in the treatment of bipolar disorder, but it is generally as an adjunct to the primary medical treatment. Supportive therapies help patients with reality testing and medication management and offer a means of regular external monitoring which can help to identify suicidal crises before they spiral out of control.

Borderline personality disorder was originally thought of as a psychological issue, but we understand today that it is best thought of as having complex biological and psychological causes. Temperament (inherited personality aspects) plays a role in creating a person who has difficulty maintaining emotional stability (who is sensitive), and then early relationship problems set up a person for social-emotional developmental delays, dramatic fears of abandonment and a tendency to understand the world in polarized, unsophisticated terms (like children do). Moods flip around easily in Borderline personality because perceptions of relationships that have emotional consequences for the patient easily flop back and forth between polarized states of "good" and "bad".

Many forms of bipolar disorder are easily distinguished from borderline personality disorder. The psychotic, hyper-energized manic states are a dead giveaway for one thing, as are long cycling periods. But there are rapid cycling forms of bipolar disorder, and milder less-prone-to-psychosis forms of bipolar that start to look very much like borderline personality and that is where the problem lies.

Regarding proper treatment, the way it is supposed to work is that you get an accurate diagnosis for your condition, and then a treatment which is matched to that condition is prescribed for you. You take the treatment and you get better, or you get your condition under better control at least. This seems straightforward, but gets complicated when you have overlap in the primary symptoms associated with different conditions associated with distinctive treatments such as Bipolar Disorder and Borderline Personality Disorder. Both conditions are associated with mood swings and there is overlap in terms of how the conditions can be treated, in part, but there are also a lot of ways that treatments for these two conditions differ. Consequently, if your diagnosis is wrong, you might miss out on a treatment component that would have otherwise worked for you. Your goal therefore, should be to work with your doctor or therapist to continually refine your diagnosis until you’ve got a treatment plan that is working for you. Rather than thinking of your diagnosis as something definitive, it may help to think of it as something provisional and subject to change. In other words, don’t get hung up on diagnosis, but instead work with your doctor to find a practical solution. Ultimately, it may make sense to think you have one or the other condition, or some combination of the two, all of these choices driven by what combination of treatments have helped you cope best.

For instance, if you and your doctor think you might have some bipolar aspect to your condition, then it may make sense to try you on a mood stabilizer medication. Try it under the supervision of a knowledgeable and experienced psychiatrist and see if it helps. If you are suspecting that you may have a borderline personality style condition, then explore therapies that have been found to be helpful for that condition, such as Dialectical Behavioral Therapy (DBT). If you are finding yourself dealing with a great deal of anger, you can explore an anger management class. If your primary complaint is turbulent relationships and/or abuse, you can look into talking about these issues in the context of a traditional psychodynamic psychotherapy.

It is wonderful when treatment plans are cut and dry based on clearcut diagnoses, but this doesn’t seem to be the case for you. So – instead, you have to consult with knowledgeable doctors, and also keep your mind open to the idea that it will take some time to refine your knowledge of what this issue or cluster of issues is. Do what you can to find a psychiatrist who is open to both medical and psychotherapy treatments, consult with that individual and try on the variety of different sorts of treatments that might help. Keep exploring (under the supervision of that doctor or doctors!) until you find what is helpful.

As a side note, I have written on this confusion between Borderline Personality and rapid cycling Bipolar Disorder before, and you may want to read that essay too.

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Comments
  • Brian

    The diagnostic criteria seen in the borderline personality disorder and bipolar disorder are very similar. The only real difference I can see is that the borderline is dealing with a sense of emptiness and a fear of abandonment. Is it possible that both disorders are on the mood spectrum and the borderline personality disorder belongs as a Axis 1 disorder with bipolar?

  • Allan N. Schwartz, PhD

    Hi Brian,

    I hope you do not mind that I am taking the liberty of answering this question for Dr. Dombeck. Borderline is a personality disorder and that is why it is Axis II. It is possible to have an Axis I Bipolar Disorder and an Axis II personality disorder at the same time. However, they are different.

    Personality disorders have to do with extremely dysfunctional patterns of behavior. There may be a variety of moods underneath the behaviors but the emphasis is on behavior. For the BPD these patterns of behavior can be very self destructive.

    Bipolar disorder is Axis I and is driven by moods, usually depressed, manic, swings back and forth between mania and depression or a mixture of both at the same time. It is possible to have Bipolar without a personality disorder or with a personality disorder other than Borderline.

    If you have any other questions please let us know and I hope this helps. There is more information on the site about each of these serious problems.

    Dr. Schwartz

  • Jeremy Springer, MSW

    There has been a lot of talk with the approaching(?) release of the DSM-V of Borderline Personality Disorder being moved to Axis I. This is a scary thought for community mental health providers which are already stretched to their max in a lot of areas.

    Jeremy

  • Matthew

    . . . . Well i think that its kind of how people socialize these days . Its part of life DEAL WITH IT , i have a more serious problem then that its taken my life day by day and its hard . . . . you sit up here and talk about this when in going through that . Its just not fair

  • laura

    I realise this is a late response, but I feel like for the sake of other people with bpd who might read this comment and feel badly that I should.

    Matthew, I'm sorry you have a serious mental health problem that's a struggle for you and I'm not belittling that, but bpd is a severe mental illness that needs treatment, and the attitude you've displayed is the kind that contribute to the already very high suicide rate, in terms of stigma and denial of care.

    BPD already has a completion rate of 10%, and I've seen rates of 70% for at least one attempt which I believe because personally, I've never met another person with bpd who hadn't.

    People with bpd usually struggle with delusional thinking, impulsive behaviour, long-term suicidal thoughts, and extreme mood swings. There's already the stigma that sure people with bpd are crazy, but unlike Axis I disorders, it's our own fault. This is wrong, and we do deserve help and treatment just like anyone else with a mental illness.

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