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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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