What Is Borderline Personality Disorder
A young woman who was diagnosed with borderline personality disorder at the age of 14 shared her story anonymously in Elite Daily. Describing her battle with BPD, she says, Relationships feel impossible, my brain never stops running and my stress is magnified. I find it very difficult to distinguish who I actually am and who my mental illness wants me to be.
In a revealing article for VICE magazine, Australian writer Patrick Marlborough offers a personal explanation of BPD: It is hard to offer a simple medical definition of BPD, but Ive heard it brilliantly summed up as chronic irrationality. Think severe mood swings, impulsivity, instability and a whole lot of explosive anger.
Frequency Of Borderline Personality Disorder In Patients With Bipolar Disorder
Twenty-four studies reported the frequency of BPD in patients with bipolar disorder . Most studies were of psychiatric outpatients, and only four were of samples of inpatients . The majority of the studies assessed BPD when the patients were in remission or with no more than mild symptom severity the remainder assessed BPD when the patient was symptomatic. The Structured Clinical Interview for DSM-IV was the most commonly used measure to evaluate Axis I and Axis II disorders. Most reports focused on either bipolar I or bipolar II disorder, and many did not discuss the bipolar I-bipolar II distinction. Two reports specified the number of patients with bipolar I and bipolar II disorder, but only reported the prevalence of BPD for the entire group without specifying the prevalence of BPD in the bipolar subtypes., Only two groups of investigators examined the frequency of BPD in patients with bipolar I and bipolar II disorder.,
The Disorder That Makes People Seem Out Of Order
BPD can make life feel almost unbearable. Its a mirage illness, Marlborough writes in VICE. You feel like someone without fingerprints. You have no identity. You move between things constantly, people and passions. Onlookers can be tricked into seeing you as boldly transformative. In reality, you are someone without a sense of self.
The young woman with BPD told Elite Daily, Long story short, its very hard for those with BPD to have successful and healthy relationships and stable confidence levels. Our version of logical thinking is most often overthinking. We have a very hard time distinguishing between real issues or imaginary issues. BPD is considered to be one of the most serious mental illnesses, as it causes a great deal of suffering and has a high-risk for suicide.
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Personality Disorders And The Bipolar Spectrum
Patients with moderate-to-severe personality disorders may wreak havoc on an unsuspecting medical office. It is increasingly important to recognize, limit, and manage those with aggressive types of PD. Likewise, it is crucial to recognize those who fit the bipolar spectrum. In particular, the mild end of the spectrum is often missed. The clinical stakes for missing bipolar are enormous, as these patients tend to bounce from antidepressant to antidepressant, with predictably poor results.
Consider the following scenario: a 28- year-old man, Bill presents to the pain clinic with severe low back pain. He seems angry on the first visit, and is very demanding with the front office staff. Bill is mistrustful of physicians and openly states to the doctor, I will go back to work when you give the right amount of drugs that help. Bill is upset with his last two health providers.
Over the next few months, the clinic bends over backwards for Bill, even though he can be abusive to the staff. Bill overuses opioids, and is manipulative. He always has a sense of entitlement. When he calls, stating, I want to talk to Dr. Smith NOW, put me through! the staff, out of fear, jumps and does as he asks. The physician finds himself in a subservient position, trying to appease the patient and end the confrontations.
Research On The Overlap
You may have heard about or even been told you are borderline. This used to be a very negative label, but now theres good evidence that specific treatment is possible and can help a lot.Linehan et al, Blum So now the label is not as pessimistic and hopeless as it was even a few years ago.
A recent review from Canada found substantial overlap between borderline and bipolar disorder diagnoses, though still concluded that borderline deserved to be regarded as a valid diagnosis, separate from bipolar disorder.MagillThis is an excellent review of this overlap or one illness issue, and I rather agree with the conclusion. Another borderline research group, led by Dr. Gunderson whos been studying this phenomenon for decades, also warns against lumping the two conditions together.GundersonHe emphasizes the same differentiating factor I present in the next section: abandonment fear is prominent in borderline, not so in bipolar.
Updating references in 2014 Im struck that in over 10 years, there as been little change in this borderline vs. bipolar discussion. You can still find both views.
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Characteristics Of Borderline Personality Disorder
While borderline personality disorder resembles bipolar disorder when it comes to impulsive behavior and mood swings, BPD is different because it is characterized by patterns of unstable relationships. Those with borderline personality disorder are very sensitive and struggle with managing their emotions. Often they turn to ineffective coping mechanisms, such as self-harm.
A person with BPD is often tortured by an intense fear of abandonment, leading to unstable relationships or staying in relationships that arent working. They experience intense emotional reactions to upsetting or disappointing life events. They are typically very self-critical and may engage in self-harming behavior.
Surprising Things Everyone Should Know About Borderline Personality Disorder
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Getting the right diagnosis often isnt easy for psychiatric conditions. In our field, we dont yet have biologic tests that can easily define one condition from another. If your blood pressure is 140 over 90, you have hypertension or high blood pressure. In mental health, we have to rely on a description of patterns or symptoms to makes diagnoses. This model is fraught with challenges.
Without a clear biological model to work from, and given the complexity of the human brain, the field has settled upon dividing these descriptions of symptoms into syndromes. The Diagnostic and Statistical Manual of Mental Disorders holds these symptom descriptions in order to help professionals make reliable and consistent diagnoses. This means a social worker in Detroit should make the same diagnosis as a psychiatrist in Boston and a psychologist in Santa Fe.
However, the diagnostic process is more complex than just reading symptoms in a DSM. Here are a few thoughts on what I have observed in making diagnoses:
- Its common to have more than one diagnosis. For many people, there may not be one simple diagnosis. For example, people can have both bipolar disorder and a substance use disorder diagnoses.
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About Borderline Personality Disorder
Borderline personality disorder is a newer diagnosis that came about in the 1980s. BPD is largely defined by a pattern of intense unstable relationships and is usually caused by a persons lack of self-identity, uncertainty of self-perception, or uncertainty of his or her role in society. A person with BPD will have strong, intense emotional reactions to his or her environment that are usually disproportionate to the situation. This is called emotion dysregulation which may show in a form of intense anger, anxiety, or depression that can last from a few hours to a few days. Often, emotional dysregulation may be triggered by an interaction a person has in a personal relationship.
People with BPD often tend to have extreme views of events or situations, perceiving them as either all good or all bad. Typically, people with borderline personality disorder will frequently change their beliefs due to their lack of identity. This may also cause them to quickly change their opinion about the people in their lives going from idolization to devaluation or from extreme dislike. Symptoms of BPD are chronic and pervasive in peoples lives. Self-harm is often exhibited in people with BPD as a way to manage their emotions. Other signs and symptoms may include efforts to avoid real or imagined abandonment, impulsive and dangerous behaviors, chronic feelings of emptiness, problems controlling anger, and difficulties trusting others.
Why Do I Have Bipolar And Bpd At The Same Time
- Thread starteritsallaboutme
I am new here, I just got diagnosed with bipolar 2 and BPD at the same time the other day. I have been reading alot since then, and it seems it is common, but I felt it was strange at the time too… Definitely didn’t see it coming.
I managed to get a copy of my medical notes and I have BP and BPD at the same time, what does that mean, is it normal to be diagnosed with both at the same time?
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Bipolar Disorder Borderline Personality Disorder May Represent The Same Disorder
Borderline personality disorder and bipolar disorder affect an estimated 1.6% and 2.6% of US adults, respectively both illnesses are severe and associated with significant disability.1,2 They commonly co-occur and share certain symptoms, including impulsivity and emotional instability. Given these overlapping features, it can be challenging for clinicians to differentiate between the two disorders.
Results from some studies support the bipolar spectrum hypothesis, which posits that both BPD and BD reflect alternate expressions of the same underlying disorder.3-7 Proponents of this concept believe that BPD should be reclassified as part of the bipolar spectrum. Other research suggests that they are different disorders based on significant differences variations in the course of illness, family history, phenomenology, and response to treatment.
To explore this question, researchers from Columbia University in New York and Hospital Universitario de Alava-Santiago in Spain examined data from a nationally representative sample of US adults from the National Epidemiologic Survey on Alcohol and Related Conditions . Based on this information, they performed exploratory factor analysis and confirmatory factor analysis of 25 symptoms .
This study is the first of its kind to use these methods to explore the links between BPD and BD. Trained interviewers assessed participants for each disorder based on DSM-IV criteria.
Bpd Symptoms Vs Bipolar Disorder Symptoms
Although theres some overlap between the two conditions, there are a few differences.
The main differences between BPD and bipolar disorder symptoms are:
The timing of impulsive behaviors
If you have bipolar disorder, your impulsivity tends to happen during periods of mania or hypomania. But if you have BPD, impulsive urges may arise without other symptoms of mania. Impulsive urges may arise anytime or may occur in response to stressors that happen randomly.
During periods of mania, people with bipolar disorder feel more energized and need less sleep. You might feel energized after just a few hours of sleep each night. BPD doesnt involve mania, so youre less likely to notice this.
Mood cycle time
People with BPD have short-lived moods that change within a few hours or days. People with bipolar disorder tend to have mood cycles that last for weeks or months, unless they have rapid-cycling bipolar disorder, in which case the mood cycle will be much shorter.
BPD is characterized by a deep fear of abandonment, which can put immense strain on relationships. People with BPD often struggle to have stable relationships as they fluctuate between extreme like and dislike for people. While people with bipolar disorder might struggle with interpersonal relationships, the fear of abandonment isnt often present.
- abnormal brain structures
- serotonin levels
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Bipolar Vs Bpd: How To Tell The Difference
The two mental health conditions are sometimes confusedbut treatment depends on which diagnosis a person actually has.
When it comes to successfully treating a mental health disorder, its important that you have the correct diagnosiswhich is easier said than done. As if struggling with symptoms isnt hard enough, in some cases, these symptoms may overlap with other conditions, making it tough to nail down the right diagnosis.
While bipolar disorder and borderline personality disorder might sound similar at first, aside from a few symptoms the two have in commonimpulsivity, promiscuity, and ragethe conditions are actually very different, Kathleen Cairns, PsyD, a clinical psychologist in Connecticut, tells Health.
How Bipolar And Borderline Personality Disorder Are Different
What is the difference between BPD and bipolar disorder, then? Some major components separate the two.
- Quality: While the disorders are both characterized by mood changes, the quality of the mood changes can be very different. People with bipolar disorder tend to experience mania and depression while people with BPD experience intense emotional pain and feelings of emptiness, desperation, anger, hopelessness, and loneliness.
- Time: In BPD, mood changes are often more short-lived. They may last for only a few hours at a time. In contrast, mood changes in bipolar disorder tend to last for days or even weeks.
- Cause: Mood shifts in BPD are usually in reaction to an environmental stressor, such as an argument with a loved one, whereas mood shifts in bipolar disorder may occur out-of-the-blue.
- Degree: The mood shifts typical of BPD rarely involve elation. Usually, the shift is from feeling upset to feeling OK, not from feeling bad to feeling a high or elevated mood, which is more typical of bipolar disorder.
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Which Disorder Is More Serious
The American Psychiatric Association classifies and issues standard diagnostic criteria for mental illnesses in the Diagnostic and Statistical Manual of Mental Disorders, or DSM. In older versions of the DSM, personality disorders were classified as axis II problems, while mood and thought disorders were classified as axis I disorders. Because they were relational, we used to think that personality disorders were not as serious or disabling as depression, bipolar disorder, or schizophrenia. However, we know from many outcomes studies that untreated personality disorders are quite disabling. Therefore, one of the most important changes in the most recently revised and published edition of the DSM was removing the ordinal hierarchy and classifying personality disorders as equal to mood and thought disorders in terms of impact and disability.
Borderline Personality Disorder Diagnosis Signs And Symptoms
Teens with BPD may experience extreme mood swings and can display uncertainty about who they are. As a result, their interests and feelings about any recent event can change rapidly.
According to NIMH, symptoms include:
- Frantic efforts to avoid real or imagined abandonment
- A pattern of intense and unstable relationships with family, friends and loved ones, often swinging from extreme closeness and love to extreme dislike or anger
- Distorted and unstable self-image or sense of self
- Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving and binge eating
- Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
- Intense and highly changeable moods, with each episode lasting from a few hours to a few days
- Chronic feelings of emptiness
- Inappropriate, intense anger or problems controlling anger
- Stress-related paranoid thoughts
- Severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body or losing touch with reality
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Drug And Alcohol Abuse
For many people, social use of alcohol or prescribed medications dont pose a problem. Thats because the concept of moderation, while requiring discipline, is an attainable goal most of the time. However, for people with untreated bipolar disorder or borderline personality disorder, moderation is difficult or impossible to achieve.
Its not uncommon for people with untreated bipolar disorder or BPD to abuse alcohol or drugs as a way to cope with their symptoms. Substance abuse and mental disorders are often referred to as co-occurring conditions. Unfortunately, substance abuse only aggravates symptoms and can hinder or hide a true bipolar or BPD diagnosis.
When a mood disorder and substance abuse co-occur in a patient, that usually calls for specialized treatment at a facility specializing in dual-diagnosis care. Because the issues are so intertwined with each other, working on both of them at the same time will give a patient better odds at recovery, compared to focusing on one primary disorder.
Is Borderline Personality Disorder More Common In Patients With Bipolar Disorder Than Psychiatric Control Groups
Eight studies compared the frequency of BPD in patients with bipolar disorder and major depressive disorder.,,-,,, Four studies found no difference between the two groups,,,, whereas three of the four studies of bipolar II disorder found a higher rate of BPD in the bipolar patients.,,, Another study found no difference in the rate of BPD in patients with bipolar disorder and schizophrenia. One study compared the frequency of Axis I disorders in a heterogeneous sample of psychiatric outpatients, and sufficient data was provided to calculate the rate of BPD in patients with different diagnoses. BPD was significantly more frequent in patients with bipolar disorder than in patients with major depressive disorder, as well as more common than in patients with any psychiatric disorder. Another study of psychiatric outpatients with mixed diagnoses found a lower rate of BPD in patients with bipolar disorder. Thus, four of ten studies found a significantly higher rate of BPD in patients with bipolar disorder compared with a psychiatric control group, and three of these four positive studies were comparisons of bipolar II disorder versus major depressive disorder.
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