Controversy Over Diagnosing Bpd
During my early training, I was told that we should not diagnose a personality disorder without having conducted a longitudinal assessment. There was resistance to label people as personality disordered because it was believed that:
- The label was pejorative
- Personality disorders dont get better
- There was no effective treatment
However, the evidence suggests the opposite is true.
BPD gets better with age and there is a range of therapy with a good evidence base. If there is still stigma, it lies with us as professionals. Patients generally welcome knowing why they feel as they do, and will often have researched their diagnosis on the internet prior to coming to see us.
Signs And Symptoms Of Borderline Personality Disorder
The signs and symptoms of borderline personality disorder are primarily emotional and driven by self-image. For example, people with borderline personality disorder are preoccupied with real or imagined abandonment, and they may make attempts to avoid abandonment from occurring. They often start intimate relationships quickly to avoid loneliness and then leave relationships suddenly in anticipation of being abandoned. Thus, their relationships are often unstable and erratic, which is a hallmark of borderline personality disorder criteria
People with bipolar personality disorder may also experience feelings of chronic emptiness and isolation. They may have difficulty trusting others and have an irrational fear of other peoples intentions. They may participate in risky behaviors such as substance abuse or unsafe sexual activity due to their impulsivity and intense emotions. People with borderline personality disorder may also struggle with self-injury, such as cutting, and thoughts of suicide.
Treatment For Borderline Personality Disorder
BPD can be treated using therapy and some types of medications for specific symptoms, like anxiety and depression. Psychotherapy is commonly suggested. Many people find that group therapy or one-on-one talk therapy is particularly effective. Generally, there are two forms of therapy often suggested for treating BPD.
- Cognitive behavioral therapy CBT is often helpful in helping someone recognize behaviors and beliefs that create their perception of the world. It can also help change some of those behaviors and beliefs.
Many people credit CBT with helping them learn how to manage their anxiety and reduce some of the mood-related symptoms that are associated with BPD.
- Dialectical behavior therapy DBT is a form of therapy designed specifically for people who have a borderline personality disorder. The concept includes a focus on acceptance and being aware of your existing emotional state and the environment youre in at any given moment. Like cognitive behavioral therapy, dialectical behavior therapy can help those with BPD overcome an urge for self-harm and improve relationships while controlling emotions.
Reviewed On: September 22, 2021
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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.
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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How Often Do Moods Change
Mood changes can be common in borderline personality disorder since people with this condition have very unstable emotions. However, mood swings are more likely to happen without warning- often lasting less than a day and not related to any specific event. In bipolar disorder, mood swings are more likely to follow a pattern or be triggered by something.
Symptoms Of Borderline Personality Disorder
The traits associated with BPD fall into five categories of dysregulation: emotions, relationships with others, behaviors, thinking, and internal self.5 Dysregulation means being unable to effectively manage these symptoms and maintain stability. These areas of dysfunctions are relational and impact interactions with others, the environment, and someones own internal state.
Early research suggested higher rates of BPD in women however, current research shows a comparable rate of BPD diagnosis in men and women. Women with BPD more often report feelings of emptiness and emotional instability, whereas men identify more with impulsivity.7
The depth of emotional misery experienced due to BPD increases the risk of death by suicide by nearly 50 times that of the general population.7Additionally, 75% of adults with BPD report at least one incident of self-harm during their lifetime.7 It is estimated that between 1 to 6% of the general population have BPD. Due to impulsive risk taking, self-harm, and suicidality, individuals with BPD are often hospitalized.7
Signs and symptoms of borderline personality disorder may include:
- Attaching easily to others and fearing abandonment
- Hating being alone
- Inappropriate and intense anger, enough to fight or throw things
- Being paranoid, or distrustful of others
- Dissociating from reality, losing track of time or staring off into space
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Bipolar 1 Vs Bipolar 2
All types of bipolar disorder are characterized by episodes of extreme mood. The highs are known as manic episodes. The lows are known as depressive episodes.
The main difference between bipolar 1 and bipolar 2 disorders lies in the severity of the manic episodes caused by each type.
A person with bipolar 1 will experience a full manic episode, while a person with bipolar 2 will experience only a hypomanic episode .
A person with bipolar 1 may or may not experience a major depressive episode, while a person with bipolar 2 will experience a major depressive episode.
Borderline Personality Disorder Vs Bipolar Disorder
BPD is a type of personality disorder that causes people to feel, think, relate, and behave differently than people without the condition.
Bipolar disorder is a type of mood disorder, which is a category of illnesses that can cause severe mood changes.
People with BPD experience an ongoing cycle of varying self-image, moods, and behaviors.
These patterns typically cause issues that affect a persons life and relationships and the way in which they understand and relate to others.
According to the National Institute of Mental Health , about 1.4 percent of adults in the United States have BPD.
Bipolar disorder affects a persons mood, energy, thoughts, activity levels, and functionality in cycles that can last for days to months. It is more common than BPD and affects an estimated 2.6 percent of the population in the U.S.
People with BPD experience instability in their self-image, moods, and behavior. These symptoms can lead to impulsive actions and problems with interpersonal relationships.
Symptoms of BPD include:
- impulsive or reckless behavior, such as unsafe sex, drug misuse, reckless driving, and spending sprees
- intense episodes of depression, anger, and anxiety
- chronic feelings of emptiness
- fear of being alone
Not everyone with BPD experiences all of these symptoms. Some people may have only a few minor symptoms, while others experience severe and frequent symptoms.
Some of the most common symptoms of mania include:
- extremely elevated mood
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What Are The Symptoms Of Bpd
Borderline personality disorder is also a mental condition that affects mood. According to NAMI, BPD can cause people to have difficulty regulating their emotionsthey feel these emotions more strongly and these emotions can change suddenly. This can cause feelings of abandonment, efforts to avoid abandonment, unstable personal relationships, distorted self-image, self-harming behaviors, chronic feelings of boredom or emptiness, and no sense of self.
It’s a particularly painful and challenging diagnosis, Cairns said, “because there is no stability. And without a sense of self, you’re just empty and lost.”
In addition to emptiness, having unstable relationships is a defining factor of BPD. People with the diagnosis often latch on to othersfriends or romantic partnersvery quickly and in full force, Cairns said. Then, their attitude can change quickly.
“One day, everything is fine. Your partner is loving and kind, and the next day, it’s awful, and you don’t know what hit you,” Cairns said. “No one really knows what triggered it. It could be because you looked at him or her funny, or you looked at someone else, or you wanted to go somewhere without that person. They perceive abandonment where there is none and then there is a huge rage.”
Are You Having Thoughts Of Suicide
- abnormal brain structures
- serotonin levels
Another potential cause of BPD involves harsh or critical parenting styles from a parent or caregiver while youre developing.
As for trauma, its thought that trauma related to BPD likely occurs in childhood or early adolescence and is usually interpersonal in nature, such as assault.
Both conditions can be inherited. Youre more likely to develop these conditions if your sibling or parent has it. Still, most people who have relatives with either condition dont develop it.
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How Can You Receive A Diagnosis With Both Conditions
Most people who have a dual diagnosis of bipolar disorder and BPD receive one diagnosis before the other. Thats because the symptoms of one disorder can overlap and sometimes mask the other.
Bipolar disorder is often diagnosed first because symptoms can change. This makes it more difficult to detect BPD symptoms. With time and treatment for one disorder, the other may become clearer.
Pay a visit to your doctor and explain your symptoms if you think youre showing signs of bipolar disorder and BPD. Theyll likely conduct an assessment to determine the nature and extent of your symptoms.
Your doctor will use the newest edition of the Diagnostic and Statistical Manual to help them make a diagnosis. Theyll review each of your symptoms with you to see if they align with the other disorder.
Your doctor will also consider your mental health history. Often, this can provide insight that can help distinguish one disorder from the other. For example, both bipolar disorder and BPD tend to run in families. This means if you have a close relative with one or both of the disorders, youre more likely to have them.
The treatments of bipolar disorder and BPD are different because each disorder causes different symptoms.
Bipolar disorder requires several types of treatment, including:
BPD is primarily treated with talk therapy the same type of therapy that can help treat bipolar disorder. But your doctor may also suggest:
Addiction Treatment With A Dual Diagnosis Of Bpd Or Bipolar Disorder
The presence of a mental illness along with a substance use disorder is called a co-occurring diagnosis or a dual diagnosis. In a 2019 survey by the National Survey on Drug Use and Health, 9.5 million adults had both a mental illness and a substance use disorder.8 According to the National Alliance on Mental Illness , when an individual experience a dual diagnosis, the best treatments address the substance use disorder and mental illness simultaneously.9 The following are interventions used for dual diagnosis clients.
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Distinguishing Between The Features Of Each Condition
Why So Much Overlap Between Bd And Bpd
The DSM approach for mental disorders is, by definition, categorical. When it comes to the diagnostic criteria for BD and BPD, it is solely based on the description of symptoms. No well-established biological markers for either condition have been, so far, identified. Moreover, comorbidity between both conditions is not uncommon. Literature findings indicate the prevalence of BD type I among individuals with BPD ranges from 2.2 to 16.1%, while the rates of BD type II seem to vary from 4.8 to 18.7% . In a recent study, a comprehensive literature review and meta-analysis of studies addressing the association between BD and BPD was performed . Results confirmed the high prevalence of comorbidity between both conditions, with 21% of bipolar patients experiencing associated BPD. The findings also pointed out the possible involvement of age and gender effects in this association, with male gender and higher mean age predicting lower rates of comorbid BPD among BD patients.
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Treatment For Bpd Vs Bipolar Disorder
Treatments for BPD and bipolar disorder are different, though therapy is recommended for both. BPD is less frequently treated with medication, with the exception of medicating co-occurring disorders like anxiety or depression. Bipolar disorder is quickly and effectively treated with medication. Research on bipolar disorder has found that using medication and psychotherapy together provides the best outcome.
Are Bipolar And Borderline Personality Disorder Related
Although it is not yet clear-cut, research has not found a strong relationship between BPD and bipolar disorder. There is some evidence that people with BPD are diagnosed with bipolar disorder at higher rates than individuals with other personality disorders.
One study found that about 20% of people with BPD are also diagnosed with bipolar disorder. Only about 10% of people with other personality disorders also have a bipolar disorder diagnosis.
Another study looked at people diagnosed with both BPD and bipolar disorder within a 10-year timeframe. The results showed that the disorders appear to be completely independent. The study’s authors stressed that it’s extremely important to treat each disorder individually for the best chance of symptom relief.
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What Causes Bipolar Disorder
Scientists dont know what causes bipolar disorder. Abnormal physical characteristics of the brain or an imbalance in certain brain chemicals may be among the main causes.
As with many medical conditions, bipolar disorder tends to run in families. If you have a parent or sibling with bipolar disorder, your risk of developing it is higher. The search continues for the genes which may be responsible for bipolar disorder.
Researchers also believe that severe stress, drug or alcohol abuse, or severely upsetting experiences may trigger bipolar disorder. These experiences can include childhood abuse or the death of a loved one.
Can You Have Borderline Personality Disorder And Bipolar Disorder At The Same Time
It is possible to have borderline personality disorder and bipolar disorder at the same time. About 20% of people who have bipolar disorder will also have borderline personality disorder and vice versa. People who have both of these disorders usually have more extreme symptoms like depression and suicidal ideation and are more likely to be hospitalized.
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How Is Bipolar Disorder Treated
Once properly diagnosed, bipolar disorder can be extremely well-managed. “You probably know someone who’s bipolar and you don’t even know it,” Cairn said regarding treatment success.
Bipolar disorder is usually treated with a combination of medications and talk therapy. Following a regular sleep routine is also crucial, Cairns said. Once a sleep cycle is thrown off schedule, it can trigger symptoms and lead to a depressive or manic statewhich can make traveling across time zones risky for people with bipolar disorder.
Like many health conditions, having a support team is also important. People with bipolar disorder who successfully manage their condition often count on friends, family, a significant other, a psychologist, and a psychiatrist, Cairns said.
Diagnosing Borderline Personality Or Bipolar Disorder
Welcome to Priory Bitesize, your monthly e-bulletin in which a mental health expert will discuss dealing with certain conditions to support your patient discussions.
This month, Dr Judith Mohring, Consultant Psychiatrist at Priory Wellbeing Centre Fenchurch Street in London, talks about the challenges in diagnosing borderline personality disorder and bipolar disorder.
A common question asked by GPs is whether a patient has BPD or bipolar disorder.
Having worked in a specialist BPD service and having set up a service in Holloway prison for women who self-harm, it was a question I felt reasonably confident to approach.
Despite this, teasing out different symptoms and making a clear diagnosis takes time and is complex. Changes in the understanding and description of bipolar disorder have added to this complexity. A thorough assessment by a specialist in general adult psychiatry can be enormously helpful to patients and GPs in guiding further treatment.
This article focuses on the diagnosis of the two conditions including:
- Controversy over diagnosing BPD
- The benefits of making a distinction between personality and mood disorder
- The core features of BPD
- The core features of bipolar disorder
- Distinguishing between the features of each condition
- A brief overview of treatment options for each condition
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