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Making the diagnosis:
Some may not like me saying this, but I do think that, due to the enormous stigma of BPD, there may be a tendency for some of those with BPD to want/prefer a bipolar diagnosis. This can involve interpreting their own symptoms in light of bipolar criteria, including attempting to fit into the criteria, perhaps often on an unconscious level. I think this makes sense given the stigma, but I also think it can impede recovery.
I think there's also a tendency to say/think: well, if I behave in such and such a way, if it's bipolar, it's "not my fault." However, if you behave in the same way, if you're diagnosed with BPD, "it *is* your fault." I personally do not buy this. At all. But I think the tendency to think this way, can lead one down the road of a bipolar label when it may not fit.
Back to misdiagnosis: if you have BPD, and do not work on the triggers, and attribute all moods and behavior to bipolar, then it will become difficult to gain the insight needed into what is triggering the mood/behavior, and work on that. The moods and behavior become something that is out of one's hands, and that needs to be treated with medication, perhaps medication alone, or primarily this. I don't think this bodes well for appropriate and potentially successful treatment.
I think some psychiatrists are responsible for misdiagnosing for all kinds of reasons -and I think this is hugely irresponsible.
I have read that many psychiatrists will diagnose bipolar II rather than BPD because this way they will be reimbursed by insurance companies. Because they don't want to saddle their patient with the stigma of BPD. Because they never get to know the patient well enough to be sure of a BPD diagnosis, so they err on the side of bipolar. Because there are many good medications these days for bipolar, not so much for BPD, and prescribe meds is what pdocs do. So they err on the side of diagnosing something they can medicate; I have read this in multiple places.
I have seen tons of people on PC having been diagnosed BPD by their pdocs and then never tell them. They only find out when they see their medical records or directly ask for them. Meanwhile, some, they may think they are bipolar. Hugely irresponsible, as I say.
I think the diagnosis of Bipolar II has been overused. I see people diagnosed with this who experience primarily depression and irritability (deemed 'hypomania') but without the energy changes required for bipolar. I also see the term 'rapid cycling' bipolar pervasively misunderstood and misused. 'Rapid cycling' refers to having 4 or more episodes a year, and yet many people attribute cycling many times within a given day to 'rapid cycling.' This, in theory, exists, but is very rare --however on bipolar boards, you will see it way overrepresented sometimes in those who also hold a diagnosis of BPD. How on earth do you distinguish 'rapid cycling' bipolar (using the erroneous definition of constant mood changes) and BPD? As I said in a previous post, there is a tendency to want to avoid the stigmatizing diagnosis of BPD, so some people will define themselves as 'rapid cycling' bipolar, but defining this as a constant roller coaster ride. You have to wonder why it is more commonly those with a diagnosis of BPD who label themselves (or are labeled) 'rapid cycling.'
Lastly, there is an article on PC today citing new research that antipsychotics, over time, lessen brain matter volume. Not only has this now been discovered to be a huge long-term risk of these drugs, but the short-term side effects can be devastating (sedation, weight gain leading to diabetes as well as other illnesses). So to prescribe someone antipsychotics, due to misdiagnosis, can have enormous consequences. All the more reason to make accurate diagnoses: this means psychiatrists being far more responsible, and patients not erroneously identifying with a disorder, for all kinds of understandable reasons, they may well not have.
My 10 cents.
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