Once upon a time it was thought that a number of people with borderline personality had co-morbid psychotic disorders. How come? Because they had occasional psychotic episodes. After much (much much) controversy the diagnostic criteria for borderline personality disorder was changed such that one of the symptoms of the condition was that there was 'brief psychotic episodes', however.

How come? Because it was found that the majority of people with borderline personality disorder exhibited 'brief psychotic episodes' during times of intense distress. As such, the presence of those episodes seemed to be part of the syndrome of borderline personality rather than being correctly regarded as a co-morbid condition.

It is hard because there is overlap in the diagnostic criteria for different disorders. Borderline personality seems similar to psychotic disorders in the sense that when a person with borderline personality is under great stress then the presentation can be the same. Borderline personality seems similar to bi-polar in the sense that there can be a cycling of moods - from elation / hypomania / irritability / anger to deep despair / hopelessness / sadness.

But... What might appear similar in a 'snapshot view' appears as a different general pattern if you take a step back and place the symptoms in a greater context.

Some differences:

- Bi-polar tends to involve intense mania - to be followed by deep despair. Bi-polar tends to be well controlled by medication. The medication seems to prevent the mania, and the absence of mania tends to result in the absence of deep despair. The baseline mood of people with borderline personality tends to be generally dysthymic and people with borderline personality are more inclined to engage in 'help seeking' behaviour (e.g., going to therapists)

The emotion dysregulation in borderline personality disorder tends to be not as well controlled by medications (there continue to be episodes of despair and elation despite medication)

- Bi-polar tends to have mood disruption that is longer lasting.

The emotion dysregulation in borderline personality disorder tends to be more rapid - changes in mood where those moods last between a few hours to a few days.

- Bi-polar tends to not be terribly understandable with respect to being an intense response to environmental circumstances.

The emotion dysregulation in borderline personality disorder tends to be understandable in light of environmental events and / or self talk. The emotion dysregulation seems to partly result from the person not seeing how their emotional responses are indeed understandable responses to environmental circumstances.

I don't know... I guess it just strikes me that:
- When you are feeling intense distress that distress seems pretty understandable with respect to the context in which you are placed. For example, feeling distressed when a job ends and / or when a new job is about to start (that is highly stressful for anyone). Feeling distressed when you have a really very busy schedule (that is highly stressful for anyone). Feeling distressed when you are having a hard time on message boards (feeling misunderstood / invalidated by others would be highly stressful for anyone).
- The medications haven't really had much affect on your mood. Sometimes... Response to medication legitimates / validates a dx. Not always... But it does contribute...
- Your mood changes can be fairly rapid...
- You don't seem to see your emotional responses as being understandable in light of environmental circumstances (instead thinking that medications to change your body chemistry are what is needed).

And that last thing in particular... Is what gives me hope that if you do learn to see your responses as understandable in light of environmental circumstances... Then you might well be able to better manage your moods.

Kind of like how... I can feel intense despair and think about killing myself etc etc etc... Then when I notice that I'm premenstrual then I don't feel 100% fine all of a sudden - but I do stop hating myself and feeling desperate. Instead... That knowledge morphs the feeling into a feeling of vulnerability. I take steps to soothe and care for myself (bubblebaths and stuff) and I manage to get through the time okay... I can seek support for others and they can comiserate because they get premenstrual too etc etc etc.

One can of course take pain killers and anti-anxiety meds to help one through that time... Or... One can learn to soothe oneself... It is unclear that the meds are what is needed.... It is unclear that meds are the answer... If the meds fail: The good news is: There are other options and other sources of hope. And of course... It is completely understandable that one doesn't know how to manage ones moods when ones parents didn't show us how... Perfectly understandable...