[Secretum]

What do you think is the difference? A lot of people use the timing of the mood fluctuations to differentiate between the two, but many of us suffer from ultra-rapid cycling. Triggered vs. non-triggered mood switches are also used, but many people with bp said that they have a lot of triggered mood changes in this thread: http://forums.psychcentral.com/showthread.php?t=200020

Relationship and attachment issues are thought to be more of a bpd issue, but it is easy to see how the mood cycling in bipolar could easily make relationships more difficult, and it indeed it often does.

The borderline forum hosted this excellent discussion on this topic: http://forums.psychcentral.com/showthread.php?t=200468

I think it is time that we with bipolar consider this issue. Where do you draw the line between the two conditions?

Sometimes I think that there is no substantial difference. Other times I feel that the differing prognoses (bpd tends to improve with time, bipolar unfortunately follows the opposite trend) suggest that there must be a real, underlying biological difference.

[Moose72]

BPD ppl don't get better with meds? Would treating them the same as bipolar work?

[sugahorse1]

I also battle to differentiate. I can relate to symptoms from both conditions. They can often co-exist too

[AniManiac]

Originally Posted by Moose72

BPD ppl don't get better with meds? Would treating them the same as bipolar work?

Personality disorders are thought to be more environmental (nurture, not nature) and so meds don't treat the real issue, only the symptoms, and therapy is needed to help the person learn to respond better to situations. Mood disorders seem fairly well established to be primarily biologically based, so meds address a very important part of the cause of symptoms, but therapy helps with associated behavioral challenges.

So BPD people can get some symptom relief from meds, especially when there are comorbid conditions (e.g. depression or bipolar), but therapy is really what it takes to help people avoid, reduce, and sometimes even eliminate recurring problems.

[AniManiac]

I'm not sure if this is a proper use of the trigger icon, but I talk about sui and self-harm in some detail below so I figured better safe than sorry?

I was told that self-harm is sometimes considered a key differentiator as well, plus the thing about mood triggers being event-based or not. But I can come up with lots of rationalizations for mood swings, which could be totally spurious. In my opinion, it would be ridiculous for anyone not to have mood swings triggered by events - if you lose someone close to you, are under a lot of stress, or suddenly have a great turn of fortune, then you're likely to have a mood change even if you're otherwise completely normal! So I don't entirely buy this as a useful way to discern between BP/BPD.

The part about cycle length also doesn't seem that useful to me, especially with the number of posts I've seen here from people who are rapid cycling. I feel like I have two layers of mood cycles - one that is the predominant mood and lasts for months at a time, mostly seasonal as far as I can tell, and then an overlay that is much more fluid and abrupt and unpredictable, which seems to have everything to do with stress and sleep.

As far as self-harm goes, I think it's also silly to think that self-harm is restricted to people with BPD. It could also be related to the sui tendencies that plague a lot of bipolar people. I saw a 2010 research article suggesting that self-harm may be more of an indicator of bipolar. So I really don't know what to think about that point. Many years ago, I was very self-destructive and have deep permanent scars from cutting and burning on my arms, wrists, and hands. I will never be able look at my own hands without seeing what I did to myself when I felt so horrible that I wanted to die. I try to think of it as a reminder to be grateful for the things in life that make me happy to be alive, even when I'm feeling rotten.

But that behavior was actually already on the decline at the point in time when I think I first had a serious manic episode, and I have had no issues with self-harm in over a decade. Some of the other BPD symptoms could have applied to me back in the day, but seem to be completely gone now, and it's not like I was in therapy or anything in between - the biggest change is that my life is more stable overall, especially with respect to sleep.

One point that I haven't seen brought up anywhere is the sleep trigger. When I get too little sleep, it pretty reliably triggers hypomania. This is not something I've seen discussed as being applicable for BPD but seems to be pretty common for a lot of people with BP.

I also haven't seen anything that links the regular and predictable mood cycles that some of us have, like seasonal depression, to BPD (except if there's a trauma history that has a sort of anniversary to it), only the erratic mood swings. I get both predictable and erratic mood swings, so I assumed that was SAD plus event-based triggers - until I started mood charting with records of sleep and (OK, this is really geeky) ran some correlations and f-tests and found very strong statistically significant relationships between sleep and mood. If I sleep more than 8 hours, I start getting depressed. If I sleep less than 5 hours, it starts a hypomanic cycle that gets out of control if I am short on sleep for 2 nights in a row, but usually only lasts 5-7 days, followed by a few days of depression, and then back to normal-ish or whatever the dominant mood state is at that point.

Yet another symptom I can't remember seeing related to BPD is hallucinations, even if rx-induced. I've had that happen too, but only once (I think) when things were really, really out of hand.

All the diagnostic tools indicate high likelihood of moderate-severe bipolar for me, though lately I'm trying to convince myself that it's not so bad as all that and maybe it's cyclothymia, but that's probably because I haven't had a serious depressive episode in a few months. The BPD diagnostic scales show very low likelihood of BPD. These scores are consistent - I've taken and re-taken these evaluations at different points in time, during different mood stages, and they don't change. I have read up on both, and really could not relate to the descriptions of BPD histories and sets of behaviors. Many of the BPD-like symptoms I've had in the past therefore seem (to me) to be very likely to have been hypo/manic - mainly impulsivity, hypersexuality, heavy drug/alcohol use (self-medication), and risky behavior. The self-harm was usually desperate sui fixation that I didn't actually want to follow through on, but the physical pain distracted me from excruciating emotional pain. Fortunately I also haven't had issues with the sui ideation for many years now, but instead "just" the sort of heavy-feeling paralytic depression that's shot through with guilt and shatters my self-confidence as well as tanking any semblance of productivity or ability to manage anything in my life. The BPD-like symptoms all aligned with periods of time when sleep was unstable and stress was high.

By contrast, the descriptions of bipolar lives were hair-raisingly familiar. I found a number of behaviors described as being related to bipolar that I wouldn't have guessed were symptomatic, mostly because it's kind of "normal" to me. And I've generally done well without therapy or close monitoring when stress was low and my life (and sleep schedule) was stable, so long as I continue to take meds. This just doesn't seem that consistent with what I've seen about BPD.

I'm not entirely sure of what to make of it. I tend to think there are real differences, along the lines of nature/nurture, but that the BP condition can lead people to BPD-like behavior.