Borderline or Bipolar

Jun 11, 2013, 01:29 AM

Quote:

Originally Posted by The_little_didgee

Visit this site: http://www.psychiatrictimes.com/schi...-diagnosis-and

Here's a direct link: http://www.psychiatrictimes.com/site...s/pt/01533.png

UnderTheRose · Jun 11, 2013, 03:12 AM

Ive read parts of this before and really found it interesting. It also really cleared up for me why my psych had said that my affective instability could be caused by either or both bpd/bipolar. I knew little of cyclothymics and assumed that any quick acting mood change with anger involved (wake up,see the sun, love life, but step on a kids toy on my way out of bed and suddenly hate the world, feel like a failure and want to break things) was BPD.. however now i see that the BPD type reaction could be part of a dysphoric or mixed state. There is SUCH a huge overlap.

dubblemonkey · Jun 11, 2013, 08:59 AM

Quote:

Originally Posted by sgthowie

Hi,

I haven't posted on here for a couple of years now. I was initially diagnosed as bipolar and then that was changed to borderline personality disorder. I have been prescribed anti depressants which did nothing and also quetiapine which I stopped taking cos of the side effects. I have had psychotherapy for 3 years now which is helping to some degree.

I am not sure if the diagnosis is correct. I do have black and white thinking, feelings of emptiness and unstable relationships but also I have a kinda leaden paralysis depressive feeling, agitation, distractability, periods of heightened creativity as well as lethargy. I also can sleep a few hours a night or for about 10 or 12. I think I am self medicating at weekends especially through alchohol. I often have blissful periods which don't last long but can last a few hours. I have lots of paranoia and anxiety. I get bored of people, projects and things very easily and my concentration is shocking. I have impulsive feelings and have crashed a number of motorcylces, cars etc in my time been quite promiscuous and then avoided sex for ages and had feelings like I was with God or merging with some wider universal consciousness.

The psychiatrist who changed me from bipolar to borderline did say it was marginal between that and bipolar with most others likely to diagnose the latter. My current psychothapist says it is a wide spectrum of experience. I sometimes wonder whether I should take meds because I am still only half functioning but really don't want to be arguing the toss about a rediagnosis.

I also had some quite severe social anxiety when I was younger and there seems to be a lot of crossover between the conditions. My shrink mentions the word temperament a lot and so do my friends. The latest letter to my doctor refers to unstable fluctuations of mood, reactive mood, difficulty developing stable relationships and sense of self.

Could I be cyclothymic or maybe atypical depressive or bipolar 2? Do you think I should try meds? I have moved on but would no way consider myself to be cured or able to function the way I would like?

such a simple question requires an equally simple answer... to make sense of a complex situation.

...I want to remove the 'or' from the question...just a reflex just a natural movement something that 'feels' very natural...to me

and I will be straight up honest with you I am writing this purely for myself for my own clarification...and if you read it and get something then that's secondary....

I thankyou for the opportunity to write....I like questions I hate the answers!

and here within lies the borderline bipolar riddle ...the magic and the pain.

the sinister... the emotionally insane the durability and the pain.
what makes the heartfelt insane gives life to the brain!

there is an urgency an expectation an evil a joy!

you see ...bipolar is a story and borderline is a reaction!

how can they not co-exist how can they not entangle and form a person?

and ...how can not this person be so utterly marvellous?!

with the co-incidence the intersection of human emotional and mental abilities combined into a glorious arrangement of calamity and how can anyone others unloved love us likewise we them unfortunate to be so crazy wonderful!

...the real questions emerge under such scrutiny...these being..??

what can I afford to experience what can 'they' afford to experience at my expense so self indulgent I will easily consume everybody in my path!

..I am emotionally starved every minute borderline being that I am... invalidated and tired hungry hold me and bipolar... I'm just not in the freaking mood right now try me in 3 minutes or 3 months or 10 fkng years I am alive forever but so damaged and in love with something even hate will do for now....

we are versatile yeah

Jun 11, 2013, 01:56 PM

Rapid Cyclist,

Those are such wonderful words. I would cry but may get giddy and then get giddy or cry!

The quite hilarious angle to this thread is that the psychiatric patients are having the same arguments on here as the psychiatrists are without coming to any firm conclusion! Part of me thinks does it matter what it is called but unfortunately if people aren't getting the correct treatment it kinda does....

Just a little about my story. I also had CBT for social anxiety in my 20s. What got me thinking also is that there are also further assertions of the link between SAD and Biopolar. I had the CBT but it did me very little long term good even though I can intellectually understand the concept behind it.

Though not officially a diagnosis it was what my therapist at the time thought I had and then came BP then changed to BPD. Being told you have those three things at different times does make you think when your own research shows some kind of link.

Here is a further article on Cyclothymia Bipolar 2 and Social Anxiety referenced on Wikipedia in the Social Anxiety section.

http://www.biomedcentral.com/content...X-5-S1-S54.pdf

ultramar · Jun 11, 2013, 10:00 PM

bipolar is a story and borderline is a reaction!

This is a very interesting take on it, I think there's some truth to this. I guess another way to say it would be episodic vs reactive -and you can be constantly reactive/unstable but when in-between episodes (bipolar) you are (presumably) stable.

Trippin2.0 · Jun 11, 2013, 11:06 PM

Also borderline reactions are primarily based on "environment" which actually translates to; People.

Bp also has triggers, like stress, insomnia or whatever, but Bpd? The people in your life trigger your reactions. How they behave toward you, or rather your perception of their behaviour is a Bpd'ers biggest trigger. The closer the person, the harsher the trigger.

Thats why I can be screaming "I fkn hate you too!"

at my phone when bf texts he's too busy to chat right now, but immediatley thereafter I can walk into a room full of people glad to see me and all is well with the world

because I'm important and loved once again...

So yes, Bp is my story and Bpd is my reactions to the people in my environment... Very well said James

Jun 12, 2013, 04:06 PM

Luminar,

Interesting point and the article is very well written. The article also mentions how Bipolar 2 Cyclothymic Borderlines had accompanying panic, anxiety and body dystrophic issues as well as binge eating and subsance abuse. What also stuck with me is the hyper sensitivity to external stimuli ie perceived rejection and things like food, noise, lights etc.

The whole thing seems to fit me to a 't'. Furthermore, in my case my psychiatrist maintains that the disruption of early attachments are contributing to my mood fluctuations. Sometimes they appear related to external events other times they just seem to happen.

I found the article very helpful. Question is that if I am on this cyclothymic anxious sensitive temperamental spectrum do I need meds or not? I am now in my early 40s and would not consider myself at a stage in which I can function in the way I would like to. I have even tried alternative therapies such as hypnotherapy, reiki and primal therapy to relive repressed early pain.

ultramar · Jun 12, 2013, 05:28 PM

disruption of early attachments are contributing to my mood fluctuations

This is a very well-known phenomenon. There are lots of good researchers and mental health professionals/theororists who write about this. There's currently a post about attachment disorders on the Other Mental Health forum with a couple of attachments to articles, which you could check out.

It's actually precisely the types of mood fluctuations as a result of attachment issues that occur as reactions to interpersonal relationships. So it sounds like your psychiatrist was referring to this. Disruptions in early attachments lead to reacting in certain ways to relationships, especially close ones, as someone mentioned above.

It seems you are very interested in re-visiting your diagnosis; I would get re-evaluated by a psychiatrist. I tend to think that our therapists -if we've been seeing them over a good period of time- know us best, but officially, only psychiatrists can make diagnoses (I think??). If you get a good one, they will not diagnose you right away, but take a history, talk to you, and then over time get to know you and eventually make a diagnosis (I say this, because I tend to be suspicious of psychiatrists who made definitive diagnoses off the bat [perhaps a provisional one makes more sense to me]; I think it takes time to get to the know the patient to the extent necessary to make a definitive diagnosis. Since your therapist knows you, the psychiatrist could consult him/her for help with the diagnosis, or you could start fresh.

I'd caution you on one point though (and I really do mean this to be helpful): if someone is hoping for/looking for a certain diagnosis (which it seems you are in terms of bipolar), there can be a tendency (unintentionally, on an unconscious level) to limit what is shared to the symptoms and experiences that point to that diagnosis, leaving out things that are also experienced, but that might point to a different diagnosis. The important thing to keep in mind is to get the treatment appropriate to what is going on with you, and once you start on bipolar meds, it can be hard to get off of that merry-go-round. A bipolar diagnosis can also lead some people to believe they do not need therapy anymore, as everything then gets attributed to the illness/the brain, but I personally think therapy is so very important.

Again, at the end of the day, the important thing is that you get the treatment you need. It sounds to me that maybe you're at an impasse in therapy? Have you talked to your therapist about lack of improvement in certain areas and what can be done about it? Have you talked to her about your thoughts about bipolar? I'd encourage you to delve into all of this with her/him. Or if you think she's taken you as far as she can, maybe you could look into another therapist and/or group therapy like DBT? (which is used to treat both BPD and BP). Best of luck!

Jun 12, 2013, 06:06 PM

Hi again Luminar,

I am having psychodynamic psychotherapy at the moment but it ends in a years time. He tends to concentrate on historical events and is Freudian in thought so a lot of it is about the lack of proper nurturing in my early childhood that is leading to the mood changes as well as issues around not being able to integrate good and bad experiences as well as referring to a reactive mood and unstable sense of self.

I asked him BP and he said that it was a wide spectrum of experience which he agreed I was on but he was trained to work on talking therapies rather than offering a diagnosis and prescribing medication. We did discuss being referred to one of his colleagues to discuss meds.

Initially he said he was not impressed with the BPD label but that seems to have changed recently by what he has been implying. I suppose I am harping on about the BP stuff because I am perhaps scared of facing up to it. Sounds ironic but I really want to be BPD because that seems to result in recovery and not having to rely on meds. The worst thing that could happen is that I finish the course of psychotherapy and find I am still not recovered and my mood changes affect my functioning.

ultramar · Jun 12, 2013, 07:01 PM

the lack of proper nurturing in my early childhood that is leading to the mood changes as well as issues around not being able to integrate good and bad experiences as well as referring to a reactive mood and unstable sense of self.

This is all 'classic' BPD, so if you prefer that diagnosis, or this conceptualization of your experiences, if you will, I think you've got it from your therapist. I certainly hope it works out with him. If you're looking for something less focused on the past, you could try a form of CBT, I don't know if you've done that. I'm actually in psychodynamic therapy and we don't focus on the past much at all, but I suppose it depends on the therapist and how strictly Freudian they are vs more contemporary reincarnations of psychodynamic therapy.

Jun 12, 2013, 07:22 PM

I have tried CBT before with little success. Obviously I need to let the currnt treatment run its course and reevaluate if necessary then.

As well as what I have mentioned above there is also the sleep disturbance, distractability and unconventional working patterns and shifts in production which don't appear to be part of BPD or not from the stuff I have read anyway. As well as the depressions. I have needed weeks of work at times. They appear to mainly manifest themselves in DSM atypical form. It is just when these things last years and years you start thinking.

Thanks for all comments. Everyone is so I intelligent and supportive here.

ultramar · Jun 12, 2013, 08:13 PM

I get the sense that you're looking at details instead of the big picture in search of a bipolar diagnosis. I would really revisit your concerns with your therapist.

You're already in therapy. So what it comes down to is if you (and your providers -therapist/psychiatrist) feel that you need mood stabilizers and/or atypical antipsychotics to treat the symptoms you're attributing to bipolar. Because assuming you would stay in therapy either way, treatment-wise, what this comes down to is exclusively a matter of medication, right? Aside from diagnosis in and of itself, it's also about the risks and benefits of some pretty heavy duty drugs. I'd talk it over with your treatment team --on the internet you're going to find what you're going to find (and maybe what you're looking for); I think communication with your providers will make sure things are specific to what you're experiencing and what treatments would be beneficial to you whatever the diagnosis may be.

Maybe a question to ask yourself would be, if you are able eventually to resolve the psychological issues your therapist mentions in therapy (and the treatment for those mentioned is therapy not meds) would you still be in so much distress due to other symptoms that you would take bipolar medications? Or, on the other hand, is it possible that if you were to resolve the psychological issues in therapy, the sleep disturbances, changes in productivity, etc. might also resolve as a result?

Jun 13, 2013, 01:59 AM

Yes. Really helpful comments.

I tried anti depressants for years which had no effect. I couldn't understand why. Also, a tried quetiapine when diagnosed initially as BP but there were side effects and I stopped taking them. I also have a lot of agitation/paranoia as well as bliss like states.

You have hit the nail on the head in the last paragraph if the symptoms continue and therapy ends regardless of diagnosis.

06:45 AM

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676679/

Again, a further interesting article on the relationship. This article shows that for those with BPD over 50% at some time have a comordid mood disorder. This is on page 11.

Interestingly the figures are still significant if you turn it around with those who have a mood disorder also having BPD including BP1 and 2. On the other side of the debate obviously people without BP such as Anxiety Disorders and other Personality Disorders could develop BPD also.

Hope everyone is well and thanks to those who have explored this with me.

UnderTheRose · Jun 24, 2013, 07:59 PM

Quote:

Other authors interpreted the affective instability of BPD as a form of prolonged ultra-rapid cycling with extreme rapid mood switching closely resembling classic descriptions of cyclothymia.

In a more hypothetical vein, we submit that cyclothymic disposition might represent the mediating core characteristic in this complex pattern of mood, anxiety, and impulsive disorders

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048510/

Are atypical depression, borderline personality disorder and bipolar II disorder overlapping manifestations of a common cyclothymic diathesis? -- is the name of the article. All this is interesting stuff.

Jun 25, 2013, 06:57 PM

This is an interesting post on Cyclothymic Personality Type. For fear of going over old coals again on here my concern is that I definately have many borderline traits and had my BP diagnosis changed to BPD. What I also have extremely strongly that is not BPD are a number of what are listed below:

Decreased need for sleep plus hypersomnia
Periods of sharp creative thinking followed by mental apathy
Shaky self esteem - overconfidence followed by total lack of confidence
Changes in productivity etc
Irritable-angry-explosive outbursts

The rest I have had pretty much all as a trait to some degree and still have.

The question I really have is that when my 4 year psychotherapy ends in 12 months if I am still having the below and the BPD elements have eased or I cannot function in work, relationships etc the way I want I am really going to have a look at trying medication again and a rediagnosis.

PTypes Personality Types proposes Cyclothymic Personality Disorder as a pervasive pattern of pronounced periodic changes in mood, behavior, thinking, sleep, and energy levels, beginning by early adulthood and present in a variety of contexts, as indicated by seven (or more) of the following:

has depressive periods: depressed mood or loss of interest or pleasure in all, or almost all, activities and pastimes alternating with hypomanic periods: elevated, expansive, or irritable mood (American Psychiatric Association, 1980, pg. 220);
becomes excessively involved in pleasurable activities with lack of concern for the high potential of painful consequences alternating with restriction of involvement in pleasurable activities and guilt over past activities (pg. 220);
alternates between over-optimism or exaggeration of past achievement and a pessimistic attitude toward the future, or brooding about past events (pg. 220);
is more talkative than usual, with inappropriate laughing, joking, and punning: and, then, less talkative, with tearfulness or crying (pg. 220);
has a decreased need for sleep alternating with hypersomnia (Akiskal, Khani, and Scott-Strauss qtd. in Jamison, pg. 264); 1
has shaky self-esteem: naive grandiose overconfidence alternating with lack of self-confidence (pg. 264);
has periods of sharpened and creative thinking alternating with periods of mental confusion and apathy (pg. 264);
displays marked unevenness in the quantity and quality of productivity, often associated with unusual working hours (pg. 264);
engages in uninhibited people-seeking (that may lead to hyper-sexuality) alternating with introverted self-absorption (pg. 264);
frequently shifts line of work, study, interest, or future plans (pg. 264);
engages in occasional financial extravagance (pg. 264);
has a tendency toward promiscuity, with repeated conjugal or romantic failure (pg. 264);
may use alcohol or drugs to control moods or to augment excitement (pg. 264);
has irritable-angry-explosive outbursts that alienate loved ones (pg. 264);
makes frequent changes in residence or geographical location (Akiskal, 1995, pg. 1143).

ultramar · Jun 26, 2013, 05:36 PM

I think it would be a good idea to make an appointment with a psychiatrist and get (re)evaluated. You clearly have a lot of concerns about your current diagnosis, and I think the person best able to help you determine what's going on, and if you need medication in addition to therapy, is a good psychiatrist. Of course when it comes to medication, that will/should be a joint decision between you and your pdoc, how severely your symptoms interfere with your daily life vs the side effects of medications, especially the heavier ones. You might consider a full neuropsychiatric evaluation (which I think a couple of people here have undergone) as it seems to be the most comprehensive. Good luck!

Jun 26, 2013, 06:21 PM

Thanks Ultramar,

I will discuss with my psychotherapist on Friday. He was astounded when he found out I had been in and out of therapy for 19 years (I thought I had told him that before!)

I am in two minds whether to continue with the course of psychotherapy (ends in 12 months) and reevaluate then or go back for reevaluation now - it is helping but I am concerned and my feeling is I am still likely to be having mood changes then which I cannot control and affect my functioning.

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