[Skittles56]

I see a lot of diagnoses that have bipolar and BPD as comorbid disorders. I don't understand that. From my reading, BPD seems to be a very radical form of bipolar with mixed episodes. I would think that you could have one or the other, but putting them together just seems like splitting hairs.

Just curious.

[A Red Panda]

No, they are actually very different.

Bipolar is a mood disorder. It CAN be triggered, but I don't think our triggers are usually as instanteous.

Like, at least for me... let's use stress for an example. Let's say I have one stressed out part of my day - say I missed the train and was running late. I'll be stressed out, but it'll pass and even then I'll likely still be fine in my actions and thoughts. Someone with BPD will likely have an episode right then and there.

Now, if I was to keep missing that train and keep being stressed out by it, it might trigger an episode. But that's only a might - it might not.

I can have episodes settle in without anything at all to really cause them. They can in fact be triggerless. Like... I've woken up various days and NOTHING in my life has changed.. and I'll be feeling on top of the world because I've just entered into an up phase. That doesn't really happen in BPD, because there would have to be a trigger.

Someone who has both bipolar and BPD have a pretty tough mix - they might be in a manic phase from the bipolar, but then still get triggered by mising that train and then have a depressive (or a mixed episode), right then and there for a few minutes and then go right back into the manic state.

[Trippin2.0]

BPD- P for Personality.
I'm screwed on an intrinsic level, my perceptions, reactions and thoughts are skewed "naturally" not due to being in the midst of an episode.

Meds can assist to help me deal, but ultimately my brain needs to be rewired if I am to have healthy relationships with others. There is a constant inner turmoil to act, react and behave appropriately, acceptably. This wears me down like no other, because I essentially have to fight my nature on a daily basis.

Extreme fear of abandonment, identity disturbance and splitting is the order of the day...

# For clarity that ^ was the simplified version...

BP - I'm screwed episodically. Usually without just cause. I was suicidal for 10 days a week ago, and nothing made me wake up wishing for death, I just was.

I have both issues and while they may seem similar on the surface, they are very different at the core.
No splitting hairs at all. Trust me.

[Skittles56]

I think I get it. It is more about the triggers. In my reading, BPD episodes are usually triggered by any feelings of abandonment (one article said abandonment, no matter how far fetched).

The thing I don't get is whether they are treated differently. If they require the same treatment, then it seems to me that the comorbidity is just academic.

[Speed3]

I copied this out of an article online....

According to Dr. Friedel, director of the BPD program at Virginia Commonwealth University, there are two main differences between BPD and bipolar disorder:

1. People with BPD cycle much more quickly, often several times a day.

2. The moods in people with BPD are more dependent, either positively or negatively, on what's going on in their life at the moment. Anything that might smack of abandonment (however far fetched) is a major trigger.

3. In people with BPD, the mood swings are more distinct. Marsha M. Linehan, professor of psychology at the University of Washington, says that while people with bipolar disorder swing between all-¬encompassing periods of mania and major depression, the mood swings typical in BPD are more specific. She says, "You have fear going up and down, sadness going up and down, anger up and down, disgust up and down, and love up and down."

[ultramar]

Someone who has both bipolar and BPD have a pretty tough mix - they might be in a manic phase from the bipolar, but then still get triggered by mising that train and then have a depressive (or a mixed episode), right then and there for a few minutes and then go right back into the manic state.

This is why it's so complicated. Because, in theory, you just don't go in and out of mania like that, it just doesn't work that way. The only way I can conceive of it is, manic episode, then this happens, there's a 'reaction' to this, but this doesn't mean a change of 'mood' into depressed or mixed. I would think it would be mania throughout, underlying all the time, it's just that something happened and there is a reaction to that, in the midst of the rest.

I think it gets tricky when labeling a 'reaction' as a 'mood.' For example, someone (anyone really) could be very depressed, but then has a very reactive reaction to something and gets very angry. This is a reaction, not a mood. Still depressed. I hope this makes some sense -it's the only way I can think of of putting the two together in this kind of scenario.

I think if you label 'reactions' as 'moods' it can seem like one's 'mood' is all over the place, when it's more a matter of momentary reactions, not any kind of sustained 'mood.'

[BipolaRNurse]

What ultramar said ^^.

It took me what seemed like forever to "get" the difference between what was the bipolar, and what was just me.

First, I had to get stabilized, and just doing that took over a year. Then recently I've been very hard hit with my husband's cancer and my career ending, and now I FINALLY understand that my current emotional state has everything to do with what's going on in my life, and nothing whatsoever to do with the BP.

What I'm experiencing are normal, even healthy reactions to the cluster-F that life's thrown at me---I think people would be more justified in worrying about me if I WEREN'T anxious, teary, scared, even a little depressed. I haven't even called my pdoc, even though I've gone a little too long between appointments this time, because there's really nothing to report. Who goes to the doctor when they aren't sick? (Well, I do usually see my pdoc every 4 weeks or so, but I'm watching money pretty closely since I don't have insurance, so I haven't been in for almost two months.)

Anyway, like we discussed in another thread, BP doesn't usually manifest itself in multiple ups-and-downs throughout a given day which are almost always triggered by external events. I'm not even sure how an 'ultradian' cycling pattern is distinguishable from borderline PD mood reactivity. But then, they don't pay me the big bucks to figure these things out, do they?

[Trippin2.0]

Originally Posted by ultramar

[B] I think if you label 'reactions' as 'moods' it can seem like one's 'mood' is all over the place, when it's more a matter of momentary reactions, not any kind of sustained 'mood.'[/SIZE][/FONT]

But in the absence of any bipolar symptoms this reactionary mood is sustained, for as long as it takes something else to happen that causes a different reaction and ultimately mood. It is in essence being all over the place emotionally, the exhaustion I mentioned above comes from either being all emotionally scattered or trying to not let everything affect you.

Example, if something causes a rage reaction, I will most likely be angry even after that something is gone or sorted. It doesn't dissapear with the something. If it was trivial or you are skilled enough to talk to yourself down, it can pass quicker, but still doesn't dissipate the mood completely but makes it more managable, until it does pass.

Idk if I make sense, these are definitly moods in reaction to things. Sometimes it passes quickly, sometimes it doesn't, sometimes you need a different trigger to get out of current mood.
Mania? No definitley not in the absence of bp but euphoria can be the a result at times.

[ultramar]

Originally Posted by Trippin2.0

But in the absence of any bipolar symptoms this reactionary mood is sustained, for as long as it takes something else to happen that causes a different reaction and ultimately mood. It is in essence being all over the place emotionally, the exhaustion I mentioned above comes from either being all emotionally scattered or trying to not let everything affect you.

Example, if something causes a rage reaction, I will most likely be angry even after that something is gone or sorted. It doesn't dissapear with the something. If it was trivial or you are skilled enough to talk to yourself down, it can pass quicker, but still doesn't dissipate the mood completely but makes it more managable, until it does pass.

Idk if I make sense, these are definitly moods in reaction to things. Sometimes it passes quickly, sometimes it doesn't, sometimes you need a different trigger to get out of current mood.
Mania? No definitley not in the absence of bp but euphoria can be the a result at times.

This makes a lot of sense -thanks for clarifying!

[Skittles56]

I asked my therapist about this today. The example he gave me clarifies this a lot for me. He was talking about people who self-injure. He said in his experience, people who SI may or may not be bipolar, but they definitely have BPD.

While bipolar mania might allow extreme behavior that might even be psychotic, that is, the controls over behavior that is out of line are missing or suppressed, BPD causes extreme and probably psychotic behavior.

The missing the train example works. I'm bipolar, so I might fly into a rage because I missed the train, but there is nothing pushing me to express that rage in an extreme way. If I'm depressed, I might just sit down and cry. If I'm manic, I might throw things and shout. However, in either case, it's a reaction based on where I am in my mood cycle. If I have BPD, I have no choice but to express my reaction in an extreme or psychotic way, no matter what my mood might be. I might do all of the above in no particular order. I'll scream, rage, cry, stomp my feet, and throw things. My BPD will drive me to do these things.

I get it now.

I can't tell you the difference from a personal perspective but as a support group participant I have seen the mood swings of people who are diagnosed with both bipolar and borderline personality disorder in action during support group meetings and they are instant reactions to something someone says or does even when not directed at them or when relating an upsetting event that occurred to them. They can go from rage to abject misery in seconds then be ok again all in the space of 90 minutes. I think just like its hard to explain bipolar to a person who doesn't have it, explaining bpd is also hard to do.

[ultramar]

Originally Posted by emomom

I can't tell you the difference from a personal perspective but as a support group participant I have seen the mood swings of people who are diagnosed with both bipolar and borderline personality disorder in action during support group meetings and they are instant reactions to something someone says or does even when not directed at them or when relating an upsetting event that occurred to them. They can go from rage to abject misery in seconds then be ok again all in the space of 90 minutes. I think just like its hard to explain bipolar to a person who doesn't have it, explaining bpd is also hard to do.

This beings up a question: do some people in the group with both diagnoses attribute the kind of reactions you're citing to bipolar, rather than BPD? Do you find that there's insight into the differences between the kinds of reactions you're talking about (likely not bipolar) vs bipolar episodes?

Surprisingly a couple do realize it's the borderline part, maybe because of therapy and from being in the support group where the majority of folks have bipolar1, I'm not sure. Usually though they come with more diagnoses than the 2 so it's complicated. It kind of depended on age too, the older people seemed to know themselves better. It didn't stop them from some interesting behaviors though.

Originally Posted by Skittles56

I asked my therapist about this today. The example he gave me clarifies this a lot for me. He was talking about people who self-injure. He said in his experience, people who SI may or may not be bipolar, but they definitely have BPD.

.

This is not true. I've self harmed since I was 12 and never had a diagnosis of BPD, I dont meet the criteria.

Im still having trouble understanding how so many people can have a multiple diagnosis of both BPD and BP, It seems extremely common on this forum. Of those that have BPD and BP have you had intensive supervision/mood monitoring to provide an accurate diagnosis? I wonder how many do have BPD and are misdiagnosed as bipolar as well since their pdocs can only make a diagnosis on what they are told. How many people are put on these potentially harmful drugs when it can be treated with behaviour therapy?

I just realised this could come across not as I intend it, I dont mean to say anyones diagnosis is wrong, I just honestly wonder how many are. And how many could be getting better treatment if they were accurately diagnosed.

[Trippin2.0]

Originally Posted by Skittles56

He was talking about people who self-injure. He said in his experience, people who SI may or may not be bipolar, but they definitely have BPD.

I call BS. There are a myriad of reasons behind SI. BPD is not the cause of it, he shouldn't be reviewing his experiences in his sessions when passing on such info but rather fact.

By your T's explanation the absence of SI nullifies the BPD dx when there are so many borders who don't SI and also makes everyone who SI's BPD when they meet no other criteria...

I have bp1 and a few months ago the added the BPD to it. Bit that has changed as I go to more and more appts. Now they've changed it to bp1 with a personality disorder nos. I show different criteria from multiple PD's. But in my opinion everyone really does.

I know I've been feeling giddy and goofy lately, and for me that's when I really need to be on guard for 2 reasons. 1) means I need to take my prn meds to knock down any mania that might be coming my way. And 2) it also makes me less able to control my reactions to things.

And that's how I determine if it's bp or not. Am I reacting to a person or event?

Sent from my C5170 using Tapatalk 2

[Skittles56]

Originally Posted by Trippin2.0

By your T's explanation the absence of SI nullifies the BPD dx when there are so many borders who don't SI and also makes everyone who SI's BPD when they meet no other criteria...

That's not what he was saying, and it doesn't logically follow.

He's not saying that anyone who doesn't SI doesn't have BPD. He's saying that in his experience, everyone he has come in contact with who SIs also has BPD. I don't take that as prejudicial because he has offered the caveat that it is just his experience.

Sorry to sound like a lawyer, but I wanted to make myself clear in case I did a bad job of it before.

[FallenTree]

BPD is borderline personality disorder?

[Skittles56]

Originally Posted by FallenTree

BPD is borderline personality disorder?

Yes. That's correct.

[ultramar]

Originally Posted by Supanova

This is not true. I've self harmed since I was 12 and never had a diagnosis of BPD, I dont meet the criteria.

Im still having trouble understanding how so many people can have a multiple diagnosis of both BPD and BP, It seems extremely common on this forum. Of those that have BPD and BP have you had intensive supervision/mood monitoring to provide an accurate diagnosis? I wonder how many do have BPD and are misdiagnosed as bipolar as well since their pdocs can only make a diagnosis on what they are told. How many people are put on these potentially harmful drugs when it can be treated with behaviour therapy?

I just realised this could come across not as I intend it, I dont mean to say anyones diagnosis is wrong, I just honestly wonder how many are. And how many could be getting better treatment if they were accurately diagnosed.

I see some people who are diagnosed both bipolar and bpd whose bipolar episodes fluctuate within a given day or day to day, etc. So, in this context, I also do not understand how such rapid fluctuations, with a diagnosis of BPD, could be attributed to bipolar. It tends to be termed 'rapid cycling' bipolar, but this only makes sense if rapid cycling meant cycling so quickly, which the vast majority of the time it is not.

I can't know what really goes on in people's lives or in their pdoc appointments, so I just don't know. I've considered the possibility that perhaps there are cases where someone has been diagnosed BPD *after* a previous bipolar diagnosis and it is assumed that it is additional rather than a re-diagnosis/instead of.

BPD and Bipolar 1 as co-morbid makes sense to me (personally). But BPD and super rapid cycling bipolar, that's tough for me to wrap my head around. Such rapid cycling bipolar is extremely unusual to being with, so if you put it together with a BPD diagnosis, it's hard to understand.

I have read in different places that some pdocs don't like diagnosing personality disorders -whether it's because of the stigma, the inability to do so accurately because of never getting to know the patient well enough, and/or because some insurance companies don't compensate doctors for personality disorders, whereas they do for bipolar. However, I think none of these are good reasons not to conduct a full and accurate evaluation -they're cop-outs and I think it's very irresponsible. I have no idea how prevalent this is, though.

A recent (the other day) PC article about BPD stated that it is often misdiagnosed as BP.

We never have anyone's 'full picture' and it's important to support each other. There's a great deal of diversity when it comes to bipolar, it's a tricky diagnosis, and everyone's experience is different. And, of course, co-morbidity does exist. I guess the issue is just how prevalent is the co-morbidity, how do they co-exist in different ways for different people. Some people do have a great deal of insight into the difference between their bpd episodes and bipolar episodes and I really admire this. It's not easy for any of us.

Everyone's experience either with having both disorders or knowing of someone who does is going to be different, just as each of us with bipolar experience it differently. What I can tell you as a support group participant, the 3 people in our group who identified themselves as having both disorders were very different in the group setting than the people who identified themselves as bipolar or depressed. It was much harder to get them to respond positively to encouragement from the group and sometimes they expressed anger towards the group for trying to be supportive. Yet they came back every week. This is just my experience.