BPD vs Bipolar

What is the difference between the two? Can you be both?

I have been diagnosed with both.

You can have both. The main difference is in the underlying cause, as the BPD mood swings come from a fear of abandonment and poor coping skills while Bipolar is chemical and doesn't necessarily have any trigger for episodes. I think rapid cyclers are often misdiagnosed with BPD, either instead of or along with bipolar, though.

I also want to learn something here. I may be wrong, but isn't one difference between the two is that behavior in BPD can be triggered by perceived events, and with Bipolar, the moods have a cyclic nature that may not relate to any specific event? And is there actual mania or depression involved with BPD? But then I hear that BPD can also be diagnosed with mood swings. So what do I know? I can see where rapid cycling Bipolar can be confused with BPD by the pdoc. What do you guys think? I am just trying to lean something here.

The two can be so similar, it's nearly impossible to separate them sometimes. In my experience, p-docs focus more on the treatment that works and not so much on diagnosis.

The 2 can look similar during an episode, so it can be hard to distinguish, and both can co-occur. One difference is that the person with bipolar will have symptom free periods when the mood is stable, or the symptoms can be thought to be caused by swings in mood, while the person with BPD will have symptoms at any times, and the mood swings are in response to other symptoms. Stress can trigger an episode in bipolar, but once a person is in an episode, external events will not tend to alter the mood. External events will affect the shifting moods in BPD.

Here's a description of the 2 disorders:

Criteria for BPD:

Identity disturbance/unstable sense of self
impulsicivity
suicidal behavio/self harm
mood instability in reaction to events, often fluctuating within the same day
chronic feelings of emptiness
inappropriate anger
transient psychotic-like symptoms such as paranoia, depersonalization, and dissociation

A theory of the cause is a reaction to a traumatic or invalidating environment, so it can be thought of as a kind of post traumatic stress reaction. The treatment is typically psychotherapy, often DBT, with or without medication. People with BPD view the world in black and white, and they hold themselves and others to this standard. So a person can be all good, but then they do something causing dissapointment or hurt, and they swing to being all bad. This is called idealization and devaluation. BPD is a very painful condition.

I'm going to describe bipolar in the next window, because I tend to loose what I"m typing, and I don't want to loose all of this and have to start again - so see the next window.

OK, Bipolar disorder is thought to be caused by neurochemical problems in the dopamine, serotonin, and norepinephrine systems. The treatment is typically medications, with or without psychotherapy. Mood states might be triggered by stress, but once a person is in the state it can be tenacious. It can be particularly hard to distinguish mixed states from BPD, because the mood will be so unstable, but it is unstable biochemically as opposed to reactively.

The difference between Bipolar I and Bipolar II - Bipolar I is when a person has at least one full blown manic episode or mixed state (symptoms of depression and mania at the same time), with or without a history of depression. Bipolar II is when the person has at least one episode of major depression and at least one episode of hypomania, but no history of mania. Bipolar II can not be thought of as simply a less extreme for of the illness because the depressions can be just as severe, and Bipolar II typically spends more times in depression than Bipolar I. Bipolar tends to get worse with age if it is untreated, while BPD tends to get better with age/burn itself out. In Bipolar, psychotic symptoms are found only during times of mood extremes, but may be severe and include hallucinations or delusions - although not all people with Bipolar get psychotic (For example, I have had brief psychosis, but it is very rare for me).

Ok - criteria

Major depressive episode - 2 weeks+ of depressed mood or loss of interest, plus combo of
disturbed sleep
appetite changes
poor concentration
suicidal ideation
feelings of guilt or worthless restlessness
psychomotor agitation or slowing
poor energy

Criteria for mania (hypomania is a less severe version of the same symptoms):

Elevated or irritable mood for at least 4 days or any length requiring hospitalization, plus combos of:

Reduced need for sleep
Racing thoughts
Pressured speech/more talkative
Flight of ideas
Increased goal directed behavior
Increased high risk, pleasurable behavior (spending, sex, substance use, etc)
Increased self-esteem
Distractibility

In bipolar the symptoms will typically be absent during times when the mood is stable.

Anyways, there is a description of the 2 disorders. It can be hard to tell apart in real life because the person may be suicidal, impulsive, into high risk activities, depressed, etc in both. The main reason for differentiating between the 2 is because the treatments are different.

I hope this explanation helps.

I am a guy and I have BP2 and BPD (or Emotionally Unstable Personality Disorder, Borderline type).

Both affect me but much, much less now that I KNOW i have this. Neither will define me as a human being.

I was wondering the same thing, good answers.

I have known a whole lot of BPD girls who swear they are bipolar, but after DBT treatment they no longer suffer from bipolar.... whats that tell ya?

Good answer(s), Curiousity77!
I'm still half-asleep (yesterday didn't happen, or most of today either, so I'm in a real fog), but will still try to be coherent…

One of the biggest problems I see in discussing them, and one of the reasons people seem to have so much confusion about the difference is that there is so much focus on "mood", which is a word that can be understood in so many ways.

But one of the things I seldom see mentioned, and can be very helpful in helping to distinguish them is ENERGY. Mood, in a bipolar context is VERY much tied with energy level. Most people would say, "well, people feel peppier when they feel good", so what is your point? The point is that with BP, it's not just a mood shift, but an energy shift that is quite extreme and goes well beyond commonly experienced levels. For instance, when I'm hypomanic, I don't just feel that good sort of energetic level people would like to have to get things done. I get frenetic. Like a freight train on a zigzag course! There can be so much I don't know what to do with it. I could get the shopping done, clean the yard, and next thing you know, I've gone and cleaned the neighbor's garbage cans(!) And still be ready to jump out of my skin for not enough to do! The more I do I don't get tired (which would be normal!), I get MORE wired. To the point where I am spinning in circles. I will ...pick up a piece of fuzz on floor, heading to wash dishes, make it 3 steps, turn 180 degrees to fill a bird feeder, realize that step stool would look good in another color, run to get the paints, make another 180 suddenly remembering I meant to put some laundry in, oh shi*, there is an overdue library book, jump on my bike and pedal while standing up all the way there, get back and have no idea what I was supposed to be doing, so re-arrange the furniture in a room. Meanwhile finding little pieces of lint and running them one by one to the garbage lest I loose track of them again (because I can't keep track of anything for more than a nano-second). You get the picture. People will stay way clear, because it is like being in the path (no matter where you are) of a giant pinball (not to mention it's just plain scary to witness). That night you might well find me dancing around on the countertops cleaning out and re-arranging all the cabinets and singing at the top of my lungs. So, yes, it's an "up mood", but hardly the sort of thing people think of with the generic "sometimes I'm up, sometimes I'm down" discussion.

To be blunt, I've never seen quite that sort of thing in someone with BPD. (My BF has BPD, and while he will get more done when he is "up", it is nothing like this.) Hope that helps.

I see where the two presentations of both the illnesses can be quite similar. I think this is why getting a patient's history is so important. I imagine the history the therapist has had with the patient will also be useful.

Also I think I noticed with BPD the person can react to external events. I remember telling who I thought was one that part of the reason I was hospitalized is the divorce I was going through, that this had at least something to do to trigger my mental state at the time, my episode of massive depression, the worst I have ever experienced in my life. He ruminated on this for awhile, came up to me, and put his hand through the window next to me. He smashed it to pieces. He needed to be restrained and taken back once again to lockup. Apparently this is a normal sequence of events for him. All he would do was mutter how I let a woman put me there in the hospital. This was far from the complete truth. But this is this only part that he managed to hear from me.

So what do you think? Would a person with this kind of violent reactivity be diagnosed as Bipolar?

I don't know his diagnosis based on that description, it could be many things.

I guess you must of missed what I was asking you. I probably was not clear enough. I wanted to know if a Bipolar in their manic mood can behave the way I described. I am very curious as to what your experience is with regards to Bipolar patients. You must have allot to offer us with your perspective. I imagine some sort of an agitated state of mind may bring about this type of impulsive aggression. But what do I know? I really do not know much.

EDIT: An interesting article is Psychiatric Times. http://www.psychiatrictimes.com/bipo...polar-disorder

[some deleted of a very good article on violence linked to trauma in Bipolar patients]

Although trauma history has a unique relationship with bipolar disorder, it should be assessed in all patients to determine the risk of violence. Trauma is associated with increased aggression in adults in general, regardless of whether an affective disorder is present.

Interesting, wouldn't you say? It looks like even violence would not necessarily differentiate Bipolar from BPD, or either Bipolar or BPD from any other diagnosis.

If you use the thread search tool you'll find quite a few discussions on this topic, here's one that was active not too long ago.

http://forums.psychcentral.com/bipol...ar-ii-bpd.html

In terms of treatment... in bipolar you're in luck! There're drugs and they actually, for most people, work.

In terms of BPD, you're screwed! (sarcasm) No drugs!

That's the short answer ---------

The longer answer follows and simply consists of some information and comments regarding Borderline Personality Disorder.

Basically Borderline Personality Disorder, like all personality disorders listed in the big books of mental "illnesses" (ie. the DSM 5 and the ICD-10-CM), is more about an ingrained way of being that was learned early in life; is nearly reflexive in nature; is very difficult to unlearn and highly resistant to change. It, like other personality disorders, is also almost always characterized by "poor insight" - that is to say have you ever met a narcissist who said "Oh wow, maybe I'm not perfect?"

An earlier poster mentioned DBT (Dialectical Behavioral Therapy) which is the current "gold standard" of care for BPD. It was first proposed by a, imho, rather brilliant woman named Marsha Linehan in her book Cognitive Behavioral Treatment of Borderline Personality Disorder, Guilford Press 1993. Basically DBT is Cognitive Behavioral Therapy "including elements of acceptance and mindfulness with a touch of Zen."

In her book, Linehan wrote that people with Borderline Personality Disorder were most assuredly not responsible for getting themselves into their mess but were unfortunately solely responsible for getting themselves out.

BPD is often characterized by attention seeking behavior, often from medical or mental health providers as a result of the fact that healthcare professionals are obligated to provide services in certain circumstances, and also in reality because nobody in those businesses wants to get sued if someone turns up dead as a result of a parasuicidal act (a sort of 'half-hearted' suicide attempt whose goal - whether consciously or unconsciously - is NOT death but is in fact a desire to garner attention). Commonly person's with BPD will have a history of self-mutilation / harm and a history of unsuccessful suicide attempts.

As a result, in cases where patients with BPD continually access services in order to gain attention which they cannot get elsewhere, DBT involves "contracting" with a therapist when it comes to things like showing up on time for appointments; calls to a therapist's office; agreeing not to commit suicide; etc. For example, a DBT client might be precluded from calling a therapist more than once every week or even two weeks, and the time limit would roll over each time a therapist is called.

BPD is a difficult personality disorder to treat. As a previous poster indicated, it is theorized that it is born out of childhood traumas and difficulties in maintaining appropriate attachments. Basically the theory is that it's like praising a puppy for peeing on the floor then beating it for obeying a command to sit. Then the next time you beat it for peeing on the floor and praise it for sitting. When the puppy (to be read PERSON) gets older and pees on the floor and isn't rewarded for it they get all confused because they thought that's what they were supposed to do. As a result, people expressing symptoms of BPD often have difficulty choosing appropriate emotional responses to their feelings / environments and look to other for cue / clues for what to do in order to get their needs met.

That's WAY oversimplified, but it's apt. People expressing symptoms of Borderline Personality Disorder, again it is theorized, learned maladaptive behaviors as kids and bring them with them all along their life course. They "split" (black and white thinking - "you love me" one moment, "you hate me" the next); they often form inappropriate emotional attachments very quickly when people pay attention to them (either positive or negative), then just as quickly cast them aside when people get exhausted from having to constantly reinforce their need for praise, acceptance, attention.

Therapists who work with clients suffering from Borderline Personality Disorder, if they are really using the DBT handbook, themselves have therapists. This is in part to ensure the therapist is keeping the therapeutic process on course, but is also to ensure the therapist isn't getting burnt out by the client.

Typically, unless it's in an inpatient setting or with a therapist who specializes in Borderline Personality Disorder and Dialectical Behavioral Therapy, a therapist will only agree to see one or two clients expressing BPD symptoms at a time before referring out. Real DBT requires very specialized training, usually in teams, and oftentimes therapists will simply refer out clients with BPD due to the reality that it is beyond the scope of their area of practice

Clients exhibiting Borderline Personality Disorder can be exhausting for therapists, both empathetically draining as well as in the sheer amount of time and resources which have to be devoted to people with such needs.

The reasons for this should by now be obvious.

-------------------------

So, that about sums up the "short version" of Borderline Personality Disorder beyond the criterion.

You can see similarities I suppose. If someone were bipolar and, for example, rapid cycling between manic and depressed they could be going from "you love me like all the stars in the sky" to "you hate me don't you?"

Key differences are usually found in doing a complete biopsychosocial history, especially looking for parasuicidal and self-harming behaviors as well as a history of rocky and unstable, often very rapid, emotional attachments / breakups. Oftentimes a history of childhood abuse (mental, sexual, physical) will also be among the list of things found in clients expressing Boderline traits.

Currently there are no known drug therapies for treating Borderline Personality Disorder. According to the National Institute of Mental Health:

...many people with borderline personality disorder are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective.

Yes, thank you very much for the link to that discussion. So BP is strongly reactionary to outside events. This is what I originally thought. That guy focused on one statement that I made which agitated him. I could tell once that statement left my lips. Then he walked over to me and had a violent outburst.

But enough of my curiosity. Sorry for monopolizing the thread. I am so trying to understand the world around me when I should be trying harder to understand myself.

PS: Maybe that should be in my signature line.

A violent outburst like that could be seen in many disorders, so the description is not enough to make a diagnosis. Examples of possible diagnoses: BPD, bipolar manic, antisocial personality disorder, schizophrenia, schizoaffective, substance induced, a general medical condition (eg delerium, brain tumor), traumatic brain injury, just an asshole, intermittent explosive disorder.

Having said that, most people with a mental illness are NOT violent, and are far more likely to be the victims of violence than the perpetrators.

Diagnosis is complex, and all the possible differentials must be considered. I do have a unique perspective because i am bipolar and i work in mental health.



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