[Curiosity77]

I'm working on a power point for my work about the updates from DSM-IV to DSM-V for mood and anxiety disorders. The audience is nurses, social workers, psychiatrists, peer support workers, and rehab staff. I'm doing this because I'm the team NP, they do not know about my illness. This is my section, the other diagnostic categories are covered by a couple of my co-workers, because we are presenting together.

Anyways, I am looking for feedback about a few slides which are about distinguishing BP from BPD. Please let me know your thoughts. I cover the details of criteria for BP I, BP II, and Cyclothymia, as well as describe mania, hypomania, depression, and mixed, in other slides which I won't post here. I wish there was a way to attach the power point, but I don't know how. So here are the slides I am wondering about:

Slide 1:
BP versus BPD

•BP mood states are persistent, BPD fluctuates within the day in response to situation

•Can be difficult to distinguish BP II from BPD

•Can co-occur

Slide 2:
Symptoms Common to both

•Affective instability

•Episodes of anger or rage

•Impulsive behavior

•High risk behavior

•Substance abuse (not criteria, but common)

Slide 3:

Unique to BPD

–Idealization/devaluation

–Black and white thinking

–Unstable relationships

–Fear of abandonment

–Identity disturbance

–Feelings of emptiness

–Self harm

What do you think?

[BipolaRNurse]

I was thinking you may want to reconsider the "self-harm" being unique to BPD, as a fair amount of bipolars do it too. Otherwise, your slides sound really well put-together. Good work!

[Curiosity77]

I was wondering about the self harm thing because i see that a lot on this forum for people with BP and not necessarily BPD, but DSM-V only lists self harm as a criteria for BPD and not for BP. It could be that the people with BP that self harm may not have BPD, but could have some BPD traits or features, but not the full disorder.

I don't really know, and i want to get it right, so i was going by the book (DSM). It could be that we have noticed self harm as a feature of BP, but DSM-V hasn't figured it our yet, maybe it will be in DSM-VI. I might handle it by leaving the slides how they are, but saying a side note that self-harm could be common to both disorders, but is not identified as officially part of BP.

Not sure what others think of that. It's important for me to teach this correctly because some of the people in the audience don't know this information, and are working with patients.

Not too sure

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I would love to help if I could. I can't even get a diagnosis other than, "It's bipolar." I have suicidal tendacies at times and have for a long time. However, I have most of the characteristics in all "3" slides.

[Skitz13]

I agree about the self-harm. My opinion is that self-harm includes suicidal behavior and is so common with people with BP.

Just my opinion but excellent work!!!

[Victoria'smom]

I have BP and self harm only in episode maybe say regularly self harms?

[Resident Bipolar]

Yeah everyone in the psych wards I met with Bipolar self harmed. To be honest, I think self harm tends to more be a symptom of the depressed phases of any mental illness or personality disorder rather than a symptom of the disorder itself.

Either way, it's incorrect to define self harm as "Unique" to Borderline in my opinion. Other than that, good job.

[Resident Bipolar]

Originally Posted by Miguel'smom

I have BP and self harm only in episode maybe say regularly self harms?

I dunno. I mean, some with OCD can self harm regardless of mood and I know that constant self harm can also be present in those with an autistic spectrum disorder. Would it still be definable as unique to BPD in that case?

[Curiosity77]

Thanks!

I'll take self harm out of unique to BPD slide, because it sounds like consensus from you folks that it doesn't belong there. It probably fits better under common to both.

Thanks everyone!

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[Curiosity77]

One of the people i'm presenting with is a psychiatrist, so i just emailed to ask her opinion on where in the slides self harm belongs. After reading your responses i'm thinking it belongs under common to both, but i want to know her opinion. She runs the DBT group, so she should know the answer to this question. I'll let you know what she says.

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[Eliza Jane]

I think it would be helpful to emphasize the episodic nature of bp and how some of the things you describe as common to both relate to behavior during an episode. For example, risk taking is probably most likely to happen for someone with "straight" bp when manic. Whereas, someone with bpd may engage in risk taking regardless of mood.

Good luck!

[Nammu]

I'm not sure but I think unstable relationships also are common to both because of the mood swings in BP. The difference seems to be how the BPD responds to someone leaving and having trouble being alone.

Relationships? I either run them off or they run off which I can't much blame 'em.

[r010159]

Originally Posted by sidestepper

I'm not sure but I think unstable relationships also are common to both because of the mood swings in BP. The difference seems to be how the BPD responds to someone leaving and having trouble being alone.

I find some BPs are afraid of rejection. I dated one who tried to run me off. It worked.

I've always been afraid of rejection. That's why I always have been a very, very shy in person. I was since birth.

[BipolaRNurse]

I don't know how I've managed NOT to run off most of the people in my life, but the vast majority of my relationships have been very stable---married almost 34 years, on good terms with my kids, have a number of friends etc. I'M the one who's unstable, yet they stick like glue. It's not that I haven't lost some friends, but those were always the ones who were fair-weather friends in the first place.

I'm exceedingly fortunate.....certainly more so than I deserve.

The mood switches in BPD tend to be primarily immediately reactive to events and changes in emotion (anger, rage, fear, etc), while the mood changes in BP are generally in relation to mood and energy state (depression or mania). Emotional changes in BP (such as anger, etc.) seem more secondary to the depression or mania.

[Curiosity77]

I checked with my psychiatrist friend about the question of whether self harm is considered features of both, or more indicative of BPD traits. She said:

"It would depend for me what was driving the self harming. Often cutting is seen as synonymous with borderline PD, however self harming can occur in many disorders.

For me if they are self harming to relieve overwhelming emotions, when under distress, to punish themselves or in reaction to abandonment fears, I generally equate that more so with borderline traits.

You would have to contextualize the symptoms with the patient's history.

Sometimes the two disorders overlap, especially in cases where a patient may have a mother with bipolar who is frequently in hospital which may be perceived as invalidation, leading to borderline character while at the same time having the genetic predisposition for bipolar.

Hope that helps?"

So that's one explanation. Gives a little bit of clarity

[Resident Bipolar]

Originally Posted by Curiosity77

I checked with my psychiatrist friend about the question of whether self harm is considered features of both, or more indicative of BPD traits. She said:

"It would depend for me what was driving the self harming. Often cutting is seen as synonymous with borderline PD, however self harming can occur in many disorders.

For me if they are self harming to relieve overwhelming emotions, when under distress, to punish themselves or in reaction to abandonment fears, I generally equate that more so with borderline traits.

You would have to contextualize the symptoms with the patient's history.

Sometimes the two disorders overlap, especially in cases where a patient may have a mother with bipolar who is frequently in hospital which may be perceived as invalidation, leading to borderline character while at the same time having the genetic predisposition for bipolar.

Hope that helps?"

So that's one explanation. Gives a little bit of clarity

From what the psychiatrist said, I think it's possible to say the self harm isn't in that case unique to Borderline hence it probably doesn't belong on a slide as "unique to BPD" as this could give the wrong impression. I wouldn't want anyone to pin a label of BPD on someone because they self harm, as self harm is present in many mental illness cases.

Also, I believe that self harm as a response to overwhelming emotions is also common in Major Depressive Disorder and Bipolar Disorder from what I've encountered. In fact if you interview a handful of 100 patients with a diagnoses of Bipolar Disorder and a history of self harm and ask why they self harm, I can bet that the majority will mention "overwhelmed" or "overwhelming emotions".

Ive always self harmed when I get overwhelmed by the emotions during an episode otherwise I probably wouldn't see the need for it.

Even if it's the case that the reason for self harm is different in BPD or it is mentioned in DSM for BPD and not Bipolar, I think the evidence points to it not being unique to BPD either way. Despite it not being a unique symptom of Borderline Personality Disorder, I'd say it's unique that it's in the DSM Diagnoses criteria (though it doesn't have to be present, it will signifiy a diagnoses of BPD when present with other criteria).

[Curiosity77]

Originally Posted by Resident Bipolar

From what the psychiatrist said, I think it's possible to say the self harm isn't in that case unique to Borderline hence it probably doesn't belong on a slide as "unique to BPD" as this could give the wrong impression. I wouldn't want anyone to pin a label of BPD on someone because they self harm, as self harm is present in many mental illness cases.

Also, I believe that self harm as a response to overwhelming emotions is also common in Major Depressive Disorder and Bipolar Disorder from what I've encountered. In fact if you interview a handful of 100 patients with a diagnoses of Bipolar Disorder and a history of self harm and ask why they self harm, I can bet that the majority will mention "overwhelmed" or "overwhelming emotions".

Ive always self harmed when I get overwhelmed by the emotions during an episode otherwise I probably wouldn't see the need for it.

Even if it's the case that the reason for self harm is different in BPD or it is mentioned in DSM for BPD and not Bipolar, I think the evidence points to it not being unique to BPD either way. Despite it not being a unique symptom of Borderline Personality Disorder, I'd say it's unique that it's in the DSM Diagnoses criteria (though it doesn't have to be present, it will signifiy a diagnoses of BPD when present with other criteria).

Yes, i'm taking self harm out of the slide for unique to borderline, and moving it to the slide for both.

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[Trippin2.0]

You could also word it to state that SH is prevalent in BPD yet not uncommon in BP...

That way its DSM accurate regarding BPD but doesn't contradict your RL consensus on BP...

[pawn78]

This thread had me questioning my own diagnosis. Do BPD people ever go into a psychotic mania after a heavy emotional trigger, or is that unique to bipolar 1?

[bleutamales]

I think your slides have all the information I've ever read on the difference between the two. My MIL is BPD so I read up on it quite a bit and I see (or get a call about) her symptoms pretty much daily.

You sound well informed and the slides are laid out nicely. I can tell you did your research and with all this input you'll be even more ready!

[Resident Bipolar]

Originally Posted by pawn78

This thread had me questioning my own diagnosis. Do BPD people ever go into a psychotic mania after a heavy emotional trigger, or is that unique to bipolar 1?

Try not to question your diagnoses too much - there is quite a bit of overlap between Bipolar symptoms and Borderline a Personality Disorder symptoms. It's actually quite common to get a diagnoses of one or the other and then to have it changed (misdiagnoses).

Psychosis is possible with Borderline Personality Disorder and that can include auditory and visual hallucinations. However, it is important to note that you don't really get "mania" with BPD as you do Bipolar Disorder and the mood changes in BPD are more commonly very rapid, often multiple times during a single day (possible in Bipolar Disorder but it's rarer occurrence than it is in BPD).

[pawn78]

Originally Posted by Resident Bipolar

Try not to question your diagnoses too much - there is quite a bit of overlap between Bipolar symptoms and Borderline a Personality Disorder symptoms. It's actually quite common to get a diagnoses of one or the other and then to have it changed (misdiagnoses).


Psychosis is possible with Borderline Personality Disorder and that can include auditory and visual hallucinations. However, it is important to note that you don't really get "mania" with BPD as you do Bipolar Disorder and the mood changes in BPD are more commonly very rapid, often multiple times during a single day (possible in Bipolar Disorder but it's rarer occurrence than it is in BPD).

Thanks, that really helps. I'm definitely bipolar 1 then, because I have had epic manic episodes. I was just curious.