[Gabyunbound]

I'll start out by saying that I've only ever had one mixed episode in my life and it involved soul crushing depression along with an extreme amount of energy at the same time.

But I see, occasionally, on this site, mixed episodes being described as switching from one mood to other within an hour, or in any case multiple times a day. To me this sounds more like the roller coaster of BPD and not BP.

My feeling is that if you're having extreme symptoms of both depression and hypo/mania really at the same time then this is mixed. Whereas, if you're truly 'switching' from one mood to the other, within a short period of time, then this could possibly be BPD.

And since, as I understand it, mixed states are atypical for BP, or at least not very common over all, doesn't it make sense that sometimes they are confused with BPD changing moods?

What do you think?

[clp9922]

I don't know. My doc is now leaning my mixed states to bi-polar, but she did inquire the other day if I had ever been dx'd with personality. I don't know, but if I can't get my moods/ states under control soon, I am afraid of what could happen...

Sorry couldn't provide much help, but that know you are not the only one struggling with this confusing situation. I am in the same boat.

[yellow_fleurs]

I think the diagnosis is difficult and probably requires a pdoc/T to do careful history and monitor over time because of overlapping symptoms. It does make sense that they are often confused, though. For four months I was trying to figure out which one it was for me and my pdoc was screening me for both I could tell, but since the mood changes were not related to external events, not baseline for me outside of the episode, I didn't have major interpersonal issues/unstable relationships or other things that are often part of the BPD diagnosis, and it improved when they lowered the dose of my SSRI, they ultimately determined it was probably a mixed episode. I also did spend a good portion of the time with symptoms of depression/hypomania at the same time. Also, I sort of think I was always experiencing a bit of both at the same time, just varying degrees of how much of each. Just my thoughts.

[MoodyMountain]

Rapid cycling and mixed are pretty hard to tell apart sometimes. My usual episodes are short, from less than a day to days for depression and can switch within 5 days or so. My worst episodes are mixed, mostly manic symptoms but the emotions are evenly split depression and irritable mania. Thing is, the DSM V doesn't classify these as mixed because there aren't enough symptoms and they are too short. I probably haven't had a diagnosable "with mixed features" episode since when I started meds in 2010, before the DSM V was written!

[Shazerac]

There are many flavors of the bipolar scale. I have mixed episodes where I am depressed, agitated and hypomanic. I also rapid cycle.

I know that some people describe mixed episodes as moods switching quickly, but that has rarely been the case for me and I have a long history of mania and depression with mixed features. In my cases, I mostly have manic symptoms with some depression symptoms simultaneously, and that state has symptoms meeting full criteria for an episode in terms of number of symptoms and length of episodes.

[Unrigged64072835]

Although mood swings can be a BPD trait it can also be ultradian cycling (rapid rapid cycling). It depends on other factors.

[*Laurie*]

The thing is that BPD is not just about mood states. BPD involves other, dominant symptoms. For example, the terrible, frightening, unyielding sense of feeling "empty" inside...like a void that cannot be filled except when the "other" is being seen as a "good" other and life is all happiness, because the Borderline has found an identity to stuff into that internal "hole"...for a brief time.

Splitting is definitely a symptom of BPD. So is the"come here/go away" syndrome. The terrible fear of abandonment - huge BPD trait.

So anyway, BD can present with all kinds of mood types and changes, whereas BPD involves many other symptoms and behaviors.

I'll echo the others in saying other prominent factors come into play figuring out if it is Borderline. (Whether trying to distinguish from mixed or rapid or ultradian cycling. I personally think the latter two are harder to parse.)

I've had true mixed as you describe --soul crushingly depressed with simultaneous extreme energy. They are sheer hell. to you.

[downandlonely]

I don't know much about it, but I think it is possible to have both bipolar and borderline. So maybe that's the case here.

[*Laurie*]

Originally Posted by downandlonely

I don't know much about it, but I think it is possible to have both bipolar and borderline. So maybe that's the case here.

Definitely. In fact, it's not uncommon for someone to have both. But BPD is still not just about mood changes; it's about mood and all the other symptoms.

What *Laurie* said. Just having crazy moods isn't enough for BPD dx and typically BPD mood swings have an identifiable trigger. Bipolar mood swings don't always and they can be really quick. I don't think it matters if you call it ultradian cycling or a mixed episode because either way you're going to want a change in mood stabilizer or antipsychotic. I just had a few days my doc called "mixed mania" because I was generally agitated and energetic but at times it looked more depressive and others more manic.

[*Laurie*]

And sometimes BD moods do have an identifiable trigger, but the mood goes haywire...over-reaction and inability to get control of the mood that has been triggered.

[Gabyunbound]

Thanks, guys. You always have useful and very thoughtful ideas/responses.