Borderline Controversy Debate: Possible Trigger

It's an interesting topic in that most pd's do not involve mood affect like bpd. So it is thought provoking. He also stated that he was not taking sides and putting the topic out there for debate. I'm sure this is triggering for some and that is why they should avoid threads marked with a trigger warning.

I am not debating the intentions of the original poster (whether to debate or take sides). I am saying that it was stated in the original post that BPD was characterized as a mood disorder and was under Bipolar. I have presented evidence that refutes this assertion.

i'm just putting this in here as it may relate to many people with BPD
i actually have PDD, for those that don't know it, Personality Disassosiative Disorder, i believe it shares some traits with BPD, only mine isn't borderline, it is what it is
however mine episodes are triggered by my emotions, thus my mood
it's not a mood disorder though as when it happens, i am a different person for all intents and purposes
to say that anything that affects another persons personality, makes them less then what they really are (by that i mean they are just not themselves in so many ways), is wrong
no-one can say that, not even if they are a "professional", most of them only know what they know through books, most of them have never even come close to living with anything like these disorders
the professors that say "that's not a disease" and so forth, they are doing it from some sterilised lab in their fancy white coats, not a single one of them has done their surveys using at the minimum 100,000 people, not one. is it impossible to do? not really, you could take an entire city and do that, although chances are you would be picking people that don't have anything wrong with them. those same chances apply when you pick 100 people, or 1000 people...
so for anyone to sit back and say "that's not X, it should Y" is just wrong
unless you're talking about something that can be seen with your own eyes, heard with your own ears, touched with your own hands, smelt with your own nose or tasted with your own tongue, you cannot say that one thing is a certainty over another thing...just an example..."the sky is purple", no, the sky is blue, i can see it with my eyes, the sky is blue...of course if you are color blind, you have to take someone elses word that it's blue if you can't see the color blue and you know you can't...

makes sense?

See I understood this could very well trigger a lot of people. Hell a smart @ss smirk triggers me! That's all it takes for me. And dealing with some of the posts here also triggers me too. One of my pet peeves is having to repeat myself and dealing with my perspective of what the posters intent is towards me. I realized all this from the start and thought long and hard before starting it. I do feel such a thread is needed, but I don't have the patience to deal with misunderstandings or have to explain myself repeatedly. Triggers happen from both ends folks. If this was a typical debate forum with no holds barred, I'd be able to do better because then I can really say what's on my mind without repercussion. As it is we all need to abide by the community standards and rules here. Makes things some times a bit harder

from the previous posters own link...

As I tried to carefully explain in my limited ability and lack of command for the english language. MANY PROFESSIONALS STILL DO NOT AGREE WITH THE LABELING OF BPD. Indeed for decades and still even now, many professionals still disagree with the current structure for diagnosing BPD and feel it belongs under mood disorders.

AGAIN I AM NOT SAYING THIS BUT MERELY REPEATING IT. I COULD CARE LESS WHAT ANYONE BELIEVES AS I AM NOT TRYING TO PERSUADE ANY ONE ONE WAY OR ANOTHER.

Some one asked me to present links for the opposing views which I basically said WTF? Because many here in the thread have done a fantastic job doing just that. My position was and is to play the devil's advocate to keep the discussion fair. And when I was unable to refute a counter claim as the devil's advocate admitted as such.

So you think you have a strong refute> Good for you post it. I can guarantee you no matter how good you think it is it will NOT end this on going debate and disagreement in the mental health field. But for purposes of this thread I welcome it all as the main purpose of this thread is to educate and bring to the readers attention opposing ideas without trying to persuade them.

Maybe rather than BPD being a mood disorder, due to some similarities with BiP, in a few years they will be deciding that rapidly cycling, affective mood disorders are actually PERSONALITY disorders and then THAT can be discussed instead.

Do psych meds help BPD'ers? Sure sometimes they do, usually all in the same way, by making us tired, flat and non-responsive. I read through the big thing at NIMH and, every medication that they used were the sort that just wipe you out. Yeah it's hard to be emotionally reactive when drugged down. Does that imply that they are both mood disorders?

That's certainly a possibility because it doesn't matter what popular opinion is now, they can change it.

As for the meds, earlier in this thread I referred to a med test for each group, bipolar and bpd. Both groups were given the primary meds given to people with bipolar, depression, anxiety. Mostly SSRIs. In both groups they did so-so with no real clear lead or advantage in either group. Here's where I find it gets interesting. They gave both groups anti-psychotic meds and BOTH groups shown significant improvement over the reg meds. So it seems that anti-psychotics worked best for both in these tests. Tests were not exactly scientific, not much is in psychology, tests were limited to a low number of patients, 20 or 30 in each group. Test did not take in consideration for any possible misdiagnosis. In the first test, the normal meds did only slightly better then the placebo. With anti-psychotic meds the improvement was significant over the placebo. This is the only test I know given this way.

Oh before I forget what this test did show was it didn't make any significant difference one way or another what you gave BPD, given the same meds as bipolar would resulted in exactly the same results people with bipolar had, nothing to get excited about. But what was the big surprise was how effective anti-psychotics were for both. Unfortunately for me I can't take anti-psychotics.

I agree. And I have seen 'mixed states' confused with ultra-ultra rapid cycling, in the sense that when some people are going up and down constantly, they attribute it to mixed state.

No. "Mixed states" are primarily limited to Bipolar I, whereas I see many people diagnosed with Bipolar II saying they have mixed states. It is *not* a roller coaster of up, down, up, down, up down, that's just not what it's about. I've essentially seen erroneous definitions of 'mixed states' mirror those of 'rapid cycling' --same thing, different label. Sometimes, this is really BPD masked as "rapid cycling" and/or "mixed states." And one has to keep in mind that a 'mixed state' like any kind of bipolar episode, does need to last a long time. It is not akin to going from one crisis to another.

[quote=IndieVisible;3276565]IMHO not very different at all. Take for example a bipolar stuck in the midst of a "mixed" episode. There does not have to be any manic or very little if any, just irritability and ups and downs, often appearing they are triggered by events.

Per literature, 'mixed states' primarily occur in the context of Bipolar I, so we are not talking about just 'irritability.' And it's not about up-down-up-down. If these constant ups and downs are occurring, and are triggered by events, then most likely it is not bipolar disorder.

If these constant mood changes are being triggered, and that person is diagnosed (or self-diagnosed) with bipolar, then this is where you need to start taking it with a grain of salt, consider the possibility of misdiagnosis, rather than assume that it is, actually, a part of bipolar disorder.

I think you're getting your definitions of mixed states more from personal accounts than the actual criteria. I have seen the same descriptions of 'mixed states' as you describe here --but that doesn't mean that this is how it works with Bipolar Disorder. This is precisely part of the problem, and why BPD seems to mirror BP --because of such accounts. You will see that many who experience mixed episodes, as you have described them here, are 'also' diagnosed with BPD.

I suspect that atypical antipsychotics could help someone with BPD with their quick reactions. They could potentially slow things down enough to allow the person to think things through before 'reacting' and I can see how this would be beneficial.

*Nonetheless* I don't think these meds will be entirely helpful if the person does not use that extra time (slowed reaction time) to re-think their reaction --they could end up reacting anyway, just a little later. It still requires DBT-type skills.

Yes, thank you for wording that so well.

Also, in regards to the medications, the one I was reading in some studies had as few as ten participants.

I do not find it interesting that anti-psychotics were effective for both. Not sure what sorts you have tried but they flatten out almost all feelings, so yeah it kinda controls mania AND freaking out.
SSRI's didn't do well I'm sure because 1) they are known to cause Mania in bipolar people, 2) they can cause extreme irritability and thats a huge downer for those with BPD. So to me, the whole 'psych meds worked for both' means nothing.
You could put chloroform over the mouths of both groups and knock them out flat too.. doesn't mean they are both the same sort of disorder.

I honestly think the same things are being rehashed now. I'm not going to revisit this thread. I find it irritating and not at all helpful.

This is not at all the typical thinking of the psychiatric community.

For a long time BPD was thought to be on the 'border' of psychosis and neurosis (hence the term). The whole Bipolar spectrum thing, in the whole scheme of things, is very very new.

Neither BPD nor Bipolar are entirely biological, by a long shot. Both are considered to have multiple origins: genetics, environment, in-born temperament, brain 'chemicals', size and functionality of different parts of the brain, etc. None of us, either BPD or BP can realistically throw up our hands (though not saying you're doing this) and say it's out of our control. In both cases, there is treatment, and in both cases, it requires a lot of time and hard work.

'Rhode Island' study that I mentioned:

Bipolar Disorder Overdiagnosed?

Is bipolar disorder overdiagnosed? [J Clin Psychiatry. 2008] - PubMed - NCBI

1854 recent?

But you are correct that the majority of the mental health field holds bpd to personality disorder as I have said a few times already.

I agree this can happen, that's why diagnosis should always be taken with a grain of salt. Before I was diagnosed I thought something was physically wrong with me and made numerous visits to my primary care doctor and the local hospital. Eventually a cute nurse and a few doctors recommended me to see a mental health professional after I described to them how severe my anxiety was. They were going to give me some benzos but I wanted to evaluated because I am scared of psychiatrists since they gave me meds that made me want to kill myself in the past. I was actually getting physical pain as a result of my psychic pain. I also heard voices in my head due to medicine mismanagement, the voices told me to do things that gave me an adolescent diagnosis of OCD. It went away after I stopped taking the drugs.I hated psychiatry and was skeptical of ever going back, it was the distress caused by the symptoms that made me seek out help from a therapist and a pdoc. I still haven't agreed to any meds from the pdoc. But have been making huge progress in therapy.

I think the amount of people who have mental health problems is greatly under estimated, for example everybody in my life is crazy, out of all these crazy people only 1 of them besides me is actually talking to a MH professional. But he refuses to go to therapy, he just wants benzos to reduce his panic attacks and anxiety and could care less about permanently fixing his problems. My dad who is obviously OCD, also refuses to seek help, I can tell his OCD because I've been there before and overcame it so I understand the disorder pretty well. I think many people with severe mental health issues refuse help because they are men and feel like seeking treatment and asking for help is a weakness. They think they need to just "man up" and put up with all the self-abuse they subject themselves to.

Hmmmm.. I'm feeling very irritated, better medicate me!!
So the "opinions of the psychiatric community"... I must assume "we" are not a part of... BS... I've begged pdoc for explanation of these symptoms in myself & older 2 teens. She says there is an epidemic of sorts going on among teens showing symptoms of both bp & bpd. She says they don't know exactly what it is but for me now to worry, treatment is the same. = Here try these meds. Our dx's are bp. We (my family) obviously also have bpd traits, so here I seek support with others who've experienced similar. I hate how controversial it gets and people sound like they want to be know it all's. ok... Guess it makes you feel better? I like debates & challenging the norm...but....
Ya I'm triggered & reacting. Don't take it too personally, this is just how I feel right now.
My ultimate point is that pdocs are trying but they don't really know what/why is going on. I sadly know people who falsify and participate in drug studies for the money. They invited me along when I was broke and I said a huge No Way, Never...

Don't know about the US but here in the UK professionals are trying to change the word BPD to emotionally unstable personality disorder (EUPD) In fact my own Pdoc says the word BPD is such an awful word and that is why most professionals are trying to change, I think now in fact when you're diagnosed with it here they do now call it EUPD.

Yeah thats what they diagnosed me with last year rather than BPD.

Actually in all honestly it really doesn't matter what they say we are. The real elements that effect us most is treatment plan, stigma and here in the USA the insurance companies crappy coverage for personality disorders.

And when we look at the actual meds used, it's about the same, doesn't make a difference at all in meds, the only difference is therapy and the prognosis for bipolar is a lot better then for any personality disorder because if it is a personality order, which btw for those curious, I do lean towards it being a personality disorder with strong mood disorder traits. Personality disorders, any of them are in engraved in our personality, it makes therapy success rate minimal or low. Hard to change personality! Specially if mood swings are so very much a part of it.

Really when you think about it, regardless of the classification you fall under, what makes the most difference for you? Feeling better of course. With meds, bipolar can be kept almost entirely under check, while bpd will still have mood swings. The reason for that is because unless you go for heavy anti-psychotic meds, your only going to curve your depression, and anxiety. Your still going to have to deal with the fluctuation between baseline to anger. And worse if your not not anti-psychotics.

I just wanted to provide as much info on BPD as possible. And honestly how many of you knew about this controversy? Well now you do. I know most of you or at least a significant percentage of you get the purpose of this thread. I only mention this again for those who misunderstand my intent because they hop in the middle or end of the thread and miss the full meaning.

For me it makes very little difference because sadly I have multiple diagnosis and well, no matter how you look at this I'm in for a rough ride. I'm just a data geek and I have to have all the information available to me from every angle and perspective both pros and cons.

I knew I said I wouldn't be back, but I lack will power.
Your final comment is depressing.
I would chose BPD over BP because BPD does not necessitate meds. Therapy in the form of DBT is HIGHLY successful, and although you might need meds to get through some depression or what not, DBT is the Gold Standard of BPD. It is in fact useful for other forms of Personality Disorders as well but BPD is the one that is most responsive by far.
BP, in order to be kept in 'Perfect Check' one is much more likely to have to be on meds for that, and sadly, BP meds are no walk in the park.
There has even been some success shown in DBT for BP, so really, DBT could be something that anyone could look into, if only more clinicians would learn it.
Hard to CHANGE personality, but it's not about changing it, it's about managing it, handling it and learning to control our outbursts that result from the sort of emotional personality that we have.
Some weeks I HATE going to DBT . It's a lot of hard work. But on days like today, I feel like I am worth that hard work, and even on days I don't feel like I am, the ones who love me are worth it so I will perservere...
Anyhow, just needed to say that. BP does not have a better prognosis than BPD.
That is possibly the stigma that makes people want to run over to one side.
BPD CAN get better. We can learn how to deal with our triggers... whereas with BP its really a lot more out of our control and we might end up over medicated.

I hope honestly that more of the 'spectrum' BP cases are re-evaluated for the 'Non Popular' BPD and that other methods of therapy are given a chance to help avoid pumping everyone full of mind numbing meds.
/me jumps off the soap box

Actually popular opinion even according to the DSM-IV is the prognosis for bipolar is very good, while the prognosis for BPD once thought almost none has improved, but still considered difficult. The difference being with bipolar therapy really isn't needed usually as long as patient stays on meds. But because so many here agree that BPD is a personality disorder, all personality disorders while promising don't have as successful prognosis as other disorders. Meds and therapy is required with much more emphasis on therapy. If you like that wording better then fine. Still sounds worse to me. The meds are required not for the BPD but for some of the symptoms accompanying the disorder. Mostly for depression and anxiety, however recent studies suggest that anti-psychotics help significantly for the mood swings, doesn't cure them but helps. Honestly, do you think I make this crap up I share? i do extensive reading and research from many sources.

Now lets look at the sources that supports what i just said ok?

Prognosis for bipolar:

The prognosis does worsen for patients who begin bipolar from childhood untreated until adult.

The Prognosis for BPD:

another problem with BPD is their inability to trust..

Then there's the insurance problem for proper coverage..

The key to treating borderline is long term psycho therapy, which is not covered by most insurances, compounded by the trust factor for most bpd patients results more often to failure then any significant success. Bipolar certainly has it's challenges as well but is fully covered by insurance companies and most mental health providers consider working with bipolar patients easier then BPD patients. Bipolar patients can resume a complete normal life as long as they stay on their meds. BPD even on meds for depression and anxiety will still have long lasting issues that can only be worked out in therapy.

Also noteworthy, many people with BPD also have other disorders too! Same can be said with bipolar patients and there are some bipolar patients who never do very well. Each group will encounter even more problems if accompanied with substance abuse.

So in conclusion, it's easier to treat bipolar, it's relatively no problem for insurance companies and most therapists don't mind treating bipolar patients. It's harder to treat BPD because it requires long term therapy and trust issues, splitting by patient, presents more challenges which have prompted many therapists to not even want to treat BPD and then there's the insurance issue to.

So which would you say has a better prognosis?

Narcissists also have mood instability. Many disorders are comorbid with other disorders. These disorders are not anything like regular diseases, psychiatric disorders are merely collections of symptoms. It is surprisingly rare for a person to only have one mental health disorder . There is a lot of overlap in all disorders, especially personality disorders. Mood instability and irritability are common in all mental health disorders. Most people with a personality disorder also have mood disorders and people rarely seek treatment for personality disorders alone, they go for treatment when other symptoms are bothering them such anxiety or depression.
Based on my research BPD has a better prognosis for recovery, Bipolar is a life-long disorder with a constant need for "maintenance" medication. Such medications are not required for BPD although usually urged by most psychiatrists, because that's what psychiatrists do: prescribe medicine.

The reason why it would appear bipolar has a better prognosis on the surface is because its easier to treat: here take this cocktail of drugs and your symptoms will get better. It takes more work on behalf of mental health professionals to treat personality disordered people. So not that many in the field are willing to undertake this daunting task as it requires good old fashioned hard work, no amount of pills will make it just go away.

Of course it's that way. Let's assume you where a therapist. You can fit 30 patients a week in your schedule. Who would you prefer to treat? I will be perfectly honest, if I was a therapist I would not want to treat any of the personality disorders. There's that and also let's not forget this..

Let's assume we are lucky enough to find a good therapist who will treat BPD people, GREAT! Now we have to deal with our own issues directed at our therapist. The splitting: my therapist is the greatest in the world! I hate my therapist he doesn't understand any thing! I'm doing great at therapy! I hate myself I and doing terrible at therapy.

And of course we know best, always.. I don't need any meds I can do this on my own!

I never said it was fair. But the deck is stacked against people with personality disorders. There are the real issues and the perceived issues and of course the insurance issues. We deserve the truth no matter how distasteful it may be.

Besides borderline the other personality disorders are a lot harder to treat because many of them don't want to change. If there is no will, than there is no way. So I would have to agree, you cannot do a personality transplant (unfortunately). Those who are Bipolar are not as crazy as they are portrayed in the media, most people I know with bipolar are doing better than I am in life right now. Many people with personality disorders do not even know that their behavior is problematic, because it is so engrained into their personality. It is only with psychoeducation that people with personality disorders begin to realize they are disordered. Only after this realization that changes can be made, the younger, more intelligent the patient the better the prognosis.

Personality disorders share many things in common, one of them is a history of trauma during their most formative years. The effects of trauma in childhood cause brain damage and impair functioning of the brain including the prefrontal cortex, the part of the brain involved in reasoning. Also the Amygdala, the part of the brain the processes emotional reactions. Which would explain why my emotional reactions are usually delayed when I am presented with triggering stimuli. What we are attempting to do in treatment is repair what is according to the scientific evidence a damaged brain. There is much more work involved in repairing a damaged brain than there is in correcting a chemical imbalance. Source: Scans Show Brain Damage in Abused Teens
Brain and Development affected after Child Abuse | Mind Forums

Sadly many parents are not aware that they are abusing their children, they are simply using the same twisted and broken techniques taught to them by their dysfunctional parents.