[IndieVisible]

Warning: Please be advised that this topic can be uncomfortable or unsettling for some people, specially those diagnosed as borderline. This thread will be a debate however everyone is expected to adhere to the community standards and rules and be civil and no personal attacks. It's ok to disagree, but let's do so in common respect for everyone.

I've debated if I should start another thread or not specially about borderline. But I think the time is ripe for it because there have been a number of new borderline threads popping up and I do have some rather unique perspective to contribute to the subject and I did not want to hijack any one's existing thread or offend any one.

This thread will deal in a few key points regarding borderline personality disorder (BPD). Is BPD really a separate illness placed in the personality disorder section, or should it have remained in the mood disorder section under bipolar? It's creation and move have presented a lot of problems and confusion not to mention insurance issues for patients. Insurance companies do not provide as much coverage for personality disorders, but cover a lot more for mood disorders. And there is also the stigma that is attached with any personality disorder. It is a cluster B classification and considered one of the most serious and difficult to treat.

A significant number of psychiatrists were verry slow to accept this new change and some still have not accept it. In fact this subject is still hotly debated among top professionals in the mental health field.

Another thing I want for us to consider is how any diagnoses could be wrong and how easily we mirror what ever we are diagnosed and told we are, many of us become attached to that diagnoses. We could be diagnosed any thing, bipolar, pdsd, etc, we go home start researching and begin mirroring it and say "yup that's me totally". Not everyone of course but most.

I will post my first post very soon, I need to collect my thoughts and organised it better first. Everyone regardless of what diagnoses you happen to be is welcome to participate. I just again remind everyone to be civil and respect each others opinions and views. Thank you in advance!

Disclaimer: For the record I nether agree or disagree with any of this but am merely playing the devil's advocate to introduce another perspective to this subject you might otherwise never know about.

[IndieVisible]

I think for the first post I will keep it simple.

Some key points of resources:
Borderline or Bipolar or both?
http://www.psycheducation.org/depression/borderline.htm
Demystifying borderline personality: critique of the concept and unorthodox reflections on its natural kinship with the bipolar spectrum - 2004 - Acta Psychiatrica Scandinavica - Wiley Online Library
Bipolar II, Mood Swings without Mania; Brain Tours; Stress and Depression; Hormones and Mood; and more...

These links provide a glimpse at the "other side" of this argument, the one that claims BPD is actually just a mood disorder and belongs to be under bipolar like it use to be.

[IndieVisible]

This post will examine how easily people follow. Regardless what diagnoses we are given, patience go home start researching their diagnoses and immediately begin mirroring it, they begin to say "yup that's me totally!" and feel better they at least fit some where and know what's wrong with them.

The reality of this procedure is pdocs do not always agree on each others diagnoses and often are wrong. Also I think so many people want to fit in some where so bad they accept what ever they are told because at least they finally fit some where and know what's wrong with them! Not all of course but certainly most.

So it doesn't matter what you are diagnosed, bipolar, pdsd, bpd, you go home start reading about it and begin identifying and mirroring it. But how can that be?

Well first of all many of the traits and symptoms overlap or exist in other disorder. Many of us can relate to other symptoms and traits as well. The moment we are told that's us, we begin to mirror that even more. I can personally relate to and identify with a number of disorders in various categories. One could easily adapt even further to what they are told they are.

[IndieVisible]

No one is saying Borderline Personality Disorder does NOT exist. Of course the symptoms are all very real and so are the traits! All that is in debate here is if it should be a personality disorder or should it have remained in the mood disorder under bipolar!

Now I will discuss the whole abandonment issue and why many feel it's over played. It is after all the hallmark of BPD. I will post about that next. Right now I'm a little tired.

[allme]

Originally Posted by IndieVisible

Warning: Please be advised that this topic can be uncomfortable or unsettling for some people, specially those diagnosed as borderline. This thread will be a debate however everyone is expected to adhere to the community standards and rules and be civil and no personal attacks. It's ok to disagree, but let's do so in common respect for everyone.

I've debated if I should start another thread or not specially about borderline. But I think the time is ripe for it because there have been a number of new borderline threads popping up and I do have some rather unique perspective to contribute to the subject and I did not want to hijack any one's existing thread or offend any one.

This thread will deal in a few key points regarding borderline personality disorder (BPD). Is BPD really a separate illness placed in the personality disorder section, or should it have remained in the mood disorder section under bipolar? It's creation and move have presented a lot of problems and confusion not to mention insurance issues for patients. Insurance companies do not provide as much coverage for personality disorders, but cover a lot more for mood disorders. And there is also the stigma that is attached with any personality disorder. It is a cluster B classification and considered one of the most serious and difficult to treat.

A significant number of psychiatrists were verry slow to accept this new change and some still have not accept it. In fact this subject is still hotly debated among top professionals in the mental health field.

Another thing I want for us to consider is how any diagnoses could be wrong and how easily we mirror what ever we are diagnosed and told we are, many of us become attached to that diagnoses. We could be diagnosed any thing, bipolar, pdsd, etc, we go home start researching and begin mirroring it and say "yup that's me totally". Not everyone of course but most.

I will post my first post very soon, I need to collect my thoughts and organised it better first. Everyone regardless of what diagnoses you happen to be is welcome to participate. I just again remind everyone to be civil and respect each others opinions and views. Thank you in advance!

Personally I couldn't care ales if they want to call it a mood or personality disorder. Personally couldn't care a less as personally it doesn't bother me.

Although I think it's true a person could possibly look at these traits (or at other personality or mood disorders) and find elements of themselves in there I believe ppl who do suffer these disorders (or whatever you want to call them) really do know the pain they are suffering and will just know it fits them. After I was dx with BPD I went through all the other personality disorders and no, for me personally, apart from little from avoidance personality, I found nothing that fit me. I have no doubt I have BPD. I have the traits/symptoms on extreme levels in some cases and lower on another but all in all they prevent me from living just a little bit of a decent life. The ppl I do fear for are teenagers that have been dx (which I wont go into out of fear of upsetting anyone) I hate to believe ppl that don't have BPD are dx with it cause they simply share some traits and then said person goes home and convinces themselves they have it because they can relate a bit. We can all relate to some disorder or whatever but it's when you can relate on a level that is ruining your life is when it is an actual disorder . I don't believe it's a disorder unless it has a serious impact on your life and prevents you from doing normal day to day things a 'normal' person can do or function emotionally like a normal person can. And then there are so many levels to this.....

I use the word disorder because in my mind it's exactly that.

[allme]

Originally Posted by IndieVisible

This post will examine how easily people follow. Regardless what diagnoses we are given, patience go home start researching their diagnoses and immediately begin mirroring it, they begin to say "yup that's me totally!" and feel better they at least fit some where and know what's wrong with them.

The reality of this procedure is pdocs do not always agree on each others diagnoses and often are wrong. Also I think so many people want to fit in some where so bad they accept what ever they are told because at least they finally fit some where and know what's wrong with them! Not all of course but certainly most.

So it doesn't matter what you are diagnosed, bipolar, pdsd, bpd, you go home start reading about it and begin identifying and mirroring it. But how can that be?

Well first of all many of the traits and symptoms overlap or exist in other disorder. Many of us can relate to other symptoms and traits as well. The moment we are told that's us, we begin to mirror that even more. I can personally relate to and identify with a number of disorders in various categories. One could easily adapt even further to what they are told they are.

I can see totally how this could happen, as you say, we all want to belong and it would help us slot in somewhere. I for one am not one of those ppl thankfully. When I was told I'm BPD I didn't go home and make it fit...it came along and made me fit me instead! I felt as though I was at home with it and it resonated so deeply, pdoc could not have been wrong. I am a seriously sick little girl trapped in a woman's body.

[IndieVisible]

My intent here is to basically bring to mind a perspective that many would otherwise never be aware of unless they follow the professional psychology news stories. I think knowledge is a good thing. Not trying to persuade any one of any thing although I will play the devils advocate here for purpose of presenting a fair balance.

[allme]

Originally Posted by IndieVisible

No one is saying Borderline Personality Disorder does NOT exist. Of course the symptoms are all very real and so are the traits! All that is in debate here is if it should be a personality disorder or should it have remained in the mood disorder under bipolar!

Now I will discuss the whole abandonment issue and why many feel it's over played. It is after all the hallmark of BPD. I will post about that next. Right now I'm a little tired.

Ok I would love to hear why you think abandonment issues are over played. For me they are not. For me they are very real and simply someone going quiet on me will bring out extreme feelings of panic, loss and anxiety, bordering on desperation too.

[IndieVisible]

Originally Posted by allme

Ok I would love to hear why you think abandonment issues are over played. For me they are not. For me they are very real and simply someone going quiet on me will bring out extreme feelings of panic, loss and anxiety, bordering on desperation too.

I believe "abandonment" and "triggers" can be applied to almost any disorder. When I get down to the nitty gritty we will see that the x number of criteria for BPD can be applied to almost any disorder. For example just a quickie for now, cutting and splitting is also common in bipolar too. Abandonment is over played in BPD in that it is suppose to be the hallmark for BPD, like lack of empathy is the hallmark for aspd. Actually a similar case can be made about empathy with aspd I may touch on that one later too. Basically a lot of people have abandonment issues. I certainly do, not denying it, so do biplar and ptsd too. More later I promise.

[The_little_didgee]

Originally Posted by IndieVisible

The reality of this procedure is pdocs do not always agree on each others diagnoses and often are wrong.

They rarely ever agree.

Once a psychiatrist makes up their mind on what diagnosis a client has, they become severely myopic.

Originally Posted by IndieVisible

Well first of all many of the traits and symptoms overlap or exist in other disorder. Many of us can relate to other symptoms and traits as well. The moment we are told that's us, we begin to mirror that even more. I can personally relate to and identify with a number of disorders in various categories. One could easily adapt even further to what they are told they are.

The criteria for BPD is so broad and open to interpretation. I find this very disturbing.

Some people get labeled with BPD, because they self injure or are just challenging patients even if they do not meet the minimum criteria. This can cause a lot of harm and is an example of how BPD can be misused.

[allme]

Originally Posted by IndieVisible

I believe "abandonment" and "triggers" can be applied to almost any disorder. When I get down to the nitty gritty we will see that the x number of criteria for BPD can be applied to almost any disorder. For example just a quickie for now, cutting and splitting is also common in bipolar too. Abandonment is over played in BPD in that it is suppose to be the hallmark for BPD, like lack of empathy is the hallmark for aspd. Actually a similar case can be made about empathy with aspd I may touch on that one later too. Basically a lot of people have abandonment issues. I certainly do, not denying it, so do biplar and ptsd too. More later I promise.

Ok so we have a hallmark for this and a hallmark for the other which are also in BPD and other disorders. But then BPD is BPD because of these hallmarks and other symptoms all bunched together to create BPD. Which is why I think it's important all of the symptoms fit. If there are other symptoms not covered then the possibility of something else may be in play. The problem with traits and symptoms over lapping is a possible incorrect dx which I have already gone through.

[allme]

Originally Posted by The_little_didgee

Some people get labeled with BPD, because they self injure or are just challenging patients even if they do not meet the minimum criteria. This can cause a lot of harm and is an example of how BPD can be misused.

This is why I believe the whole of the glove should fit. Not just one or two of the traits but at least 90% of them....and to a degree where the person is not able to function in the real world to a satisfactory standard that is not causing them significant harm and distress.

[IndieVisible]

Originally Posted by allme

Ok so we have a hallmark for this and a hallmark for the other which are also in BPD and other disorders. But then BPD is BPD because of these hallmarks and other symptoms all bunched together to create BPD. Which is why I think it's important all of the symptoms fit. If there are other symptoms not covered then the possibility of something else may be in play. The problem with traits and symptoms over lapping is a possible incorrect dx which I have already gone through.

You would think except the counter argument for that is simply we already had those criteria in place for a milder version of bipolar. See they inject 2 new traits which pretty much everyone or a lot of people already had, abandonment and self harm and created BPD in the personality division ignoring the fact that many bipolars have that too. This could very well have been called Borderline Mood Disorder or Bipolar 3 if they wanted a distinction that made sense and cause less confusion.

Remember: no one is denying the symptoms or traits! Just the classification of it.

[allme]

Originally Posted by IndieVisible

You would think except the counter argument for that is simply we already had those criteria in place for a milder version of bipolar. See they inject 2 new traits which pretty much everyone or a lot of people already had, abandonment and self harm and created BPD in the personality division ignoring the fact that many bipolars have that too. This could very well have been called Borderline Mood Disorder or Bipolar 3 if they wanted a distinction that made sense and cause less confusion.

Remember: no one is denying the symptoms or traits! Just the classification of it.

Ah you see, I never knew that! That's interesting....

[IndieVisible]

And there you see the heart of this debate what is Borderline? A mood disorder or personality disorder? Well for now the majority of the mental health field professionals consider it a personality disorder, but NOT without resistance or constant debate. Many feel it should be in the mood disorder category because those new criteria used for making it a personality thing are and have been present with bipolars. So what exactly made it a personality disorder then?

You will hear a couple of things.

1. Well a Bipolar mood swings for longer duration.
2. A BPD mood swings are shorter duration.

Well they seem to agree it's a mood disorder there lol. The durations can easily be explained as simply a milder version of bipolar.

3. Yes but bipolar is triggered by chemical imbalanced and BPD is triggered by events.

Says who? There is even disagreement here! Recently doctors noticed thyroid changes in BPD people when their mood changes just like in bipolar people! Also, the idea of what causes the trigger is not enough even forsake of argument assuming is true not enough to warrant a massive change to a personality disorder.

[shortandcute]

Wow-I think you're thinking this a bit too hard maybe? I mean I can see your points, but really, in the long run--who cares?

[IndieVisible]

Originally Posted by shortandcute

Wow-I think you're thinking this a bit too hard maybe? I mean I can see your points, but really, in the long run--who cares?

As I said I really don't care and make no stand one way or another but am bring this to the table because it is a hotly debated subject among top mental health professionals and a perspective that many might not otherwise have been aware of. Since there seems to be so much interest in BPD I thought a dedicated thread regarding it's controversy is in order. I am not as I said from the start trying to persuade people one way or another. I really don't care that much. I am bring a brand new perspective to a lot of people and playing the devil's advocate for it to provide a fair balance in the discussion. I feel people deserve to know the truth and the whole story and make up their own minds.

[greentires4me]

but as a BPD person its like when it rains it really pours. It really gets too much these days as BPDer we find ourselves with bits of paper trying to make a full picture as to what we are feeling at any given time. BPD is a long or polite scope of saying you might show signs of schiophrenia, narrasstic, paranoid, Bipolar, and depression etc. its a wide umbrella that has not been clearly marked out as its own space in time. its been a calculation of different things to be classified as BPD. its a riddle as much as Autism is...the how and whys don't connect up or down. its like the symptoms could explain someone with major depression or Bipolar or OCD, or DID or etc. Its not clear where they show up at just that if our parents weren't there all the time or even in high school when we might of gotten tortured by our peers.

What is clear that I have it and major depression and BPD with schizotypal...so I may be a loose cannon one day and the next day I am walking zombie and the next moment I am bottle full. I may have not agreed with it but its so what it is.

[ultramar]

I believe there are very important -and glaring- differences between bipolar disorder and BPD. I do not think there's any evidence to prove that 'abandonment' is an issue with those with bipolar -except in instances where they have been diagnosed, additionally, with BPD.

The difference between duration of 'episodes' between bp and bpd are very important. Because it's not just a matter of 'duration' per se, but of the origins of the moods and behavior. I think one of the reasons mood episodes last so much longer in the case of bipolar is because they are not being *constantly* triggered from one mood to another. And it's this triggering (and relative lack thereof, or not on such a constant basis) in the case of bipolar, that sets it apart from BPD.

Once someone with Bipolar enters into an episode, of course they may be affected throughout by things going on in their environment. But these do not cause them to 'switch' so radically up and down and otherwise due to those occurances. *Despite* them, in fact, they will continue down the road of the mood-episode they have entered into. On the other hand, my understanding is that in the case of someone with BPD, each mood that is triggered by something going on in the environment is all-consuming; the mood radically changes, and the new mood, whether it lasts for minutes or hours, *is* the mood, all-encompassing. It is a rollercoaster, of up and down and other moods, each very intense, rather than a *pervasive* (relatively consistent) mood that goes on and on and on, not *suddenly* and *abruptly* brought down into depression and then into irritability because of something that happened.

So, pervasive versus sudden and short lived.

I think BPD is more about triggers (and the nature of those triggers) than mood per se. I think it is because of this that treatments such as DBT, from what I know about it, works on triggers so as to avoid the 'moods' in the first place, whereas treatment for bipolar concentrate on changing the mood (a bipolar episode may begin with a 'trigger' but it will not typically then go on a roller coaster of different emotions/moods due to a series of triggers after triggers, within a given day).

Lastly, the latest DSM incarnation has added to the bipolar criteria, that not only a change in mood must be present, but change in energy. And I think this makes an important distinction between bipolar and BPD: someone with BPD may vascillate between depression and irritability, but that irritability -with the new criteria- would not be considered 'hypomania' by virtue of the 'mood' itself --what has to come along with it, is an enormous increase of energy, often characterized by little or no sleep and yet an enormous of amount of energy/not feeling tired.

Okay, now lastly, I think much of BPD is a 'disorder' of relationship and the kinds of triggers from which BPD symptoms ensue, have to do with relating to others, in one way or another. Bipolar triggers are not so limited to this. I have also not read/seen evidence that black and white thinking, projective identification, feelings of emptiness, lack of stable identity are part and parcel of bipolar disorder. Some of these may be present to some extent or another, but they are not at the core of the disorder, or the moods.

I do believe they are very different disorders. I don't know if one should be classified as a 'personality disorder' and the other a 'mood disorder' but however the distinction is made, as far as label, I think the distinction should be made, because they are very different. And treatment is different.

[IndieVisible]

Actually treatment is pretty much the same for BPD and Bipolar and tests have revealed very similar results from the same meds for both.

The duration and "energy" level is also still very much in dispute as well. Again most people are comparing BPD to the current two levels of bipolar which does not reflect a 3rd level that Borderline could play. A distinction should indeed be made and we pretty much disagree on if it should be mood or personality. May find more similarity with mood disorder then with personality disorder and that is the heart of the debate among professionals, why make it a personality disorder? Because of triggers? Duration of mood swings? Amount of energy with mood swings? Notice we are still talking about mood swings. Indeed the bottom line is this Borderline distinction is better fitted as a mood disorder not a personality disorder.

So again it comes down to why is it a personality disorder? And how does
1. duration of MOOD swings
2. level of MOOD swings
some how make it not a mood disorder but a personality disorder?

[ultramar]

Making the diagnosis:

Some may not like me saying this, but I do think that, due to the enormous stigma of BPD, there may be a tendency for some of those with BPD to want/prefer a bipolar diagnosis. This can involve interpreting their own symptoms in light of bipolar criteria, including attempting to fit into the criteria, perhaps often on an unconscious level. I think this makes sense given the stigma, but I also think it can impede recovery.

I think there's also a tendency to say/think: well, if I behave in such and such a way, if it's bipolar, it's "not my fault." However, if you behave in the same way, if you're diagnosed with BPD, "it *is* your fault." I personally do not buy this. At all. But I think the tendency to think this way, can lead one down the road of a bipolar label when it may not fit.

Back to misdiagnosis: if you have BPD, and do not work on the triggers, and attribute all moods and behavior to bipolar, then it will become difficult to gain the insight needed into what is triggering the mood/behavior, and work on that. The moods and behavior become something that is out of one's hands, and that needs to be treated with medication, perhaps medication alone, or primarily this. I don't think this bodes well for appropriate and potentially successful treatment.

I think some psychiatrists are responsible for misdiagnosing for all kinds of reasons -and I think this is hugely irresponsible.

I have read that many psychiatrists will diagnose bipolar II rather than BPD because this way they will be reimbursed by insurance companies. Because they don't want to saddle their patient with the stigma of BPD. Because they never get to know the patient well enough to be sure of a BPD diagnosis, so they err on the side of bipolar. Because there are many good medications these days for bipolar, not so much for BPD, and prescribe meds is what pdocs do. So they err on the side of diagnosing something they can medicate; I have read this in multiple places.

I have seen tons of people on PC having been diagnosed BPD by their pdocs and then never tell them. They only find out when they see their medical records or directly ask for them. Meanwhile, some, they may think they are bipolar. Hugely irresponsible, as I say.

I think the diagnosis of Bipolar II has been overused. I see people diagnosed with this who experience primarily depression and irritability (deemed 'hypomania') but without the energy changes required for bipolar. I also see the term 'rapid cycling' bipolar pervasively misunderstood and misused. 'Rapid cycling' refers to having 4 or more episodes a year, and yet many people attribute cycling many times within a given day to 'rapid cycling.' This, in theory, exists, but is very rare --however on bipolar boards, you will see it way overrepresented sometimes in those who also hold a diagnosis of BPD. How on earth do you distinguish 'rapid cycling' bipolar (using the erroneous definition of constant mood changes) and BPD? As I said in a previous post, there is a tendency to want to avoid the stigmatizing diagnosis of BPD, so some people will define themselves as 'rapid cycling' bipolar, but defining this as a constant roller coaster ride. You have to wonder why it is more commonly those with a diagnosis of BPD who label themselves (or are labeled) 'rapid cycling.'

Lastly, there is an article on PC today citing new research that antipsychotics, over time, lessen brain matter volume. Not only has this now been discovered to be a huge long-term risk of these drugs, but the short-term side effects can be devastating (sedation, weight gain leading to diabetes as well as other illnesses). So to prescribe someone antipsychotics, due to misdiagnosis, can have enormous consequences. All the more reason to make accurate diagnoses: this means psychiatrists being far more responsible, and patients not erroneously identifying with a disorder, for all kinds of understandable reasons, they may well not have.

My 10 cents.

[IndieVisible]

appreciate everyone's 10 cents lol.

Certainly as I pointed in the beginning there are two other sticking points related to this issue. One the stigma that is associated with it as u pointed out, and more importantly imho is the insurance issue regarding this. But those are not the main reasons for this debate at all. I added them in because I do feel it is worth mentioning.

You are aware that before BPD came to be, they were simply a form of bipolar. Also in the present, about half of bipolars are said to be misdiagnosed as bpd, and about half of bpd are said to be misdiagnosed as bipolar. If PROFESSIONALS can not sort that out so easily, certainly it demonstrates how similar bpd is to a mood disorder. They are not confusing it with another personality disorder, but with a mood disorder

[MoxieDoxie]

Originally Posted by IndieVisible

This post will examine how easily people follow. Regardless what diagnoses we are given, patience go home start researching their diagnoses and immediately begin mirroring it, they begin to say "yup that's me totally!" and feel better they at least fit some where and know what's wrong with them.

The reality of this procedure is pdocs do not always agree on each others diagnoses and often are wrong. Also I think so many people want to fit in some where so bad they accept what ever they are told because at least they finally fit some where and know what's wrong with them! Not all of course but certainly most.

So it doesn't matter what you are diagnosed, bipolar, pdsd, bpd, you go home start reading about it and begin identifying and mirroring it. But how can that be?


Well first of all many of the traits and symptoms overlap or exist in other disorder. Many of us can relate to other symptoms and traits as well. The moment we are told that's us, we begin to mirror that even more. I can personally relate to and identify with a number of disorders in various categories. One could easily adapt even further to what they are told they are.

Well what else am I suppose to do when your therapists says you are BPD and it is just fear of abandonment......I go home and researches it because I left his office so confused. He never explained anything.

[ultramar]

Originally Posted by IndieVisible

Actually treatment is pretty much the same for BPD and Bipolar and tests have revealed very similar results from the same meds for both.

The duration and "energy" level is also still very much in dispute as well. Again most people are comparing BPD to the current two levels of bipolar which does not reflect a 3rd level that Borderline could play. A distinction should indeed be made and we pretty much disagree on if it should be mood or personality. May find more similarity with mood disorder then with personality disorder and that is the heart of the debate among professionals, why make it a personality disorder? Because of triggers? Duration of mood swings? Amount of energy with mood swings? Notice we are still talking about mood swings. Indeed the bottom line is this Borderline distinction is better fitted as a mood disorder not a personality disorder.

So again it comes down to why is it a personality disorder? And how does
1. duration of MOOD swings
2. level of MOOD swings
some how make it not a mood disorder but a personality disorder?

For one thing, there's a big difference between a constant roller coaster ride, up, down, up, down, stuff in between, as intense reactions to what's going on in one's environment and long, pervasive moods. In some ways, perhaps one is more of a 'reaction to triggers' and the other more of a case of 'mood.' There's a big difference between maintaining, more or less, the same 'mood' over a long period of time, and fluctuating between many moods (or reactions) over a very short period of time. It's just very different.

[ultramar]

Originally Posted by IndieVisible

appreciate everyone's 10 cents lol.

Certainly as I pointed in the beginning there are two other sticking points related to this issue. One the stigma that is associated with it as u pointed out, and more importantly imho is the insurance issue regarding this. But those are not the main reasons for this debate at all. I added them in because I do feel it is worth mentioning.

You are aware that before BPD came to be, they were simply a form of bipolar. Also in the present, about half of bipolars are said to be misdiagnosed as bpd, and about half of bpd are said to be misdiagnosed as bipolar. If PROFESSIONALS can not sort that out so easily, certainly it demonstrates how similar bpd is to a mood disorder. They are not confusing it with another personality disorder, but with a mood disorder

As I said, I think the apparent 'difficulty' in distinguishing between the two is less a product of their similarities than due to other issues: insurance, stigma, medications (they *are* generally more effective with those with bipolar) and people presenting themselves as bipolar (perhaps not consciously) when perhaps they are not, due to the stigma.

In brief, I do not think the misdiagnoses are primarily due to similarities between the two disorders --there are other things at play.

Additionally, there was a huge study done (out of a university in Rhode Island?) of hundreds of people diagnosed with bipolar, who were given very very thorough evaluations (far more extensive than most pdocs will do) and the majority, it turned out, were misdiagnosed (most actually had BPD). So, according to this study, if you do the evaluation right, if it's very thorough, it's not so hard to distinguish.