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Borderline personality disorder
Joseph F Goldberg, MD posted:
Hi folks,

Given the many areas of overlap between bipolar disorder and borderline personality disorder, there is often a temptation to ignore the unique features of borderline personality disorder and pretend it is identical to bipolar disorder. Unfortunately, borderline personality disorder has different treatments than bipolar disorder, and medications often are not very useful. There is an excellent and informative website maintained by Dr. Robert Friedel called BPDdemystified which has a wealth of information on this condition, which is easily confusable with bipolar disorder.

- Dr. G.
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32 of 39 found this helpful
hope7951 responded:
There are so many people who either have a dual diagnosis or who have been treated for bipolar when BPD could have been resolved if treated properly. This is excellent information for a mistake that is made much too often.
ThePhoenix888 responded:
Dr G:

I was wondering if you could help me. I wrote to you before about BPD and also the "atypical personality disorder" categories I got on the MMPI. I would swear I got those results several times on the test in the 1990's.

I did a quick search of the current version of the DSM, and the top results for "atypical" were the newer antipsychotics and a category of "atypical depression". Has the category "atypical personality disorder" been phased out? Is it called something else now, or am I wrong, and maybe just not remembering correctly?

When I asked the doctors at the hospital what it meant, they just told me not to worry, everybody gets some sort of slot they are put into, so not to worry. And then I was told, of course, to just take your bipolar meds and you will be just fine. LOL

Thanks for your input.

phoenix out
Joseph F Goldberg, MD replied to ThePhoenix888's response:
Dear Phoenix,

It may be more useful to think of personality structure along the lines of "clusters" -- A, B or C, as the DSM calls them. A corresponds to odd, paranoid, patterns with strange or idiosyncratic ways of thinking (rather like a mini version of schizophrenia); B corresponds to highly dramatic, impulsive or emotionally volatile styles (a mini version of bipolar, if you will) and C corresponds to withdrawn, insecure, avoiding contact with people, and self-doubting (kind of depressed and anxious). "Personality disorder not otherwise specified" has always meant that someone's personality structure does not neatly conform to one of the pre-existing categories, but has elements of A and/or B and/or C. So more important than which slot someone falls into would be understanding what cluster(s) best describe their style and structure in relationships and world view. Medicines also don't do a lot to change's more fundamentally a descriptor of who someone "is." Maladaptive aspects of personality (like, blowing up when faced with frustration, or tendencies to blame other people for how one feels, or feeling empty or dead inside) can be tempered through psychotherapy, but fundamentally, we are who we are.

Hope that helps.

- Dr. G.
ThePhoenix888 replied to Joseph F Goldberg, MD's response:
Dr G:

Thanks for your input. It really helps. I think I will give those 2 therapies you mentioned for BPD a try. And I will take the MMPI again to see exactly wheree I am at, to address A, B, and/or C.

Thanks again,

Afraid4MyFuture responded:
I am glad to have found this site. I have been treated for bipolar for 3 years now. Nothing is working, we have changed meds so many times I just want to ask for lithium and become some passive drooling zombie. But I can't. I am currently attending nursing school and refuse to let this get in the way of my future even though I am uncertain and afraid for my future. I fully believe I have BPD and that is why the current treatment is not working. I have no phsychiatric coverage and feel as if I will struggle with this forever. And i am going to have to do it alone because i would not expect anyone to go the long run dealing with the crap i dish out while trying so hard to stop it at the same time.
ddnos replied to Afraid4MyFuture's response:
Hi Afraid.......I just have one comment and that is where you s aid that you just want to ask for lithium and become some passive, drooling zombie.

I just want to let you know that when lithium works for a person and they are not given too much, it doesn't turn someone into that passive, drooling zombie you speak of. I have been on lithium for 20 years, and if it did that to me, I'd be off that stuff so fast!

I don't know if you have that image of lithium based on various movies or you've seen people like that, but either way, that's not how lithium works when given properly. Some people may have that kind of reaction to it, but then that would not be the med for them.

Another thing you may want to ask your pdoc given that you've tried so many meds w/o success, is ask about MAOI's. They are generally not given as a first choice med, but when nothing else works, some pdocs will try that. MAOI meds such as Nardil or a patch called EmSam, and I can't remember the name of another commonly prescribed one. I was treatment resistent and nothing else worked and then my doc tried Nardil and have been on it ever since - 20 years!

Just a thought.

Forgiveness is letting go of the hope that the past could have been any different --Unknown

Featuring Experts

Joseph F. Goldberg, MD, is a Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. He also maintains a private prac...More

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