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    Differentiating bipolar disorder from borderline personality disorder
    Joseph F Goldberg, MD posted:
    Borderline personality disorder is a condition in which people can very easily become angry and upset in response to stresses -- especially stresses involving relationships. Borderline personality disorder also can involve periods of feeling suicidal, not so much out of clinical depression but as an expression of distress. Moodswings, and trouble managing extreme mood states, are hallmark features of borderline personality disorder, although sudden or abrupt moodswings are not part of the definition of bipolar disorder. People with borderline personality disorder may feel inclined to injure or cut themselves as a way of relieving distress, although self-injurying behavior is not part of bipolar disorder. People with borderline personality disorder often see other people or situations as "all good" or "all bad" rather than in the middle. They may also have a tendency to project their own emotions on to other people, rather than acknowledge them as their own (eg, anger) and may therefore often feel victimized or taken advantage of. The term "borderline" refers to the "border" between reality and psychosis, meaning that under times of stress, people with borderline personality disorder may become paranoid or unduly suspicious or even hallucinate. An unfortunate aspect of borderline personality disorder involves longstanding chaos and stormy patterns in relationships. It can be very disabling. Specific forms of psychotherapy have been developed that are the most effective known form of treatment. Medicines in general have only modest value.

    About 10% of people with borderline personality disorder may also have bipolar disorder. Bipolar disorder involves periods of intense energy, overactivity, getting by with very little sleep and not feeling tired the next day, and extreme productivity. Mood problems are only one aspect of bipolar disorder, and some researchers think that the high energy states of bipolar disorder are more important and specific to making the diagnosis than mood, since mood problems can occur from many other causes.
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    Indiaguerita responded:
    Borderline Personality Disorder sounds more like what I am. I was diagnosed with Bipolar in May/June and I have some of the symptoms of Bipolar, but not all.

    I have the paranoia and suspicion of someone with BPD...

    I am going to mention that to my psychologist during one of my sessions...

    I am currently taking 50 mg of Lamictal to treat the Bipolar, but now I'm wondering if maybe it's not Bipolar but BPD.

    Thanks for sharing this information...very interesting.

    appyannie responded:
    I sometimes wonder if there is a tendency to cover symptoms with an axis 1 diagnosis when possible because there is medication for those whereas an axis 2 is more likely to require more extensive psychotherapy and less benefit from meds and therefore are less likely to receive a positive nod from third party payers. This might leave the clinician in a bind as to how to serve the best interests of the client.

    sheila000 replied to appyannie's response:
    Annie, I think this happens a lot. It is a "follow the money" thing. Thank you for bringing it out.
    krystalelaine replied to Indiaguerita's response:
    Thats exactly how I am. i have the bipolar symptoms but I also have frequent and sudden anger/jealous/paranoia/suspicion "rages". They are so bad, I never remember when its all over and everytime I feel like Im starting to mad I automatically think hes mad at me for something. It just turns into a BIG MESS!! Ive done some research and am going to make an appointment with my Dr. as soon as I can!!
    courtneedawn responded:
    kind of confused about this cause i have been diagnosed as both but without tha bipolar meds i am much worse acting than when i take them without tha bipolar meds i dont sleep or eat i just clean n shop n go everywhere then about 4 months later i cant get out of bed n think about sucide and sometimes act on it so i dont know if this is bpd or bipolar or both because i have been on meds for so long so how do u tell cause im different with meds than i am without them
    sheila000 replied to Indiaguerita's response:
    I worked in the correctional system in CA before my job got cut. Many women in the system had this problem of being borderline but taking meds for bipolar that weren't working. I think this is widespread as meds are easy to give out while therapy takes time. Government and people want the easiest way to handle problems. This is a problem.
    An_188868 responded:
    It's still hard for me to see the distinction between the two, especially since borderline is set apart as a personality rather than a mood disorder. It's also very strange to me that it's almost exclusively diagnosed in women which makes me wonder about whether there's some kind of gender bias going on.
    Joseph F Goldberg, MD replied to An_188868's response:
    Think of the distinction more as, bipolar disorder is mainly a disorder of energy, cognition and sleep (with mood being an associated aspect), while borderline personality disorder mainly involves problems in the ability to regulate one's emotional responses and behaviors (usually aggressive behaviors) to stresses from the environment and other people.

    - Dr. G.
    BipolarDisorder2 replied to sheila000's response:
    Shelia000: Congratulations on your carreer, hopefully you were able to make a positive difference in the lives of those amazing women. Were you a PO or a CO...? Just curious ;p

    I'm a Criminal Justice/Criminology major w/ a Corrections concentration, and I spent 4 months working with parolees/probationers (many of whom were sex offenders) for an internship. My ex-boyfriend did time, so the prison population and the parolee/probation population are VERY close to my heart. I'm planning on getting my Masters in Criminology and my Doctorate (AHHH) in Criminology but I would also liek to do parole...we shall see.
    Indiaguerita replied to BipolarDisorder2's response:
    BP2 -

    I'm going to say this as carefully as I can so that it won't be deleted:

    I don't think Sheila is around the boards any longer...


    SaraMPH responded:
    Dr. Goldberg, This description you posted has been quite enlightening as I am concerned about my husband. He has many of the BPD characteristics, such as seeing all good or all bad, projecting his anger, and perhaps a little paranoia in the past (I think he may be insecure). He has been dealing with job loss for a long time now, like over a year. So depressive characteristics to him seem "normal" based on his situation. Recently we both began following the bipolar discussion thread as he has bouts of extreme productivity and energy, so much so that we even joked about his "jekyll and hyde" personality. He has never been suicidal or into self-injury, but gets angry from the stress of finding a job, and can get angry with his family and blow up at them on a dime (suddenly, somewhat unexpectedly).

    What good could come of determining if there is a diagnosis? Perhpas these are just personality characteristics....I can't determine where to draw the line when it comes to this.
    Joseph F Goldberg, MD replied to SaraMPH's response:
    Dear SaraMPH,

    An actual evaluation with a mental health professional can lead to recommendations about whether or not he might benefit from some type of treatment, whether that were medications, psychotherapy, or both. Personality disorders don't spring up overnight...they typically are evident by adolescence. Also, in the setting of unusual stress, like job loss, anyone might be expected not to be at their best in terms of personality characteristics and structure, or resiliency and the capacity to adapt to stress. Also, if his "blow ups" are placing unusual stress on your relationship with him, or his relationships with others, clarifying whether that comes from his coping style (psychotherapy may be useful) versus something else for which medication may be useful would be some potential benefit of a consultation.

    - Dr. G.
    FirstMate53 replied to Joseph F Goldberg, MD's response:
    Dear SaraMPH and Dr. Goldberg,
    I thought you were describing my husband. He lost his mother 14 months ago and I don't know this man. We have been to the psychiatrist, he is on Depakote, and psychologist. Therapy didn't help, he either denied feelings or lied and said everything was my fault. I can't get a diagnosis from his therapist, he won't talk to me, and I feel left out in the cold. We have started seeing a marriage counselor but she doesn't think it will work. She says he doesn't have an emotional investment into the marriage. My husband loves me but I can't reach him. We have only been married 4 years and looking back I see now things I didn't noticed then. I am just trying to be as happy as possible. Any suggestions?????
    ThePhoenix888 responded:
    Thanks for this discussion. This really sounds close to what I am: Bipolar/borderline pd.

    Do these diagnoses change over time?
    I have taken the MMPI many times during hospitalzations. I think I got an atypical personality disorder a couple of times, and a bpd once or twice too.

    I was classified a rapid cycler bipolar early on when I was hospitalized, and meds seem to only work for short periods of time. Could this be because therapy for the bpd or the atypical was not really addressed. The solution is always very quickly the meds, but other longer term costly solutions get overlooked.

    So what is your advice. What is the standard treatment for bpd?

    Thanks in advance for your insights.

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