"Bipolar or Borderline? A Widely-Used Diagnostic is Getting it Wrong"
Hello again,
I often read of the common overlap between Borderline Personality Disorder and Bi-Polar Disorder so I would like to share and learn of our experiences in relation to this concept. I know Borderline rarely travels alone and it is important to note that a comorbid diagnosis could be present in some of us. However, I think it is important to differentiate here because these illnesses are in fact not the same.
It was found in a recent study that using common diagnostic tools could often lead to incongruent results regarding mental health on this topic specifically.
"In the article that appears online ahead of print in the Journal of Clinical Psychiatry, the researchers question the effectiveness of the Mood Disorder Questionnaire (MDQ). The MDQ is the most widely-used and studied screening tool for bipolar disorder. It is a brief questionnaire that assesses whether a patient displays some of the characteristic behaviors of bipolar disorder.
The research team interviewed nearly 500 patients using the Structured Clinical Interview for Diagnostic Statistical Manual IV (DSM-IV) and the Structured Interview for DSM-IV for personality disorders. The patients were also asked to complete the MDQ.
The research team then scored the questionnaires and found that patients with a positive indication for bipolar disorder using the MDQ were as likely to be diagnosed with borderline personality disorder as bipolar disorder when using the structured clinical interview.
Further, their findings indicate that borderline personality disorder was four times more frequently diagnosed in the group who screened positive on the MDQ."
Psychology is a relatively new frontier and therefore, highly imperfect. That is, we are in a constant state of learning and publication/diagnostic renewal. It is not uncommon for these two disorders to be misdiagnosed as one another, or as something else entirely. So, what are the differences between Borderline Personality Disorder and Bi-polar Disorder? The article continues:
"According to Dr. Friedel, director of the BPD program at Virginia Commonwealth University, there are two main differences between BPD and bipolar disorder:
1. People with BPD cycle much more quickly, often several times a day.
2. The moods in people with BPD are more dependent, either positively or negatively, on what's going on in their life at the moment. Anything that might smack of abandonment (however farfetched) is a major trigger.
3. In people with BPD, the mood swings are more distinct. Marsha M. Linehan, professor of psychology at the University of Washington, says that while people with bipolar disorder swing between all- encompassing periods of mania and major depression, the mood swings typical in BPD are more specific. She says, "You have fear going up and down, sadness going up and down, anger up and down, disgust up and down, and love up and down."
Discuss: What has your experience been with diagnosis and treatment? Do you feel it is accurate? What are some things your loved ones and care providers misunderstand about your illness?
Visit the Source: "Three Ways to Differentiate Bipolar and Borderline Disorders", Randi Kreger, Psychology Today
I have both diagnosis but on the note that BPD has more expressed and frequent changes in mood- I think that could also be rapid cycling bipolar. I do however agree about the causation behind the changes in mood being more dependent on circumstance specially fear of abandonment or rejection in BPD whereas bipolar is more biological and therefor chemical. I experience more Borderline type swings ie fleeting and rooted in circumstance and behavior of others though I can definitely pinpoint periods of chemical imbalance that I would attribute to being bipolar. I think comorbidity esp with these diagnosis is extremely common and BPD almost never travels alone as it is a learned disorder (personality disorder) with a major predisposition Caused by having a mood disorder (chemical imbalance).
Having differentiated between the two- I truly believe the same behavioral approaches apply, regardless of the root. Mindfulness, looking at our symptoms and feelings before they turn into behaviors, and creating a supportive network of friends and family with whom we can have dialogue on these matters is essential. Though it should be noted DBT/behavioral therapy is effective for both disorders where as medication is only an accepted therapy for bipolar.
@SelenoPsych21
Thank you for sharing! I always cherish your insight. 
I agree on the rapid cycling diagnosis. I have come across many variations of Bi-polar disorder in my reading including its less severe variation, Cyclothymic Disorder.
BPD has been shown to respond to pharmaceutical interventions in conjunction with therapy as well, and has evidence based results in biology and physiological changes in the brain also. For example, the the limbic system of emotional regulation, danger, and fear is overactive. Similarly, the pre-frontal cortex of higher order thinking is less active. This indicates a biological difference in individuals with BPD perceiving the world around them as angry or hostile, when in fact that may not be the reality. These findings are so important as people continue to learn that mental illness is in fact a medical condition and one not to be snapped out of. It does include a predisposed vulnerability matched with environmental factors. This is where Bi-polar disorder becomes less compliant and perhaps not worse, but more disheartening, in that you seldom have a reason or a trigger, making treatment more difficult. Without a current diagnosis I can say it can be difficult, primarily when I FEEL the change as unreasonable or non-circumstantial. Awareness has allowed me to detect my mood swings, but leaves little to be done about them.
Support systems are so important, primarily in a world where stigma and silence allow suffering to thrive.
Do you find yourself easily discouraged living with both?
@blitheSun94 well your continued effort in creating this space is always appreciated. That is a great question. For the most part I've found the knowledge has been my ally where I previous has only confusion and loneliness. Being diagnosed bipolar when I was about 19 after a 5 year diagnoses of depression that didn't quite fit was a blessing, I felt like "okay I'm not crazy, im legitimately ill" and even more so with the Borderline diagnosis. It fit. It gave a pathology and therefor a treatment and plan to what was otherwise Judy feeling "crazy". I firmly believe education in mental illness not only on why and what we have but how to cope and move forward is the single most valuable element to wellness and for me- I had to focus on just that: moving forward. I can't dwell on the differentiating ie "is this my borderline or bipolar." Which is why I noted that I think it's more important to look at the mood and behavior themselves and go from there. When I get irrationally angry- I look at why, who, what, when and there is often a root but whether or not that was a chemical or situational trigger- I have to refocus and be mindful and move into a healthier head space. So I find differentiating maddening and don't try to label those things too much :)
@SelenoPsych21
"Moving forward" is beautifully stated here. I know a large part of Dialectical Behavioral Therapy, a therapy designed specifically for the struggles of BPD, is radical acceptance. Which is invaluable given the temperament of this illness. I think you've illustrated the importance of neutralizing your head space so as not to dig too deep into the specifics. Essentially, asking the mind to understand itself is an unfair task. In this case, finding stability, developing skills, and thriving function outweigh a maddening attempt in analysis.
Thank you for sharing!
@blitheSun94 likewise ❤️
Hi! I posted in this group about 20 min ago and someone referred me to you @selenopsych11. Please help me!
@blitheSun94
My daughter has been diagnosed with both. I completely agree with the bpd but not bipolar. Her mods change by the minute reacting to everything. I have not seen any manic that wasn't in response to something fun or great happening.
Her state insurance gives her limited options, and the new doctor she sees asked us what borderline is, and said "oh, Bipolar, yes, this she has" and dismissed everything else! It's terribly frustrating. And with her depression, moods, etc, it's hard enough to get her to follow through getting help.
Hello! I am new to the site! Can anyone tell me a little more about testing for bi polar? I have not went to the store so I have not been officially diagnosed. However sometimes I think I might be. Any output, help, suggestions, or info about bp would be helpful. Thanks.
@Sunshine020280
Welcome! I would like to refer you to @SelenoPsych21 on this topic. She will be better suited to answer your questions.
Enjoy your stay.
Thank you
@blitheSun94
I have both diagnoses, and I identify more with one over the other. My therapist has posited that my BPD diagnosis may have been mislabeling in a pre-acute stage of the development of Bipolar.
I have often read about mislabeling, and have heard from many that they were diagnosed with one, only to find out from a psychiatrist that they exclusively have the other. I think it's something that's really important to talk about.
Ultimately, I try to stay away from labels and am simply honest about how I identify with my own feelings. That way, I know we are targeting symptoms over constructs.
@Lee
You bring up a great point about the importance of symptom based treatment. This is often frowned upon. Why do you think this is the case?
Thank you for sharing! ♡
@Lee @blithsun94 I recently went through this, as well as at other times in my treatment. ie "you don't have depression, you are bipolar"; "No you are Borderline", and recently "you have major depression and generalized anxiety disorder, not bipolar." The thing is- as it follows the diagnostic criteria- our symptoms can change and therefor our diagnosis is fluid, not a label to put on and stick with but rather a way to help us see the pathology and treatment that works best for that set of criteria. I agree that symptom based assessment and treatment, with a very light to no focus on the actual diagnosis has worked best for me.
I was also diagnosed with both disorders by a group of doctors during an inpatient stay. I think I describe having both in a similar fashion as you all seem too; one (borderline) is my reaction to situations and feelings the other is my mentality towards everything for a much longer period of time. It's the personality disorder versus the mental disorder, is how I look at it. I've talked to a lot of people who are so uncomfortable with the labels and I encourage them to just focus on treating the symptoms, I'm really glad to see I'm not alone with this mindset.
@Sweetteaa extremely well said, i can relate to the need to treat symptoms away from any sure diagnosis. They can end up hindering our healing more than anything. Thank you for your input. <3
@Sweetteaa
This reminds us to be wary of clinging to labels. While it can sometimes to be a relief to understand that there is something off kilter, something treatable even!- it can be tempting to get lost or become disheartened by the diagnosis itself. I think returning to symptom based treatment is an excellent way to keep perspective, and achieve some semblance of functioning,
I have been diagnosed Bipolar, but I am entirely sure it is a misdiagnosis. I know that I have BPD, but the doctors that I went to at an inpatient stay wanted money more than they wanted to help me. My therapist knows about this diagnosis, and says he has no opinion of it because "he doesn't like using labels". Oftentimes, I find myself lying to him about what's been going on in my head, and I pretend that everything is fine. I actually do this with everyone, but can't help my emotions sometimes. My mom always writes it off me being 'dramatic' or that my medication needs adjusted. I'm scared to tell anyone what really goes on, because I'm afraid they aren't really going to 'look into it', and are just going to say is because I'm Bipolar. I'm also afraid of discrimination. Its si frustrating.
@blackparadeisdead
It sounds like you're feeling very alone despite being surrounded by a lot of people. I am sorry the ones in your life don't understand your experience. Try to give them as much grace, patience, and education as possible. It is likely your doctor is sticking with an axis-I diagnosis (psychological disorders) because your insurance company is more likely to pay out. Bipolar disorder is treated with a combination of medication and therapy, whereas BPD is an Axis-II (personality disorder) diagnosis treated with long-term, often years of, intensive cognitive and behavioral therapy with sometimes dismal outcomes and utilization of numerous resources including a high percentage of inpatient hospitalizations. It has improved in recent years thanks to Dr. Linehan and Dialectical Behavioral Therapy, but insurance companies haven't caught up yet. Please do not be discouraged! <3 I am telling you all of this because with knowledge comes power and even if there are very few things that can be changed right this second, progress is coming. I hope that you find someone who is ready and willing to help you soon. Perhaps its time to consider a different care provider?
I found this, it's more informative:
BPD vs. Bipolar Disorder
Borderline Personality Disorder (BPD) and Bipolar Disorder are similar in that both are characterized by dramatic changes in mood. It is thought that many people who suffer from BPD are inaccurately diagnosed as having Bipolar disorder because it generally carries less stigma and is easier to treat with pharmaceuticals. However, there are also some important differences between Bipolar & BPD:
Frequency of Mood Cycles
Mood swings for people who suffer from Borderline Personality Disorder typically cycle much faster than for people who suffer from Bipolar Disorder. BPD sufferers often exhibit mood cycles lasting from a few hours to a few days. People who suffer from Bipolar Disorder typically exhibit mood swings lasting from a few weeks to a few months.
It should be noted that some Bipolar patients are characterized or diagnosed with Rapid Cycling Bipolar Disorder which has the same symptoms as Bipolar Disorder but with a shorter cycle time.
Relationship Basis
People who suffer from BPD often exhibit an acute Fear of Abandonment. The mood swings a person with BPD exhibits are often attached to their fear of being left alone or their preoccupation with not being alone. Sometimes, BPD is described as a "relationship disorder" in that it manifests itself in interactions with others.
Bipolar Disorder tends to be less relationship-based. People who suffer from Bipolar Disorder often display cycles of mood which are more inwardly self-focused and have less to do with how they feel about the relationships they are involved in.
Dissociation
Borderline Personality Disorder comprises both psychotic & neurotic thought processes. This gives rise to the name "Borderline" because it is thought to be on the "borderline" between psychosis & neurosis. The thinking and behavior of a person with Borderline Personality Disorder includes more mental departures from reality, known as Dissociation or "feelings create facts".
In contrast, Bipolar Disorder tends to be more neurotic in that the mood swings tend to be based more on extreme exaggerations of fact.
Response To Treatment
People who suffer from Bipolar Disorder often respond positively to appropriate regimes of medication.
People who suffer from Borderline Personality Disorder may also exhibit some improvement when treated with appropriate medication but typically also require extensive therapeutic intervention such as DBT over a period of months or years in order to see comparable results.
Both groups are often reluctant to seek help and may be resistant to medication. Also, both groups have a tendency to stop taking prescribed medications when they begin to feel better which often leads to relapses.
