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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by borderliner21 on January 23, 2002, at 12:54:23
Are these two disorders linked? Is a bipolar 2 likely to have borderline personality? I am wondering what medications would be best if these two disorders co-exist.
Posted by spike4848 on January 23, 2002, at 17:09:25
In reply to bipolar vs. borderline , posted by borderliner21 on January 23, 2002, at 12:54:23
Hey,
See the post above .... Soft Bipolar Disorders-Repost from Elizabeth(long) spike4848 1/23/02.
Spike
Posted by Dinah on January 23, 2002, at 17:43:35
In reply to bipolar vs. borderline , posted by borderliner21 on January 23, 2002, at 12:54:23
Well, here's my take on it. A borderline personality disorder diagnosis is made based on actions. It represents a pervasive way of relating (note - an action word). For example, I have a lot of the mood dysregulation that would characterize borderline personality disorder but no one would ever diagnose me with it because I don't exhibit the behaviors. I am a rather reserved and, on the surface, unemotional person. My relationships are very long-lasting and stable. I'm not at all sure it is a fair diagnosis, because there is almost definitely a biological component to borderline "personality disorder" and the actions are that person's habitual and dysfunctional way of dealing with the underlying mood disorder. A person with a different habitual and dysfunctional way of dealing with the mood disorder would be diagnosed with a different personality disorder. A person with a functional way of dealing with the mood disorder wouldn't be diagnosed with a personality disorder at all. But all three hypothetical people would be suffering from the same mood disorder and medication treatment should be the same although psychotherapy treatment should be tailored more to the overt actions of the individual.
On the other hand, bipolar II refers to underlying mood cycles. So many people who are bipolar II may also have borderline characteristics, but many may not. And many people who are borderline may have bipolar II but many may not.
Bipolar II mood cycles would probably be less dependent on life circumstances than borderline mood cycles. Bipolar mood cycles just happen in many cases (although of course stress and sleep disturbances can trigger cycle changes.) In other words, people with bipolar II cycle without regard to rejection, loss, etc. Borderline mood cycles would be more tied into relationships, boredom, etc. But it can be very hard to tell the difference sometimes, because bipolar II people in a depressive cycle or especially an agitated depression can see rejection and loss where there is none due to distorted thinking and can create huge crises over things that they would take in stride in any other mood.
So, in my apparently not so humble opinion (forgive me, I'm in an up phase of my own cycling) borderline personality disorder is probably a useless diagnosis for medication management since it could be the result of a number of underlying biological causes. And bipolar II is probably a useless diagnosis for psychotherapy purposes because it does not address dysfunctional behavior, although it is useful for understanding that the individual will probably have mood swings that have no cause based in life circumstances.
Posted by Blue Cheer 1 on January 23, 2002, at 19:22:07
In reply to Re: bipolar vs. borderline , posted by Dinah on January 23, 2002, at 17:43:35
> Well, here's my take on it. A borderline personality disorder diagnosis is made based on actions. It represents a pervasive way of relating (note - an action word). For example, I have a lot of the mood dysregulation that would characterize borderline personality disorder but no one would ever diagnose me with it because I don't exhibit the behaviors. I am a rather reserved and, on the surface, unemotional person. My relationships are very long-lasting and stable. I'm not at all sure it is a fair diagnosis, because there is almost definitely a biological component to borderline "personality disorder" and the actions are that person's habitual and dysfunctional way of dealing with the underlying mood disorder. A person with a different habitual and dysfunctional way of dealing with the mood disorder would be diagnosed with a different personality disorder. A person with a functional way of dealing with the mood disorder wouldn't be diagnosed with a personality disorder at all. But all three hypothetical people would be suffering from the same mood disorder and medication treatment should be the same although psychotherapy treatment should be tailored more to the overt actions of the individual.
> On the other hand, bipolar II refers to underlying mood cycles. So many people who are bipolar II may also have borderline characteristics, but many may not. And many people who are borderline may have bipolar II but many may not.
> Bipolar II mood cycles would probably be less dependent on life circumstances than borderline mood cycles. Bipolar mood cycles just happen in many cases (although of course stress and sleep disturbances can trigger cycle changes.) In other words, people with bipolar II cycle without regard to rejection, loss, etc. Borderline mood cycles would be more tied into relationships, boredom, etc. But it can be very hard to tell the difference sometimes, because bipolar II people in a depressive cycle or especially an agitated depression can see rejection and loss where there is none due to distorted thinking and can create huge crises over things that they would take in stride in any other mood.
> So, in my apparently not so humble opinion (forgive me, I'm in an up phase of my own cycling) borderline personality disorder is probably a useless diagnosis for medication management since it could be the result of a number of underlying biological causes. And bipolar II is probably a useless diagnosis for psychotherapy purposes because it does not address dysfunctional behavior, although it is useful for understanding that the individual will probably have mood swings that have no cause based in life circumstances.
That was a scintillating exposition -- thanks!Blue
Posted by Dinah on January 24, 2002, at 10:19:15
In reply to Re: bipolar vs. borderline » Dinah, posted by Blue Cheer 1 on January 23, 2002, at 19:22:07
> That was a scintillating exposition -- thanks!
>
> Blue(Chuckle) Yes, but I upped my depakote dose last night and I'm feeling muuuch better now. :)
Posted by Blue Cheer 1 on January 25, 2002, at 6:30:58
In reply to Re: bipolar vs. borderline » Blue Cheer 1, posted by Dinah on January 24, 2002, at 10:19:15
> > That was a scintillating exposition -- thanks!
> >
> > Blue
>
> (Chuckle) Yes, but I upped my depakote dose last night and I'm feeling muuuch better now. :)No, really. I've read some BPD texts that didn't compare to your synthesis.
Blue
Posted by Dinah on January 25, 2002, at 9:35:51
In reply to Re: bipolar vs. borderline, posted by Blue Cheer 1 on January 25, 2002, at 6:30:58
Posted by jazzdog on January 25, 2002, at 13:04:34
In reply to Re: bipolar vs. borderline , posted by Dinah on January 23, 2002, at 17:43:35
Hi Dinah -
I also like some of the distinctions you make, especially your suggestion that borderline personality disorder is basically a dysfunctional way of coping with a mood disorder. A couple of qualifications though. I think bpd can be chemically ameliorated, particularly with mood stabilizers and abstinence from alcohol. In my experience, some degree of biologically induced mood stability is essential in order to establish a platform to allow therapies to take effect. Intensive therapy is needed, both to correct maladaptive behaviours and to develop a coherent sense of self that is not so vulnerable to perceived rejection and loss. And is not the underlying mood instability itself indicative of bipolar II? I think that's why bpd is now being thought of as a subtype of bipolar II.
- Jane
Posted by Dinah on January 26, 2002, at 11:55:13
In reply to Re: bipolar vs. borderline , posted by jazzdog on January 25, 2002, at 13:04:34
I've always thought that BPD had biological underpinnings, although perhaps not the same biological problems in all cases. And I am firmly in favor of combining medication and therapy. I just think that the "personality disorders" axis of the DSM-IV could use some work, since many of "personality disorders" are probably manifestations of Axis I or neurological conditions and are not in themselves of any additional value in medication decisions, except as a factor in diagnosis of the underlying condition. However, I do thing the "personality disorders" Axis II conditions are useful in structuring therapy.
I'm probably getting wrapped up in semantics here. Sorry, it's a bad habit of mine.
Dinah
Posted by PattyG on January 30, 2002, at 20:09:08
In reply to Re: bipolar vs. borderline , posted by jazzdog on January 25, 2002, at 13:04:34
I also like some of the distinctions you make, especially your suggestion that borderline personality disorder is
basically a dysfunctional way of coping with a mood disorder. A couple of qualifications though. I think bpd can
be chemically ameliorated, particularly with mood stabilizers and abstinence from alcohol. In my experience, some
degree of biologically induced mood stability is essential in order to establish a platform to allow therapies to take
effect. Intensive therapy is needed, both to correct maladaptive behaviours and to develop a coherent sense of
self that is not so vulnerable to perceived rejection and loss. And is not the underlying mood instability itself
indicative of bipolar II? I think that's why bpd is now being thought of as a subtype of bipolar II.- Jane
/////BPD a subtype of Bipolar II? Not questioning - I would tend to agree (difficult to to distinguish) but where might I read about this? Thanks, PattyG
Posted by petters on January 31, 2002, at 1:08:07
In reply to Re: bipolar vs. borderline , posted by PattyG on January 30, 2002, at 20:09:08
> I also like some of the distinctions you make, especially your suggestion that borderline personality disorder is
> basically a dysfunctional way of coping with a mood disorder. A couple of qualifications though. I think bpd can
> be chemically ameliorated, particularly with mood stabilizers and abstinence from alcohol. In my experience, some
> degree of biologically induced mood stability is essential in order to establish a platform to allow therapies to take
> effect. Intensive therapy is needed, both to correct maladaptive behaviours and to develop a coherent sense of
> self that is not so vulnerable to perceived rejection and loss. And is not the underlying mood instability itself
> indicative of bipolar II? I think that's why bpd is now being thought of as a subtype of bipolar II.
>
> - Jane
>
> /////BPD a subtype of Bipolar II? Not questioning - I would tend to agree (difficult to to distinguish) but where might I read about this? Thanks, PattyGHi...
Interesting information. I hope you don´t mind I´m asking, but were have you heard that borderline disorder is a form of a subtype of Bipolar 2 disorder?
Sincerely...//Petters
Posted by jazzdog on January 31, 2002, at 14:24:19
In reply to Re: bipolar vs. borderline , posted by petters on January 31, 2002, at 1:08:07
Sorry, my power's been out for four days due to a freak snowstorm, so I couldn't access my computer. A good place to start is under the heading borderline - bipolar connection on the following page: www.psycom.net/depression.central.borderline.html.
- Jane
Posted by Ponder on February 1, 2002, at 1:08:11
In reply to Agree completely. » jazzdog, posted by Dinah on January 26, 2002, at 11:55:13
Dinah, I have heard these terms, Axis I, Axis II, but have never understood what is meant. Could you explain? Thanks.
> I've always thought that BPD had biological underpinnings, although perhaps not the same biological problems in all cases. And I am firmly in favor of combining medication and therapy. I just think that the "personality disorders" axis of the DSM-IV could use some work, since many of "personality disorders" are probably manifestations of Axis I or neurological conditions and are not in themselves of any additional value in medication decisions, except as a factor in diagnosis of the underlying condition. However, I do thing the "personality disorders" Axis II conditions are useful in structuring therapy.
> I'm probably getting wrapped up in semantics here. Sorry, it's a bad habit of mine.
> Dinah
Posted by Dinah on February 1, 2002, at 10:51:48
In reply to Axis I vs. Axis II, posted by Ponder on February 1, 2002, at 1:08:11
I'm not a mental health professional, so understand that I may not have this exactly right.
The DSM-IV suggests that diagnosis be made along 5 axes.
Axis I - "Mental" disorders such as mood disorders, anxiety disorders, thought disorders, substance abuse disorders, etc. I'm not sure if autistic disorders fall under this axis or not.
Axis II - "Personality" disorders are dysfunctional personality traits and ways of relating to others and coping with stress.
Axis III - Non-psychiatric medical conditions.
Axis IV - Sources of stress in your life. I suppose they put this one in to see if your condition might be a reaction to or at least exacerbated by factors in your environment.
Axis V - Global Assessment of Functioning measures the severity of your problems in terms of how much it affects your daily life. It is a measurement of that particular point in time.My humble opinion is that in many, if not most, cases an Axis II disorder is just a symptom that should be used to look for mood, anxiety, post traumatic stress, or others disorders or neurological problems. It is just plain lazy for a doctor to assign an Axis II disorder without looking darn hard for an underlying Axis I disorder. People cope the best they can and many people with "personality disorders" are just coping the best they can with an underlying mood disorder. However, Axis II diagnosis can be very helpful as a starting point in determing what dysfunctional ways of coping and which distortions in thinking should be addressed in therapy.
If I've got this wrong, I hope someone will correct my misperceptions.
Dinah
Posted by jimmygold70 on February 1, 2002, at 11:44:27
In reply to bipolar vs. borderline , posted by borderliner21 on January 23, 2002, at 12:54:23
Definetly not. Although the mood swings associated with BPD resemble those of rapid cycling Cyclothymia (like but less severe than Bipolar 2), and respond to the same treatments, and that both Bipolars and Borderlines express anger and are very impulsive, Bipolars don't have a chronic feeling of emptiness and boredom, don't have much problems with interpesonal relationships (when mood is intact), their identity is quite stable, their are MUCH less suicidal, and not likely to have paranoid ideation.
Jimmy
Posted by helenbpd on February 27, 2002, at 18:49:59
In reply to Re: bipolar vs. borderline » borderliner21, posted by jimmygold70 on February 1, 2002, at 11:44:27
> Bipolars don't have a chronic feeling of emptiness and boredom, don't have much problems with interpesonal relationships (when mood is intact), their identity is quite stable, their are MUCH less suicidal, and not likely to have paranoid ideation.
> JimmyI agree, Jimmy. I would also add that Borderlines often get no benefits from mood stabilizers (lithium, depakote, etc) and antidepressants, UNLESS there is congruent intense, cognitively-based psychotherapy, and it is certainly not as radical a shift from symptomatic --> stable as is reported in the Bipolar community.
Certainly my own loved one (dxed with BPD by three different therps) has a level of transient psychosis, dissociation, self-injury and a very specific kind of anhedonia/boredom that doesn't seem to be Bipolar. And he spent three years trying every single Bipolar mood stabilizer on the market, with nary a change, either subjectively or objectively. He's now taking a newer antipsychotic (zyprexa), which is working very well. Do those dxed with Bipolar II show any changes in affect on atypical antipsychotics alone? I'd love any feedback.
I know a lot about Borderline Personality Disorder (my SO has it, and I run a large resource site on it, link below for the curious), but less about Bipolar II. It's my observation that there are definitely enough similarities between the two to warrant a LOT more research than is presently being done.
On the other hand, from the evidence of many more thousand accounts by both sufferers and loved ones, the behavioral and affective patterns of BPD are clearly similar enough to warrant a category of their own.
I've got a bunch of material on the Dx of BPD, theorists who suggest other names (Judith Herman's "Complex Post-Traumatic Stress Disorder", etc), on my site.
Dinah, I agree with your assessment re. the development of a PD in response to an underlying mood disorder -- perhaps by the time a personality disorder is diagnostically "caught", the cognitive patterns have set to a rigidity beyond the "mere" reach of psychopharmaceuticals.
One can't neglect trauma as a causal factor in BPD, either -- official stats set about 75% of those diagnosed with BPD as having experienced childhood abuse. -- is this true for BiPolar?
Recent research on medication for Alzheimers is showing that it may also be effective for PDs -- which speaks in favor of the theory of traumatic damage to the hippocampus and amygdala (frontal lobe), and certainly helps explain the very odd and sometimes parapsychotic "rescripting" of historical events which is common to those with BPD.On the OTHER hand (I'm sprouting hands here), there is also evidence that the self-reported experiences of childhood abuse are mis/over-represented, due to precisely this faulty recollection ability of the Borderline.
Leading one to a real chicken/egg dillemma.Jim Phelps has an *excellent* essay on the BPD/Bipolar connection:
http://www.psycheducation.org/depression/borderline.htm
And my site is at:
http://home.hvc.rr.com/helenbpdAny input welcomed.
Helen
ps apologies for blathering on here, this is a pet topic of mine! :)
Posted by justyourlaugh on October 2, 2003, at 9:50:11
In reply to Re: bipolar vs. borderline, posted by helenbpd on February 27, 2002, at 18:49:59
helen,,
what a wonderful site!!
the information was so helpful and has giving me a great deal of hope.
i understand me...thats the first step...
thanks again helen for the link..
mabe posting it again in a new post would be really helpful for others..
j
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