[mrsmaz76]

So, I went to see my pdoc last month, and as it was (yet another) new one I took the bull by the horns and asked outright what my dx was being considered as.

Always thought I was just abnormal (miserable, different from everyone else, hopeless) growing up, major depressions/suicidal episodes followed as I matured, came to a head in a close call with an overdose a few years back. Since then, had therapy and ADs until this time last year when I recounted some of the weird goings on when I'm "well" to my therapist. Which would be considered to be hypomanic episodes by many ppl. Have been on mood stabilisers since, and in the main they've helped enormously. Lithium in particular, along with a low dose Depakote and Sertraline 150mg (upped recently cos I was feeling crappy). So I thought, yeah, I'm maybe a bit BP.

The dx from my pdocs? "From your notes, there has been a working diagnosis of possible Emotionally Unstable Personality Disorder since your involvement in the service (ie when I nearly overdosed, the first time I sought help) and since then another diagnosis of possible Bipolar Affective Disorder." Now as I understand it, this emotionally unstable crap is roughly equivalent to Borderline Personality Disorder, which is closely interlinked and overlapping with Bipolar. Have I got that right?

Soooooo..... all this time they've been harbouring this possible dx without telling me, and until just over a year ago I had always been led to believe that it was just recurrent depression. In fact, my GP had been writing medical certificates saying I was unable to work due to "anxiety affective disorder" and "depression" at various times. When all along they had their suspicions, and I was unmedicated other than 50mg Sertraline, and obviously struggling (I was in therapy a lot) and I'm partly confused as to why it wasn't suggested to at least try a mood stabiliser years ago and partly angry to have been just left to get on with it.

And how do I feel now about the poss dxs? I just don't know. Has anyone else got any insight into this whole thing? Have I got it right that EUPD (ICD-10) is equivalent to BPD? And does it really matter to my treatment one way or the other? I know BPD responds better to CBT than meds, and that if I'm BP I shouldn't consider stopping my meds, so... I dunno. Help, anyone?

Cheers

[Persephone]

Ahhh, the stealth BPD diagnosis! I really, really hate that shit. If pdocs are going to diagnose you with something, they need to have the balls to tell you to your face.

You are right "Emotionally Unstable Personality Disorder" is the more accurate term for BPD.

There are many reasons why they wouldn't tell you. Axis II conditions are generally not covered by insurance (if you are not in the US, I'm not sure if that would be a problem with nationalized health care). It could be to shield you from the severe stigma BPD has with other health care providers and employers. It could just be old-fashioned paternalism.

Also, even though there is speculation if BPD is part of the BP spectrum, BP and BPD are not an either/or proposition. There are several CB members who are diagnosed with both. There is no reason that you can't stay on medication and go to CBT/DBT. As for the meds, it's also a controversy if meds help with BPD - but if they help you, that's all that's important. I'm sorry - it just sounds like you were screwed over all around.

Any BPD experts care to weigh in?

[mudpuppy]

Borderline can carry a significant amount of stigma. They may have wanted to be sure, before they attached a potentially stigmatizing dx.

[mrsmaz76]

mudpuppy, on 09 February 2010 - 12:51 AM, said:

Borderline can carry a significant amount of stigma. They may have wanted to be sure, before they attached a potentially stigmatizing dx.

I get that, but you know i made the decision to have another child in the meantime, which they knew, and said nothing. I was feeling better at the time, and it precipitated a whole load of crap. I really feel that was unfair, not just to me, but to my whole family. I don't know that I'd have done things differently, but I feel robbed of a chance to make an informed decision. Medication-wise, treatment-wise, family planning-wise. I realise that I don't have enough insight into this whole area, but still. I could've been given the chance, y'know?

Know loads about bipolar, but not so much about borderline. I'm now researching, but it's confusing. Suppose I should just be grateful that they now acknowledge that there's something more than just MDD going on, and that I'm on Lithium, which helps. It doesn't solve things, but the highs and lows are less frequent and less pronounced. Mis-dxs suck.

[helenllama]

Added to that.

There are two types of EUPD
Impulsive type and Borderline type.

But for the Borderline type to be present you must also meat the criteria for impulsive type.

[tryp]

Welcome to the club

I'm sorry you feel like you weren't told soon enough.

To be honest, the medication for BP and for BPD is pretty similar. The only thing is, you'll probably need long term therapy.

[OscillateWildly]

You can have both. BPD and BP.

Also, if BPD was initially suspected, it does not mean this is your present diagnosis. It sounds as if your BPD diagnosis was changed to bipolar affective (possibly because of a positive symptom response to medication). Or, you could be dx as BPD and BP.

I would ask them why they feel you meet the criteria for BPD and why this was their initial impression. If they would let you read the notes, that will tell you what you need to know
Most doctors won't write anything they can't defend in court, all doctors should let you see the notes. You have a right to your medical records FYI.

It's possible that your hypomanic sx was perceived as reactivity due to borderline personality. If the ups (and downs) were triggered by thoughts and environment, it's more likely to be borderline than bipolar.

Like, here's a classic/stereotypical example of borderline mood reactivity:

"My S.O. left for work. I was alone and felt empty and became very depressed and intensely suicidal in thinking, intense urges to take an overdose... then later that day i went out to distract myself with friends, I became hyper and talkative because of excitement of having them around, I became excessively social and impulsive in spending"
This type of stuff, if it happens for you as chronic day-to-day thing, that's more of a borderline personality problem (unstable identity, mood fluctuations in response).

A bipolar mood problem is not reactive to environment. Environment may modulate the extent of your up (or your down) but it does not *cause* it. A depressed person, if out with friends, may be distracted, but they will still be depressed and inside have negative thoughts. When the depressed person is removed from the distraction, will return to depression instantly.
Sometimes, going out with friends, while depressed, can cause exhaustion and a more intense depressed feeling later. But the key to remember here is that, for a depressed person, environment cannot *cause* depression nor can it *take it away*.
A manic person, if they sit in a quiet dark room, may feel somewhat more calm, but they are not going to become "not manic" and switch to depression. A manic person, if they go to a very stimulating environment like a party, a bar, a mall, may become more symptomatic temporarily (because there is an outlet for mania), but they aren't going to instantly become manic because they are doing these stimulating activities. And the mania will not stop when those activities do.

Mania and depression are "episodes" that tend to last last days or weeks. They are primary, endogenous occurring events in the mind, environment affects them only secondarily.


So, I suppose, the real issue here is whether or not your instability is a primary internal thing that has little to do with the environment that last for distinct blocks of time, *or* if your moods are mostly reactions to people and situations and you lack a grounded self.
Note, it is not an either or proposition and sometimes you can have both. But as a rule, if you do have BP, it is inappropriate to diagnose BPD until your BP is stabilized, since it is impossible to tell what is your real personality if you are still afflicted with bipolar/endogenous mood episodes.

This post has been edited by OscillateWildly: 11 February 2010 - 04:28 AM

[mrsmaz76]

yeeeeeessss......

Well, here's the thing. Sometimes I am mood responsive to situations/people. Other times, it makes no difference whatsoever. I dunno, sometimes I think maybe it's just me taking my mood and emotional cues from others, what they say, what they think of me, what is expected considering my situation, and other times it doesn't make a blind bit of difference, I'll be depressed with or without "outside reason" or ludicrously happy and impulsive despite the same shit.

I have an appt next month with my pdoc, and my tdoc has signed me off (the joys of the NHS, they won't see you indefinately regardless of dx) so if I am joining the ranks of the borderlines I will be therapy-less. I'm not really bothered by that right now, but I'm concerned for what that means for the future. Meds are fine for now, but I still don't feel that I'm where i need to be. But then does anyone?!

I guess it's normal to feel that you are being cast out to get on with it, after all, without a cure that's what we have to do and hope that the meds keep the worst of it at bay. I just can't help feeling really disappointed that I might just have to live like this for the rest of my life, and I'm scared that in a depressive mood I might just decide it's not worth the hassle. Sigh....

[OscillateWildly]

Hi again maz,
it's normal to have your mood affected by environment and other people. The question is, who is the primary driver of your mood? Is it you, your mind, or is it environment? Borderline PD is a condition where people's moods and emotions are heavily determined by environment, and their moods are quite extreme and often disproportionate to the environment.

What you say about your mood coming from other people, and doing what is expected of you, that is suggested of borderline PD. Because of the unstable/deficient self identity in borderline PD, people with this condition find themselves wearing lots of masks and doing whatever they think people around them want them to do... they aren't sure of what they really feel or want or think and are constantly "acting" in a sort of way.
But, being depressed for distinct blocks of time is also suggestive of a mood disorder.

So far what you say suggests your diagnoses may be both correct.

I am curious why your doctor and therapist didn't have you start emotional coping therapy/DBT skills if they thought you were borderline. That doesn't make sense. It's like thinking someone is bipolar but not starting medicine for months. Weird. This is why I think they might have revised your dx... doesn't make sense to have a patient who you think is borderline and never suggest they start DBT.