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Is bipolar depression worse than MDD?


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My spouse and I both got depressed recently. He's pretty much over it, but I'm far worse now. Almost to the point of suicide. Are there any studies out there (or personal experiences) that address the differences?

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I don't know from studies, or personal experience with the exact same thing. Awww, don't argue about that. I hate having the "Who is suffering more" argument. Suffering is suffering plain and simple. You cannot compare one person's suffering to another's, it's just suffering. Who suffers worse? Probably niether, we all feel it to our own degrees.

Sorry I had nothing scientific to back this up. Or personal experience, you can disregard this if you wish.

but you won the "Who suffered the longest" argument lol(that was not meant as offensive, just a joke)

Sorry you ARE suffering though, I hope you feel better soon.

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I don't know the answer, honestly. I've had months-long bouts of depression, medicated and unmedicated, and they sure felt awful. Crushing, tiring, beating depression. But now I know it was bipolar.

Here's something I found on the net: http://thebrain.mcgill.ca/flash/a/a_08/a_0..._08_cr_dep.html It might answer your questions.

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My spouse and I both got depressed recently. He's pretty much over it, but I'm far worse now. Almost to the point of suicide. Are there any studies out there (or personal experiences) that address the differences?

I really think it is case by case. I've seen unipolar depressives who were just, wow, close to death from simple apathy and self neglect. I remember in school, doing psych rotation, a unipolar depressive man who was pretty much rotting in his apartment like a corpse, emaciated, until his niece pleaded with him to go to the mental hospital. When I met him he was a thousand times better, now capable of talking again and sometimes smiling, but still unable to concentrate or really function. He wasn't bipolar, but he may have been one of those "recurrent depressives" who have a form of it without mania/hypomania.

We only had one bipolar on the unit, who was manic at the time. He was a permanent resident in the home because his manic depression was so severe and uncontrollable, he cycled constantly, always a severe episode that made functioning impossible. We never got to see him depressed because he was manic for the whole rotation, but staff told us what it is like... he more or less cried constantly. Which, in my opinion, seems to me like his depression is at least as bad if not less bad than the unipolar mentioned above (because, he was doing things and eating, albeit he was miserable).

So yea I would say it is case by case... but in general I think the depression can be equally bad. Don't forget the mild forms of bipolar... it would be like a severe recurrent unipolar saying "I don't think bipolar depression is as bad as major depression because my spouse has cyclothymia/type 1 with mania only and she doesn't/never has been as low as I get".

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Hm. I'm not a professional, but here's my response:

I think the perception is that MDD isn't as bad as depression in BP as it more common for people to have MDD diagnoses than BP diagnoses. Depression is pretty common, so much so that people say things like "That's depressing" or "I feel depressed" in a colloquial way. There's less of a stigma, thanks to in part to those Prozac ads, so it must not be so bad.

Here's something I found on the net: http://thebrain.mcgill.ca/flash/a/a_08/a_0..._08_cr_dep.html It might answer your questions.

This made me think of a couple questions. Is there a difference between BP and recurrent MDD (me thinks very little, but I'm not a professional)? What is the difference between those persons who experienced one episode of depression and those that have experienced multiple episodes? Can one have symptoms of MDD without having MDD?

Kind of an interesting conversation. Perhaps someone more knowledgeable will chime in.

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I have not seen any studies nor any mention in Jamison & Goodwin, showing any difference between MDD and Bipolar depressions, nor comparing which is 'worse'.

Bipolars have a higher suicide rate than MDD'ers, approaching 25%. BP'ers spend more time in depressed phase than manic, as much as 52% of the time per J&G, 1st ed.

a.m.

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I wonder if the high rate of suicide in BP may be partially related to manic psychosis element to depression... the energy while being depressed, you know, can sorta push you to do it. Which is why antidepressant are thought to increase suicidality early on, that extra jolt of energy makes for some crazy and impulsive behavior. So, then, it might be that unipolar depression which may have a tendency to be more of a catatonic type, is less likely to result in suicide, whereas bipolar depression can be more often an activated type perhaps even with psychosis and this can lead to suicide? This is just an idea I had, no idea if it is true or not.

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I wonder if the high rate of suicide in BP may be partially related to manic psychosis element to depression... the energy while being depressed, you know, can sorta push you to do it. Which is why antidepressant are thought to increase suicidality early on, that extra jolt of energy makes for some crazy and impulsive behavior. So, then, it might be that unipolar depression which may have a tendency to be more of a catatonic type, is less likely to result in suicide, whereas bipolar depression can be more often an activated type perhaps even with psychosis and this can lead to suicide? This is just an idea I had, no idea if it is true or not.

Most likely bipolar depression is more apt to be stuporous since atypical depression is more common in those with bipolar. Atypical depression includes leaden paralysis, eating for energy, retarded cognition and movement. Although atypical does happen in MDD, melancholic depression is more common - deep sorrow, loss of appetite. (Both forms have more symptoms, of course.)

Both MDD and bipolar depression can include anxiety. Although psychosis can happen in MDD, it is more common in bipolar depression.

Then there are the bipolar only flavors. Only bipolar depression can include agitation which is not always of a physical energy form. However, as the mixed state increases in intensity, it has all the feelings of depression plus the energy of mania. Mixed mania can go on to include psychosis.

Those with bipolar have more occurrences of depression and spend more time depressed that the average person with MDD. I think (not certain).

I recently read somewhere that bipolar suicides occur as much in mixed mania as in depression, which is consistent with your observation about the energy having something to do with the rate difference. There probably also is a small number who cash it in after they come out of a bad state when thinking they just don't have the energy to do it all over again.

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Hmm.. I've been dx depressed... then bipolar... then depressed... and I bet if I saw another pdoc, I could end up with another bp dx...

So personal opinion is... what does it matter what you call it if it fucks up your life? Is one group any more miserable then the other? You know, I doubt it. They all cycle anyway. You can go from "normal" to manic, manic to depressed, or "normal to depressed".

They all suck.

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I wonder if the high rate of suicide in BP may be partially related to manic psychosis element to depression... the energy while being depressed, you know, can sorta push you to do it. Which is why antidepressant are thought to increase suicidality early on, that extra jolt of energy makes for some crazy and impulsive behavior. So, then, it might be that unipolar depression which may have a tendency to be more of a catatonic type, is less likely to result in suicide, whereas bipolar depression can be more often an activated type perhaps even with psychosis and this can lead to suicide? This is just an idea I had, no idea if it is true or not.

Most likely bipolar depression is more apt to be stuporous since atypical depression is more common in those with bipolar. Atypical depression includes leaden paralysis, eating for energy, retarded cognition and movement. Although atypical does happen in MDD, melancholic depression is more common - deep sorrow, loss of appetite. (Both forms have more symptoms, of course.)

Both MDD and bipolar depression can include anxiety. Although psychosis can happen in MDD, it is more common in bipolar depression.

Then there are the bipolar only flavors. Only bipolar depression can include agitation which is not always of a physical energy form. However, as the mixed state increases in intensity, it has all the feelings of depression plus the energy of mania. Mixed mania can go on to include psychosis.

Those with bipolar have more occurrences of depression and spend more time depressed that the average person with MDD. I think (not certain).

I recently read somewhere that bipolar suicides occur as much in mixed mania as in depression, which is consistent with your observation about the energy having something to do with the rate difference. There probably also is a small number who cash it in after they come out of a bad state when thinking they just don't have the energy to do it all over again.

I trust your research, you seem very researched whereas my information is not well researched and mostly anecdotal. All of that "atypical depression" sounds like me <20.5 yrs old. I'm unsure if I had/get leaden paralysis. At times the fatigue may reach a point where it is difficult to move my arms/limbs. I do not know if leaden paralysis is a literal inability to move from fatigue, or if it is just a perception of it being difficult, because I do have that symptom quite a lot. It's funny as I used to blog about my depression I would always say "I can barely move my arms" and I had no idea this was considered such a significant symptom.

I have never had melancholic depression. I could never relate to deep sorrow and definitely not lack of appetite or insomnia, and for a long time I thought I was just a weakling because this is what I always thought depression was. I slept all day, never felt rested ever and couldn't stop eating. I had no energy at all, and while I felt really awful and hopeless and guilty, it was less a feeling of "sadness" over something... it was more of a guilty hopeless feeling that was quite terrible, which didn't much involve sadness.

It's funny, I never did much research on DEPRESSION even though I recognize it nearly destroyed my life in my late teens. Well, it did at least smash my life up good, real good.

<a href="http://pn.psychiatryonline.org/cgi/content/full/38/20/20">This describes me rather well</a>, it's almost like they are talking about who I used to be... and sometimes still am, but not as bad as before, never gets that bad again thank god.

Hmmm I guess I am bipolar II. The more I learn the more I can understand how everything fits rather than seeming out of place. I always had doubts about the nature of my 'depression" since I subconsciously felt it was "fake" or a result of "laziness" because of all the sleeping and eating and lack of sadness (in place a hopelessness, meaninglessness, guilt type feeling that was very very bad but definitely not "sad")... now that I know more about atypical depression and how this is what happens in bipolar, I suppose what happened is consistent.

Anyway, back to the subject at hand... I suppose this explains the differences I observed in school in the depression of the manic patient and the unipolar patient, as the manic patient clearly had atypical depression with eating and lack of energy. I wonder, what about the sort of catatonic depression I observed in the unipolar? Is that just an extreme form of melancholic, where the sorrow and lack of appetite reaches a point where you might die from inactivity?

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I trust your research, you seem very researched whereas my information is not well researched and mostly anecdotal. All of that "atypical depression" sounds like me <20.5 yrs old. I'm unsure if I had/get leaden paralysis. At times the fatigue may reach a point where it is difficult to move my arms/limbs. I do not know if leaden paralysis is a literal inability to move from fatigue, or if it is just a perception of it being difficult, because I do have that symptom quite a lot. It's funny as I used to blog about my depression I would always say "I can barely move my arms" and I had no idea this was considered such a significant symptom.

I have never had melancholic depression. I could never relate to deep sorrow and definitely not lack of appetite or insomnia, and for a long time I thought I was just a weakling because this is what I always thought depression was. I slept all day, never felt rested ever and couldn't stop eating. I had no energy at all, and while I felt really awful and hopeless and guilty, it was less a feeling of "sadness" over something... it was more of a guilty hopeless feeling that was quite terrible, which didn't much involve sadness.

It's funny, I never did much research on DEPRESSION even though I recognize it nearly destroyed my life in my late teens. Well, it did at least smash my life up good, real good.

<a href="http://pn.psychiatryonline.org/cgi/content/full/38/20/20">This describes me rather well</a>, it's almost like they are talking about who I used to be... and sometimes still am, but not as bad as before, never gets that bad again thank god.

Hmmm I guess I am bipolar II. The more I learn the more I can understand how everything fits rather than seeming out of place. I always had doubts about the nature of my 'depression" since I subconsciously felt it was "fake" or a result of "laziness" because of all the sleeping and eating and lack of sadness (in place a hopelessness, meaninglessness, guilt type feeling that was very very bad but definitely not "sad")... now that I know more about atypical depression and how this is what happens in bipolar, I suppose what happened is consistent.

Anyway, back to the subject at hand... I suppose this explains the differences I observed in school in the depression of the manic patient and the unipolar patient, as the manic patient clearly had atypical depression with eating and lack of energy. I wonder, what about the sort of catatonic depression I observed in the unipolar? Is that just an extreme form of melancholic, where the sorrow and lack of appetite reaches a point where you might die from inactivity?

What you describe sounds like atypical depression. Leaden paralysis is I guess a perception, but it always felt pretty damn real to me. ;) As said, it does occur in unipolar depression, too. I would not use that alone as a bipolar indication. Talk it over with your psychiatrist, or see one if you are not already.

As for the catatonic unipolar guy, ooh, sad, bad place that sounds. I don't know the answer to your question, but I would guess maybe atypical depression was the precursor. That really is a guess.

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I trust your research, you seem very researched whereas my information is not well researched and mostly anecdotal. All of that "atypical depression" sounds like me <20.5 yrs old. I'm unsure if I had/get leaden paralysis. At times the fatigue may reach a point where it is difficult to move my arms/limbs. I do not know if leaden paralysis is a literal inability to move from fatigue, or if it is just a perception of it being difficult, because I do have that symptom quite a lot. It's funny as I used to blog about my depression I would always say "I can barely move my arms" and I had no idea this was considered such a significant symptom.

I have never had melancholic depression. I could never relate to deep sorrow and definitely not lack of appetite or insomnia, and for a long time I thought I was just a weakling because this is what I always thought depression was. I slept all day, never felt rested ever and couldn't stop eating. I had no energy at all, and while I felt really awful and hopeless and guilty, it was less a feeling of "sadness" over something... it was more of a guilty hopeless feeling that was quite terrible, which didn't much involve sadness.

It's funny, I never did much research on DEPRESSION even though I recognize it nearly destroyed my life in my late teens. Well, it did at least smash my life up good, real good.

<a href="http://pn.psychiatryonline.org/cgi/content/full/38/20/20">This describes me rather well</a>, it's almost like they are talking about who I used to be... and sometimes still am, but not as bad as before, never gets that bad again thank god.

Hmmm I guess I am bipolar II. The more I learn the more I can understand how everything fits rather than seeming out of place. I always had doubts about the nature of my 'depression" since I subconsciously felt it was "fake" or a result of "laziness" because of all the sleeping and eating and lack of sadness (in place a hopelessness, meaninglessness, guilt type feeling that was very very bad but definitely not "sad")... now that I know more about atypical depression and how this is what happens in bipolar, I suppose what happened is consistent.

Anyway, back to the subject at hand... I suppose this explains the differences I observed in school in the depression of the manic patient and the unipolar patient, as the manic patient clearly had atypical depression with eating and lack of energy. I wonder, what about the sort of catatonic depression I observed in the unipolar? Is that just an extreme form of melancholic, where the sorrow and lack of appetite reaches a point where you might die from inactivity?

What you describe sounds like atypical depression. Leaden paralysis is I guess a perception, but it always felt pretty damn real to me. ;) As said, it does occur in unipolar depression, too. I would not use that alone as a bipolar indication. Talk it over with your psychiatrist, or see one if you are not already.

As for the catatonic unipolar guy, ooh, sad, bad place that sounds. I don't know the answer to your question, but I would guess maybe atypical depression was the precursor. That really is a guess.

Just so you know this is seesawliving (I changed my name to one only marginally less lame... plus I like the smiths... btw thank you for suggesting to me how to change my name).

So the reason I said that it "fits" is because I was always uncertain it was depression since it didn't fit the description of sad, low appetite, insomnia... it was kind of the opposite... but exactly like "atypical" depression description. Dr did ask me about my depression and this was part of the reason she said I had bipolar II.

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I trust your research, you seem very researched whereas my information is not well researched and mostly anecdotal. All of that "atypical depression" sounds like me <20.5 yrs old. I'm unsure if I had/get leaden paralysis. At times the fatigue may reach a point where it is difficult to move my arms/limbs. I do not know if leaden paralysis is a literal inability to move from fatigue, or if it is just a perception of it being difficult, because I do have that symptom quite a lot. It's funny as I used to blog about my depression I would always say "I can barely move my arms" and I had no idea this was considered such a significant symptom.

I have never had melancholic depression. I could never relate to deep sorrow and definitely not lack of appetite or insomnia, and for a long time I thought I was just a weakling because this is what I always thought depression was. I slept all day, never felt rested ever and couldn't stop eating. I had no energy at all, and while I felt really awful and hopeless and guilty, it was less a feeling of "sadness" over something... it was more of a guilty hopeless feeling that was quite terrible, which didn't much involve sadness.

It's funny, I never did much research on DEPRESSION even though I recognize it nearly destroyed my life in my late teens. Well, it did at least smash my life up good, real good.

<a href="http://pn.psychiatryonline.org/cgi/content/full/38/20/20">This describes me rather well</a>, it's almost like they are talking about who I used to be... and sometimes still am, but not as bad as before, never gets that bad again thank god.

Hmmm I guess I am bipolar II. The more I learn the more I can understand how everything fits rather than seeming out of place. I always had doubts about the nature of my 'depression" since I subconsciously felt it was "fake" or a result of "laziness" because of all the sleeping and eating and lack of sadness (in place a hopelessness, meaninglessness, guilt type feeling that was very very bad but definitely not "sad")... now that I know more about atypical depression and how this is what happens in bipolar, I suppose what happened is consistent.

Anyway, back to the subject at hand... I suppose this explains the differences I observed in school in the depression of the manic patient and the unipolar patient, as the manic patient clearly had atypical depression with eating and lack of energy. I wonder, what about the sort of catatonic depression I observed in the unipolar? Is that just an extreme form of melancholic, where the sorrow and lack of appetite reaches a point where you might die from inactivity?

What you describe sounds like atypical depression. Leaden paralysis is I guess a perception, but it always felt pretty damn real to me. ;) As said, it does occur in unipolar depression, too. I would not use that alone as a bipolar indication. Talk it over with your psychiatrist, or see one if you are not already.

As for the catatonic unipolar guy, ooh, sad, bad place that sounds. I don't know the answer to your question, but I would guess maybe atypical depression was the precursor. That really is a guess.

Just so you know this is seesawliving (I changed my name to one only marginally less lame... plus I like the smiths... btw thank you for suggesting to me how to change my name).

So the reason I said that it "fits" is because I was always uncertain it was depression since it didn't fit the description of sad, low appetite, insomnia... it was kind of the opposite... but exactly like "atypical" depression description. Dr did ask me about my depression and this was part of the reason she said I had bipolar II.

Makes sense.

Thanks for saying it was you.

That was an interesting article, btw. The part I found interesting is the reactivity symptom of atypical depression. Although I have the rest of the symptoms, I am not reactive when I'm depressed. If something good happens... ha, it doesn't phase me in the least. I'm withdrawn, I don't care how anyone acts towards me. It just doesn't really register. That's when it's bad. Mild, yes, reactivity sort of applies. However, with one exception, my depression has had agitation to agitation++ for many, many years. Heh, I guess that would make it mixed atypical depression. (haha, made up, of course)

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When I was depressed I did have very bad reactivity. I do not have this when I am not depressed. I was less reactive to "good" things, mostly to bad things, and that seemed to fluctuate with energy. Depressed mood + more energy = huge reactivity. I suppose even when I was "Depressed" some days I would have more energy and some days less... thinking back I did notice a trend toward nighttime rage which is when I get hypomania worst now, etc. Back then I was not mindful of how I felt at all, but I do distinctly remember times when my energy levels changed a whole lot but I never approached happiness or normal mood and didn't even consider I could be bipolar till a few years ago.

I only get agitation when I have hypomania that is dysphoric, which is this specific feeling of being overwhelmed with energy and wanting to really rip off my skin and beat a table with it... and I usually get that when I am going to be depressed or coming out of depression. I feel so extremely uncomfortable. I don't feel depressed at these times, just aaangry.

The rage I have when depressed primarily is usually more of a reactive type, it's like my coping with misery really reaches nil and my energy is temporarily higher so, rage it is. It didn't feel like anger, more panic and a complete sense of being overwhelmed/frantic.

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Here's another good article on atypical depression :

http://www.mcmanweb.com/atypical_depression.html

I wonder how borderline personality disorder and atypical depression can coexist as diagnoses? I suppose it is borderline if there is not weight gain and sleeping more and chronic depression... but atypical depression instead if the reactivity/sensitivity to rejection occurs as part of general depression with leaden paralysis, hypersomnia, hyperphagia?

If someone is bipolar II (which according to this link has the strongest association with all traits of atypical depression), and female (according to the link above only females with atypical depression have mood reactivity), how can it be possible to diagnose borderline personality in the same patient... but I notice a lot of people are bipolar II and bpd. How can you tell if if it is borderline, or if the bipolar depression is not resolved totally? Or, how can you tell if bipolar was ever the problem, maybe it was just borderline personality plus atypical depression that is recurrent (since borderline personality can look a bit like the mild hypomania of bipolar II).

Thinking, overthinking, I think.

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Here's another good article on atypical depression :

[link=http://www.mcmanweb.com/atypical_depression.html"'>http://www.mcmanweb.com/atypical_depression.html" target="_blank]http://www.mcmanweb.com/atypical_depression.html[/link]

I wonder how borderline personality disorder and atypical depression can coexist as diagnoses? I suppose it is borderline if there is not weight gain and sleeping more and chronic depression... but atypical depression instead if the reactivity/sensitivity to rejection occurs as part of general depression with leaden paralysis, hypersomnia, hyperphagia?

If someone is bipolar II (which according to this link has the strongest association with all traits of atypical depression), and female (according to the link above only females with atypical depression have mood reactivity), how can it be possible to diagnose borderline personality in the same patient... but I notice a lot of people are bipolar II and bpd. How can you tell if if it is borderline, or if the bipolar depression is not resolved totally? Or, how can you tell if bipolar was ever the problem, maybe it was just borderline personality plus atypical depression that is recurrent (since borderline personality can look a bit like the mild hypomania of bipolar II).

Thinking, overthinking, I think.

BPD traits persist regardless of mood state. BPII symptoms stop when the person becomes stable. I assume that a person with both experiences BPD traits all the time, but they are compounded by bipolar symptoms when in a mood state. The key, I think, is how a person is when the bipolar is stabilized.

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Most likely bipolar depression is more apt to be stuporous since atypical depression is more common in those with bipolar. Atypical depression includes leaden paralysis, eating for energy, retarded cognition and movement. Although atypical does happen in MDD, melancholic depression is more common - deep sorrow, loss of appetite. (Both forms have more symptoms, of course.)

really? i never heard that before. i wish i had - it would have helped me understand why my depression didn't fit the MDD criteria as neatly as it should have (i "get it" better now that i know my reaction to straight-up ADs resembles BPII stuff). i understand that people with MDD don't get these "mixed state" symptoms. but i wouldn't have thought that the depression component itself might look different, too. is there any reading material out there you've seen about this, Stacia?

ETA: duh, i just saw the link to mcmanweb, thanks Oscillate!

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Only bipolar depression can include agitation

Not officially -- agitated depression is still considered a subtype of MDD, not of bipolar (although you can find plenty of articles debating how it should be classified.)

As to the original question, although I know the discussion has veered off -- non-bipolar depression can be very severe. As can bipolar depression. An individual case of the former could well be more severe than the latter. But taken as a whole, non-bipolar depression encompasses many mild cases, much more so than bipolar depression. So when picking a random case from among all cases, non-bipolar depression is likely to be less severe than bipolar depression. Does that make sense? The mild cases bring down the average severity. It doesn't mean the really severe cases don't exist.

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As far as BPD, my experience has been that my depressions are in response to something that happens externally, like a breakup with a boyfriend. I just finally got diagnosed with everything (see siggie) but so far, my opinion is that my BP depressions are for really no reason (like right now), or maybe more seasonally. I was depressed when my husband and I went through marriage problems last year, but I believe that that's "normal," not due to BPD or BP. So there are a lot of reasons why someone can become depressed.

I generally agree with what others have said about having more rage and energy with BP depression. But then again, since I have BPD, I have a lot of rage issues anyway.

Also, I wanna add that I debate the difference between BP II and BPD as well, but somehow, having been diagnosed with both, it seems that there is some "essence" that is different. BPD *is* my personality while BP II is just a mood state I fluctuate around in.

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