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Conflicting doctors: am I Borderline OR Bipolar?

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Lost story short: I saw another psychiatrist as a follow up today because I had a major upset yesterday. I'll see my regular one on Thursday.

My question is this: when I asked my regular psychiatrist a few weeks back and asked her if she thought I might be Borderline, she actually laughed. She said I wasn't Borderline and didn't really elaborate. (I'm diagnosed as Bipolar--probably I, she thinks, because of irrational anger outbursts and delusions and mild euphoria.)

Today I asked this psychiatrist this question: "Why is it that today I'm relatively normal feeling, while the past four days I've been lower than I've ever been?" He said it might have to do with a Personality Disorder--Borderline specifically. Please note he DIDN'T say I had it and admitted that he couldn't make that call, but it was something that my regular psychiatrist might want to consider after seeing me for several months.

I suppose the main red flags that speak to me not being Borderline: I'm typically non-confrontational, don't self harm, and don't feel empty. I always know who I am, even at my lowest moments. I'm not afraid of being abandoned and always (try) to see the good in people, even if they've done bad things to me, etc. In other words I don't have black and white judgement.

So--if these things aren't true, can I still be Borderline? My largest concern is that if I'm Borderline all these Bipolar medications won't do much good, and instead I should be doing intensive therapy as opposed to a visit every two or so weeks.

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These are the DSM-IV criteria for BPD, of which you must have 5:

(1) frantic efforts to avoid real or imagined abandonment.

(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

(3) identity disturbance: markedly and persistently unstable self-image or sense of self

(4) impulsivity in at least two areas that are potentially self-damaging

(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

(6) affective instability due to a marked reactivity of mood

(7) chronic feelings of emptiness

(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

(9) transient, stress-related paranoid ideation or severe dissociative symptoms

You say you don't have abandonment issues (1), identity issues (3), self-harm (5) or emptiness (7). You're non-confrontational, but you do mention irrational anger, so maybe (8). I'm not hearing anything like (2). You also don't mention impulsivity (4) or transient paranoia or dissociative symptoms (9) (delusions, but dunno what). Basically the only thing you clearly seem to have is (6).

That does not immediately suggest BPD to me.

As a general rule, I would trust your regular psychiatrist over someone you only see once. Especially when it comes to personality disorders.

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You were just seeing the doctor, and he is not your regular doctor? He does not know you?

Don't let some 'concept' that he just tossed out there rock your boat.

He does not know you. I think it was slightly irresponsible for him to toss out the possibility of a PD.

Just continue in treatment with your regular doctor.

And some bipolar people can switch moods rapidly.

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Ladybug is right, sometimes doctors can blurt out a passing thought that shouldn't be taken seriously because they just didn't think hard about it, just like the rest of us. I would accept your regular doctor's opinion, s/he knows you best

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PD's are funny things. A significant portion of people who meet criteria for an Axis I disorder meet criteria for an Axis II disorder.

I wouldn't doubt the Bipolar dx, but consider the possibility that you have personality dysfunction on top of it. You could very well have symptoms that indicate something is amiss personality-wise but do not fit full criteria for a personality disorder.

I'm not diagnosing you or anything. This is becoming my almost standard personality disorder public service announcement. People seem to have issues with personality disorders, thinking they're horrible and to have one is to be doomed. In reality, they're common (more common than Schizophrenia even), treatable disorders.

(off soapbox)

That said, you may very well have some poor coping mechanisms if you feel your mood shifting wildly like that. Or you may need a med tweak. Either way, things to discuss with your regular doctor.

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Something to remember is that, in addition to having to satisfy the criteria for BPD in order to be officially diagnosed, you'd also have to fulfill the criteria for personality disorders in general. http://www.behavenet.com/capsules/disorders/prsnltydsrdr.htm I found them here if you'd like to check them out. It might make you feel better. ;)

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I agree with what the people above had said. I would also say - and note that this is my opinion, not fact - that crisis situations are often associated with PD diagnosese. At least, where I am, I find that a lot of people who go to hospital after trying to commit suicide or self-harming end up getting labelled "borderline" by the crisis team (obviously, this is not a diagnosis, just a label). I don't know what your major upset was, but remember that that psych had only see you once, and that was in the wake of a crisis situation.

Yeah. I hope that made sense. Anyway, I wouldn't get too upset about it. If your regular psych doesn't think you're borderline, I'd go with that. If you're still worried, then next time you see him/her ask them their reasons why they say that you're not borderline.

Hope that helps.


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Guest Vapourware

If you are really concerned about the prospect of a PD dx, then perhaps explore the concept with your pdoc some more at the next session. You can ask your regular pdoc why she was so outright dismissive of a PD dx, and see if you agree with her rationale. It also sounds like your BP might not be completely stable, so perhaps trying to tease out whether you have a PD is currently premature because the unstable BP is colouring how you present to the world, and your responses to your environment. I would also try and work on the BP first before seeing if there are other issues that are affecting your life.

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  • 1 month later...

Hi, I have the same problem as you.. but I guess I'm a bit more confused.

I was a seeing a pdoc for three years and his official diagnosis for me was borderline PD with cyclothymia.

I switched pdocs and I was diagnosed bipolar 1, which then progressed to my current diagnosis of schizoaffective bipolar type, and that diagnosis has remained that way for 2 years.

When I ask my current pdoc if I have borderline PD, he outright says NO because he says I'm perfectly fine when I'm not in a mood episode.

But I think I have it. I'm usually always confused. I break down at the drop of a hat. I am emotionally labile. I self-harm. My EMOTIONS change hour to hour. I have abandonment issues. And I have a history of abuse.

BUT I also have MOOD episodes that last days to weeks. Mixed states. Hypomania. I had long-standing delusions that lasted for YEARS.

I think I may be a mixture of schizoaffective and borderline. I don't know what to do, really.

We medicate all we can, but the emotional lability is still there, and I don't know what to do about that anymore.

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It's also possible that you're like me: I am not borderline. I have borderline traits, enough so that they interfere with my life & functioning, but not enough for a diagnosis.

I'm in DBT because, well, the traits interfere with my life & functioning. And also because DBT is good for other things too.

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