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My name is Stephane, and I've been recently diagnosed with borderline and/or bipolar II...which is where my dilemma comes in. My psychologist believes I have borderline PD, my psychiatrist, who spends more time with me, believes I have rapid cycling bipolar II. I see my psychologist once a month and my psychiatrist twice a week. I've tried to get them to talk to each other to come up with one concrete diagnosis, but they only want to go through me. I know a diagnosis won't define me, but I sure wish I knew what I am so I can come up with a plan of action. Has anyone else had this issue? I believe I'm bipolar--I was diagnosed bipolar by my primary care physician as a child--but I can't help but feel mounting frustration. The doctor not in charge of my meds wants my meds upped to take the edge off my psychosis. The doctor in charge of my meds gets mad that the other doctor is challenging his BPD diagnosis and says no. Help. What would be a good way to help fix this? I love both my doctors and respect them both, but the only thing they agree on is that I have OCD.

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Both psychologists and psychiatrists are licensed to diagnose and treat mental illness. Psychiatrists go to medical school for four years then do a residency of three or four. Psychologists complete a

Yes but these articles don't prove any of what you said. You said pediatric bipolar doesn't exist (whether it really does or not I am not sure, but I do believe it can be over-diagnosed which doesn't

I would try meds for mood stabilization and therapy/DBT for emotion regulation and coping skills.  No matter the label, it is really about finding a path of less suffering and more meaning and stabili

I would not expect a psychologist to Dx bipolar as it is strictly a medical condition and they can't treat/don't have a treatment for medical conditions. Their points of view are totally different. One is from a medical point of view and the other psychological, so this totally taints their diagnosis. One tends to diagnose what they have treatments for. 

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I'm pretty sure it is possible to have both.

Honestly, I'd let each treat me for whatever they think my true problem is. That way between the two of them, I'm likely to get the proper treatment. That's a lot better than having a wrong diagnosis.

Edited by jt07
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I would try meds for mood stabilization and therapy/DBT for emotion regulation and coping skills.  No matter the label, it is really about finding a path of less suffering and more meaning and stability.  Medication management and therapy are not mutually exclusive.

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The fact that you were diagnosed bipolar as a child tells me you're probably borderline, if either.

Evidence suggests that not only does ""childhood bipolar"" more or less not exist, but the diagnosis is predictive of later MDD and/or BPD and rarely carries into actual adult bipolar disorder.

But I am not a professional, so take what I say with a grain of salt.

Edited by Lexie
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5 minutes ago, Lexie said:

The fact that you were diagnosed bipolar as a child tells me you're probably borderline, if either.

Evidence suggests that not only does ""childhood bipolar"" more or less not exist, but the diagnosis is predictive of later MDD and/or BPD and rarely carries into actual adult bipolar disorder.

But I am not a professional, so take what I say with a grain of salt.

How do you figure? Do you have any peer reviewed scholarly articles to really back up your claim that childhood BP doesn't exist and is predictive of MDD or BPD? If so, could you provide those articles please? I have never heard of anything like you are talking about. But I'm not a professional either so...who knows?

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I know of more than one person who was dx'd with bipolar as a 14-year old (and one who was dx'd schizophrenic at 15). All of these teens grew up to be adults with their respective diagnosis intact. There are a lot of politics around getting a BPD label - it's not always necessarily the correct one, but it can happen for a variety of reasons.

 

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34 minutes ago, lifequake said:

I would try meds for mood stabilization and therapy/DBT for emotion regulation and coping skills.  No matter the label, it is really about finding a path of less suffering and more meaning and stability.  Medication management and therapy are not mutually exclusive.

I think you are spot on quake!

And OP, It is entirely possible to have both BPD and BP as evidenced by many members diagnoses here.

And DBT is used not just for BPD but also for different MI's. My tdoc specializes in DBT and I have a psychotic mood disorder so we focus on skills and structured therapy. I also attend a CBT group and find that helpful too so, YMMV.

Good luck finding good meds AND therapy to help you feel better!

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6 minutes ago, WinterRosie said:

I know of more than one person who was dx'd with bipolar as a 14-year old (and one who was dx'd schizophrenic at 15). All of these teens grew up to be adults with their respective diagnosis intact. There are a lot of politics around getting a BPD label - it's not always necessarily the correct one, but it can happen for a variety of reasons.

 

Coincidentally, 15 is precisely the age where you're considered to be reaching adulthood for the purposes of a lot of psychiatric stuff. In other words, it's the age where you see a peak in initial presentations of psychotic and manic episodes.

If you're referring to teenagers as children, you're blurring very important lines in a big way, neurologically speaking.

ETA: I am looking for studies which investigate the long-term stability of pediatric bipolar diagnoses, give me a bit.

Edited by Lexie
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The symptoms overlap and you can have both. It may cause more confusion but if it is possible you could get a 3rd opinion from a different pdoc. 

I have a different opinion than Lexie, but I agree with her that childhood bipolar is debatable. They have a new dx in dsm 5 Intermittent explosive disorder which some of the children that had previously dx as bipolar are dx. If you ask adults with bipolar to track back their mood symptoms many of us had differences long before we were dx. Some in childhood. I believe childhood bipolar occurs, not sure what is the best way to deal with it.

i am a little confused as to who is treating what. Your pdoc says bipolar, but the one who prescribes meds is different? 

I know sometimes the labels don't matter so much, but this is causing you distress. I really hope you can get it figured out somehow or at least treat the symptoms properly

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5 minutes ago, WinterRosie said:

How am I blurring neurological lines given that the pre-frontal cortex continues to mature into one's early 20s?

I don't know about bipolar, but I know schizophrenia seems to generally be caused by connections being culled, not built.

It's true that connections continue to be built into one's early 20s, but it's also true that there's major pruning which kicks into high gear at about 15 and continues until the age of 30. Coincidentally, schizophrenia tends to develop around that 15 year mark, and almost never develops after 30--except in women (and perhaps afab trans people), where it sometimes kicks in with menopause, because estrogen is apparently an antipsychotic hormone.

I've done some research. Rosie. I could still be wrong about OP's bipolar diagnosis, but I know very well that 15 is an important year for these things.

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Here is a news article on pruning for you Lexie 

http://www.nbcnews.com/health/mental-health/too-much-brain-pruning-may-cause-schizophrenia-study-finds-n505451

average age of onset for sz 18 males 25 females will add link

Schizophrenia is a disease that typically begins in early adulthood; between the ages of 15 and 25. Men tend to get develop schizophrenia slightly earlier than women; whereas most males become ill between 16 and 25 years old, most females develop symptoms several years later, and the incidence in women is noticably higher in women after age 30. The average age of onset is 18 in men and 25 in women. Schizophrenia onset is quite rare for people under 10 years of age, or over 40 years of age. The diagram below demonstrates the general "age of onset" trends for schizophrenia in men and women, from a representative study on the topic. 

szage.onset.gif
Source: A typological model of schizophrenia based on age at onset, sex an familial morbidity. Acta Psych8atr. Scand. 89, 135-141 (1994).

Edited by confused
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Both psychologists and psychiatrists are licensed to diagnose and treat mental illness. Psychiatrists go to medical school for four years then do a residency of three or four. Psychologists complete a doctorate degree in usually three or four years, then have a post-doctoral fellowship of one to two years. The difference is that psychiatrists can prescribe medication where psychologists cannot. Both get training in therapy. Both are equally qualified to diagnose and treat with therapy. The issue is not which provider is more qualified.

Distinguishing between bipolar disorder and borderline personality disorder is one of the hotbeds of contention in the diagnostic world in general, regardless of the type of provider, particularly when bipolar is rapid cycling. Ultimately, cheese's response has a lot of utility. Stabilize the mood with meds and learn a bunch of skills to help things go more smoothly for all the symptoms, regardless of the etiology or diagnosis.

In the interest of coordination of care, your providers really would do best to talk to each other, or only see one of them. Especially if you are getting therapy from both, and they are NOT willing to coordinate with each other.

 

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I'm not finding anything directly investigating the stability of the diagnosis, but I am finding studies and discussions of diagnostic problems and confusion of symptoms.

Mostly, the finding is that childhood diagnoses of bipolar have often been made based on continuous moods and/or a habit of sudden flashes of emotion (especially anger), and this is wildly inappropriate and doesn't actually indicate bipolar at all. Exceptionally angry/acting out children tend to later develop other problems, not bipolar--anger as a symptom of bipolar disorder doesn't tend to develop until adolescence.

Also, emotional problems in childhood in general actually predict that a patient diagnosed with bipolar on the basis of psychosis with possible mania will later be diagnosed with schizophrenia (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224340/), general anger problems in childhood tend to predict depression (http://www.ncbi.nlm.nih.gov/pubmed/20853919), and general acting out problems/ADHD/ODD/etc. tend to predict borderline personality (http://www.ncbi.nlm.nih.gov/pubmed/21671009), but these sorts of problems have often been mistakenly taken as possible childhood bipolar symptomatology.

It would help if we knew OP's age and symptoms at that initial diagnosis, but this really is ultimately a question for the professionals to discuss anyway, so.

Edited by Lexie
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It would help if we knew OP's age and symptoms at that initial diagnosis, but this really is ultimately a question for the professionals to discuss anyway, so.

Indeed, diagnosis is not something a bunch of other crazy people on the internet are qualified to do.

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1 minute ago, Wooster said:

Indeed, diagnosis is not something a bunch of other crazy people on the internet are qualified to do.

God knows I'm not qualified. I probably wouldn't be qualified even if I had qualifications.

I am crazy, after all.

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7 minutes ago, Lexie said:

God knows I'm not qualified. I probably wouldn't be qualified even if I had qualifications.

I am crazy, after all.

?

You can be a pdoc/tdoc with a dx or am I missing something (probably)

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