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So I have BP2 and high anxiety.  My therapist sat me down yesterday and said that due to my self hatred, rapid mood swings, etc that she thinks I also have BLPD. I thought you can't  be both BP2 and BLPD?  She says that BP2 is brain chemistry and BLPD is mood.  Two separate diagnoses.  One requires medication and one therapy.  

So does anyone have both or know if you really can? 

Edited by BatsBelfry
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People do get diagnosed with both bipolar disorder (BP) and borderline personality disorder (BPD). BP is classified as a mood disorder while BPD is, a "personality disorder." The defining traits of BP (depression and mania) last for four days to months to years. That is, you are manic or depressed for a long period of time. The traits of BPD that get confused for mania, mostly, are emotional dysregulation and can be much more fleeting and unpredictable. I've read arguments that cases of rapid or ultra-rapid cycling bipolar disorder are actually mis-diagnosed BPD.

I really like this blog post from The Last Psychiatrist for understanding what many psychiatrists mean when they give a diagnosis of BPD. BPD has become shorthand for "difficult patient". Be wary.

This is an interesting blog post in Psychology Today discussing the diagnostic similarities and differences between BPD and BP. The author argues that "Ironically, a patient who is actively manic and one who is acting out from borderline personality disorder look nothing alike if seen when symptoms are present. The difference is not subtle at all! Furthermore, if psychiatrists know the tricks of the trade (and most do not), they can get a patient with BPD to turn many of their symptoms off and on like a faucet. Manic patients stay manic no matter what the doctor does in the short term - short of knocking them out with sedating drugs"

This article in Current Psychiatry discusses the diagnosis of Borderline Personality Disorder with Bipolar Disorder. The intended audience for the article is psychiatrists, not lay-public like us, but the gist of it is that the two do co-occur and are often confused for each other.

According to that article:

  • Bipolar disorder is generally considered a clinical disorder or brain disease that can be understood as a broken mood “thermostat.”
  • Borderline personality disorder is characterized by an enduring and inflexible pattern of thoughts, feelings, and behaviors that impairs an individual’s psychosocial or vocational function.
  • BPD and bipolar disorder often co-occur. Evidence indicates ≤20% of patients with BPD have comorbid bipolar disorder and 15% of patients with bipolar disorder have comorbid BPD.
  • The confusion between bipolar disorder and BPD may be particularly problematic for patients with bipolar II disorder or subthreshold bipolar disorders.

 

In your position, particularly given your current BP2 diagnosis, my questions to the diagnostician would be:

  1. Which criteria for BPD do I meet? 
  2. What makes you sure those are not just symptoms of (possibly more severe) BP?
  3. How would a diagnosis of BPD change my treatment plan?
  4. Would those changes be beneficial even if I do not have BPD?
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Thank you so much for all of this.  It really means a lot.  Now I need to sort out all the information.   

 

To answer your questions: 

1. I seem to meet a lot.  But so many are so close to BP2 

2. I don't think I have or want to have BPD. I think my symptoms are just my BP2 but I rapid cycle.  

3. We focus on dealing with the personality side more in therapy.  Really not much of a change.  Try and help my self image and hatred.  We talk about that a lot and she attaches that to BPD.

4. Yes they would.  I just don't want to have BPD.   It has a bad stigma and I have enough crappy things about me.

 

Edited by BatsBelfry
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