View Full Version : Differentiating between Mood disorders and Borderline Personality Disorder.


saturday
02-02-13, 05:09 PM
Being generally interested in psychology and especially interested in mood disorders I've tried to keep track of what I consider trending topics on the subjects. I've seen a lot of talk lately on Rapid Cycling and had started to compare the symptoms with those of Borderline Personality disorder. Both include extreme mood swings and with the new term of "ultradian cycling" which describes mood cycles happening within hours and minutes of each other, I find it even harder to differentiate between the two diagnoses.

The thing that seems to be the main difference is that mood changes with BPD seem to be linked with a fear of abandonment or rejection, criticism, or being harshly judged in some way.

Does anyone have insight they would like to share on the differences between these two diagnoses?

saturday
02-02-13, 05:13 PM
The thing that seems to be the main difference is that mood changes with BPD seem to be linked with a fear of abandonment or rejection, criticism, or being harshly judged in some way.

And then thinking about these "fears", what about paranoid delusions that can be a symptom of some mood disorders like Bipolar Disorders with psychotic features or Schizoaffective Disorder?

daveddd
02-02-13, 08:46 PM
a couple of important differences im aware

borderline-less able to identify and accept emotions, more self harm,more empathetic distress,very strong negative affect, specific neurological LDs have also been seen

keliza
02-02-13, 09:00 PM
As a forewarning, my understanding on this subject comes from being a patient with bipolar disorder, having a handful of friends with borderline personality disorder (BPD), and having done extensive reading on the subject, both in an academic setting and on my own time. None of this is a 'professional' observation by any means.

I also want to say before I start that when I say "ego" in this context, I don't mean ego as in what we usually think - ego as in big-headed, having a big ego, being full of yourself, etc. I mean ego as in the self, the sense of self, that person's identity.

With that said, I think you hit a lot of the key differences between bipolar and BPD. The biggest difference to me is that BPD is a personality disorder and bipolar disorder is an episodic illness. BPD is a set of symptoms that present because the person has a fractured sense of self, and their reactions to the world come from that broken, absent sense of self. Bipolar disorder does not have to do with the ego, with the personality of an individual. Rather, it is a disorder of enduring mood episodes that fluctuate due mostly to chemicals in the brain.

Bipolar disorder is on axis I of the DSM-IV-TR. The multi-axial system of the DSM allows for diagnoses to be made based on the general 'type' of illness a person is experiencing, and factors that influence diagnosis. They break down into five axes, but for our discussion's sake, only the first two are important:

Axis I: All psychiatric disorders except personality disorders and pervasive developmental disorders. That includes depression, anxiety, bipolar, schizophrenia, ADHD, OCD, eating disorders, etc.

and

Axis II: Personality disorders and pervasive developmental disorders (PDDs). PDDs include autism, Asperger's, and mental retardation not caused by accident, injury, or another whole-body genetic condition (like Down syndrome or cri-du-chat syndrome).

With that known, you can see that bipolar falls on axis I, while BPD falls on axis II. They are different kinds of disorders. Personality disorders are, at their root, an instability of ego. The person's sense of self is fundamentally unstable, their personality is at its very essence disordered. A person with only axis I disorders, on the other hand, has no clinical flaw in the wiring of their personality, their ego. They have a stable sense of self that is always present, even when they are experiencing episodes of illness.

That is the biggest underlying difference between the two illnesses, theoretically. It's not always so easy to delineate in real life between the two, but that is the big difference at the core of these disorders. Bipolar disorder has a stable self, and the episodes tend to be longer, more enduring mood episodes that are reflective of a disruption of chemicals in the brain, not the individual's identity.

That is why medication works so well for bipolar disorder, but not for BPD. Some meds can help with BPD, but overwhelmingly they do not. (A specific type of therapy however, called DBT, can be extremely helpful for BPD, further highlighting the fact that it is an issue with the ego and an individual's cognitive schemas rather than brain chemistry.)

BPD has a fractured sense of self, and that is evident in episodes that are shorter and more rapid (what many people think is rapid-cycling bipolar disorder often ends up being BPD, especially in the absence of ever having had a true manic episode). BPD moods are also more reflective of a cognitive schema that is altered - constantly feeling like they are being abandoned, volatile responses to any perceived abandonment or slight from others, very reactive to the environment and relationships around them in general, etc. People with BPD are also more likely to react in very explosive, self-destructive ways to the perceived slights of others (like self-harm and suicide attempts).

To me, one of the easiest ways to look at someone and make a fairly decent call on whether or not they have bipolar disorder or BPD is to look at their reactivity. People with BPD are highly reactive to their environment, good or bad. The mood episodes in bipolar disorder are not reactive in that way. If someone with BPD has something great happen to them, they can go from being majorly depressed and suicidal to feeling on top of the world, then back down again, all within the afternoon! If someone with bipolar disorder has something great happen to them while they are in a major depressive episode... nothing changes. They might have a momentary blip of happiness, but there is very little general reactivity to the event. They are still majorly depressed, nothing has changed.

Here's another example to showcase the core cognitive differences that separate the two illnesses. Let's say Susie gets stood up on a date. Susie has BPD. Because Susie's identity is so fragmented and she does not have a stable core sense of self, she is going to be devastated by being stood up. She's angry, majorly depressed about it, may cut herself out of her explosive rage/sadness/anger, and may have a slew of thoughts like, "I'm not good enough, nobody loves me, I would be better off dead, that guy is a horrible person, I hope he gets run over by a truck, I hope *I* get run over by a truck, I should just go die" etc. Very reactive, very negative, everything revolves around Susie's lack of a stable ego.

Janet, on the other hand, was also stood up on a date tonight. She has bipolar disorder. Janet will probably get p*ssed about being stood up, like anyone would. But Janet's reaction totally depends on what mood episode she's in. If she's already depressed, she's going to react like a depressed person would. But if she's manic, Janet probably doesn't give two flying figs about being stood up. In fact, Janet might already have driven half-way to Reno to blow all her savings on slots because why not? Being stood up isn't going to make Janet suddenly plunge into an angry depression or irritable mania. It's not going to trigger a huge cascade of out-of-control responses like it did with Susie. Janet knows who Janet is at her core, her ego is not damaged by someone else's perceived judgment or abandonment. Janet is still Janet, and Janet will be Janet when she comes down from the mania or up from the depression. Those things won't change because someone stood her up for a date.

To me, that reactivity is the biggest difference between the two. Yes, some people truly have rapid-cycling or ultradian bipolar disorder, and may have multiple mood episodes in one day. But I'm highly suspicious of that in a lot of people, personally, as someone with bipolar disorder myself. A lot of people I see who believe they have ultradian bipolar disorder are often a lot more borderline-like, in my observation, the way they interact with others, the way their relationships tend to go, the explosiveness of their reactions, etc. Things that their psychiatrist doesn't see because they don't report it to them, but things the people in their lives on a daily basis can observe.

saturday
02-02-13, 09:40 PM
Thanks Keliza, that helps a lot. It pretty much is the direction I was thinking. But I never really bought into the term ultradian cycling. BPD is more reactive, and while Bipolar can be triggered I personally dont buy cycling within hours or day.

crystal8080
02-03-13, 02:23 AM
I guess that depends on the person right. I was going through a period where I was constantly in flux. It wasn't like I was going from floor 2 to floor 5 back and forth as if I was in an elevator. It was unpredictable and swift and had nothing to do with my environment. Here, then I'm here, now I'm over here. I don't wish it on anyone. Its so scary and exhausting.

I don't think I have BPD. Not because I think it is that bad, but because I am sure of who I am. My core, my inner being is constant. Luckily, my moods are stable at the moment and I have some relief from this nightmare. But right now, other than my general run of the mill weirdness, I'm pretty normal.