Understanding my BPD diagnosis.

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I have bipolar II, BPD, and generalized anxiety disorder. I "relate" more to the bipolar and generalized anxiety disorder and have been having a hard time understanding my diagnosis of BPD. I definitely believe I have it since the stuff my prescriber said makes sense. But, I have a hard time "separating" my symptoms out. I relate everything to bipolar and am not actually sure what symptoms relate to BPD, or what the things are that I think people without mental illnesses do that are actually related to BPD. So I guess I am having a hard time understanding my BPD diagnosis and what it means to me. Thoughts?

[Celyn]

From what I've read (not based on personal experience, sorry!) there definitely can seem to be an overlap between symptoms of Bipolar and Borderline Personality Disorder, so I understand why it is difficult for you to untangle what's what.

My take on what I've read is that symptoms of BPD often appear in the context of personal relationships (friends, family, romantic partner etc), whereas with Bipolar, triggers of symptoms aren't necessarily to do with relationships but may be due to not taking medication correctly, not sleeping enough etc. There's also a difference in that with Bipolar, changes in mood can last for weeks or months at a time, whereas I've had BPD explained to me as very rapid changes (a guest lecturer at uni who treated people with BPD explained it as imagine all the best moments of your life, then all your worst moments, and imagine cycling through those feelings every few minutes/hours all day). Both Bipolar and BPD can effect relationships but again, people with BPD will often have a 'push/pull' type of relationship...small things may cause strong emotions which will push others away but then they get scared of the person leaving them so may cling to them to pull them back (the difference is that it can feel very intense for the person with BPD to the point of feeling suicidal at the thought of a loved one leaving/abandoning them....something that people without mental illness are unlikely to experience). For untreated BPD this may happen on a regular basis, but I imagine that with Bipolar, once the hypo/manic episode has ended (maybe days/weeks/months later), then there may be guilt or shame if the person has treated someone in a way that they wouldn't have if they hadn't experienced an episode.

The same may be said for identity. For people with BPD, they may frequently change their appearance (hairstyle and colour, clothes), their aspirations, and values/beliefs, partly to do with significant people in their lives (maybe if they fell out with someone important they would change everything that reminds them of them or they may change to be more like someone they are idolising). With Bipolar, identity changes may be due to a manic episode, rather than due to the people around them.

Bipolar is more 'biological' which is why medication is often the best route for managing symptoms, whereas BPD is more interpersonal so therapy may be the best route. But I imagine that Bipolar and BPD can interact...for example, if one gets worse, you may notice the other worsens as well.

The problem really is that diagnosing, especially disorders that can seem similar, can be quite subjective, so you may want to talk with your prescriber about what BPD means for you and how you can distinguish the symptoms from Bipolar.

Hope this helps a bit and that others can also help you!

[Stacey]

BPD/Bipolar/Anxiety can have a lot of overlapping symptoms so having difficulty separating the two is understandable.

A simple way to distinguish the two is that bipolar often has distinct periods of mania/depression. BPD on the other hand has similar symptoms like impulsivity, mood swings, abrupt changes to behaviour/appearance/etc. but they are almost always triggered by relationship interactions and drastic life changes/events.

While it is a very basic way to look at it, for the most part, any symptoms/thoughts you feel that are extreme or abrupt after some sort of relationship interaction or stressful life event is likely to be BPD. What triggers your BPD can absolutely trigger bipolar symptoms as well though, but you may be more likely to sink into one of those periods of mania/depression after a bit of time has passed, BPD reactions are often in quick response to the trigger. Since both BPD and bipolar are diagnoses of "extremes" so to speak, it can be very difficult to tell the two apart, especially at the moment. You may find it easier to separate the two when you look back in hindsight at particular moments.

More so than the diagnoses, the biggest difference is how the two are treated. DBT (dialectical behaviour therapy) is considered the "gold standard" for BPD treatment whereas bipolar is typically treated with medication.

There's a great video by Ofir Sasson on Youtube called Borderline Personality Disorder (2017) that does a great job at breaking down BPD.

[¯|_(ツ)_|¯]

So, immediately going to the extreme of "everyone is going to think I'm incompetent, I'm going to get fired" and things like that probably are more BPD than Bipolar because it has to do with people's reactions? And the reaction hits fast?

[Celyn]

Potentially.

Since BPD is often (not always) rooted in trauma, it may be that if you experienced hostile reactions or rejections when you've messed up (or felt that you have) in the past, you are more likely to jump to that conclusion in similar situations.

But as I said, it's subjective. It could even be part of the generalised anxiety.

It's also confusing when there's other people involved because it's easy to blame ourselves and think that we are quick to react when it may also be that the other person is strict/harsh, causing us to react (which would happen to anyone, not just people with BPD). For example, I was in a counselling group for people interested in becoming a counsellor and someone raised the topic of feeling that they were treated differently in class. Their tutor (a counsellor) and many of the group agreed that they should focus on how they reacted and what caused them to react that way (e.g. they were triggered from a past trauma, causing them to feel this way). But what few took into consideration is that there is a difference in feeling like you are treated differently and actually being treated differently.

So bottom line, before thinking that all reactions are because of your BPD/Bipolar, make sure that you aren't being treated negatively either (you might worry about being incompetent but good colleagues and managers should support you...if you are being made to feel incompetent then it's likely more to do with the other person rather than any of your diagnoses....that's my take on it anyway).

[Stacey]

Holly makes a great point. There are bipolar/BPD reactions but then there are reactions caused by negative interactions. It's incredibly difficult to work through what is what, especially in the initial stages of diagnoses/figuring out what treatments work for you. It may be helpful to make note if you recognize that you're having a reaction that may be "extreme" or abrupt and bringing it up when you talk to your doctor, therapist or whoever is helping manage your medications and mental health care. Making note of things that you notice about yourself and your interactions or particular things you notice about yourself that you're curious about and then discussing them with a professional can be a great way of working out what may be caused by what or why you said/did something (if that is an important part of understanding and treating your mental health, for you)