reactive episode - psychotic episode vs personality disorder

[Ballerina123]

A lot if people with personality disorders are told they have reactive behaviours and emotions. It is even part of the diagnostic criteria for EUPD.

Reaserch and information provided by professional mental health bodies say that psychotic and affective mood disorders (ie schizophrenic spectrum disorders, bipolar, ect) are often a result of stress.


When it comes to being reactive, surely both (ie most) mental illnesses are a result of reactivity?

For example if someone with a personality disorder had had a really stressful week with exams at college and as a result they started to have mood swings that would be classified as reactive.
However someone with bipolar under the same situation might become depressed due to the stress. Yet they are not diagnosed as having reactive symptoms.

I just don't get it? Surely all mental illness has a degree of reactivity. So why do psychiatrist make such a big deal out if it in PD patients? Do you think this is a result of poor assessment or am I seeing it wrong?

I do feel that if reactivity was recognised in all mental health problems that people could get better treatment, especially when it comes to relapse prevention.

[sherlock holmes]

I have bipolar and my CMHT recognise that I get unwell when I am under a lot of stress/pressure.

In fact I think everything I've read about bipolar has said it's important to have a daily routine, relaxation etc as stress is a trigger so it's important to keep it down.

[random.swirls]

My take on it is that with personality disorders the reactivity is more in terms I triggers and lengths. So for example someone with bpd may wake up in a good mood get a bad mark in a test which makes them depressed later on they go out with friends and are hyper but on going home they tell someone about the marks and go into depression again so the mood fluctuates daily etc.

Someone with bipolar may get the same mark on the test but be okay however they work much harder for the next exam and push themselves to the point that they become very stressed and ultimately this triggers an episode when the stress abates so might the depression but this would be a long time later.

I think it's emotional dis regulation that is key to bpd which isn't the case so much with bipolar.

One thing also to say is that reactive illnesses are common but these tend to respond to therapy whereas non reactive tends to respond to medication.

[Serendipity.]

My take on it is that with personality disorders the reactivity is more in terms I triggers and lengths. So for example someone with bpd may wake up in a good mood get a bad mark in a test which makes them depressed later on they go out with friends and are hyper but on going home they tell someone about the marks and go into depression again so the mood fluctuates daily etc.

I do get what you're saying here but I don't think it is necessarily that simple. I have BPD but I find that my mood is more 'reactive' when I am doing okay. Like, getting a bad mark would make me feel sad but I might be able to cheer myself up by going out with friends and taking my mind off it, but it wouldn't be to extremes, and those emotions wouldn't stop me from being 'okay' overall. Whereas if I am already having a 'mood swing' those events probably wouldn't affect me a great deal because the low (or high, I guess) that I'm already in is so all-encompassing and there isn't much room left for anything else.

So I don't know, it confuses me too.

[Ballerina123]

My take on it is that with personality disorders the reactivity is more in terms I triggers and lengths. So for example someone with bpd may wake up in a good mood get a bad mark in a test which makes them depressed later on they go out with friends and are hyper but on going home they tell someone about the marks and go into depression again so the mood fluctuates daily etc.

Someone with bipolar may get the same mark on the test but be okay however they work much harder for the next exam and push themselves to the point that they become very stressed and ultimately this triggers an episode when the stress abates so might the depression but this would be a long time later.

I think it's emotional dis regulation that is key to bpd which isn't the case so much with bipolar.

One thing also to say is that reactive illnesses are common but these tend to respond to therapy whereas non reactive tends to respond to medication.
Either way both is a reaction to a trigger therefore it is reactive.

Time frame from the original trigger to the reactive symptoms is never stated in medical literature. Therefore reacting that day or a week later doesn't make it any less reactive.

Except from the time frame both of your examples showed reactivity of equal amounts.

[whirlpools]

I think stress should be considered in all forms of mental health. I honestly thought it was. I don't know much about this, but I *think* the stress-vulnerability model helps in understanding psychosis, perhaps other mental health issues too. It's been a long time since I read about it but I think it recognises a vulnerability to mental health (perhaps biologically/genetically) and combines that with observing stressors in understanding relapse, or first episode.

In my experience with PD, the reaction is not necessarily brief or quickly changeable. A mood can last weeks for me, when I'm in crisis. When stable, moods might be a bit more changeable but in a more normal way. I think that's what Hannah was suggesting too, sorry if that's a misinterpretation.

I believe that early childhood experiences can change the way the brain develops (including neural pathways) so in a sense I also believe that PDs have a biological element, which might explain why medication is so helpful in some.

But to come back to your original query, Kate, I do believe stressful events should be an important consideration in everyone, to help teams know how to help people best. I believe the wellness and recovery action plan has a section for triggers, so that might be a helpful relapse prevention plan?

[random.swirls]

Sorry I should have added that it's not that simple but I was tryin to provide a simplistic definition and that not everybody with a pd will react like this and equally not everyone with another diagnosis will react as we are all human beings. I do think emotional disregulation is key and also what treatment works for the person as medication is unlikely to help someone with reactive symptoms.

It's also worth bearing in mind that people with bpd may have a concurrent diagnosis of depression and this may not be reactive which complicates things even more!!