BPD and Bipolar

[HildaOgden]

There seems to be some suggestion that I could have Bipolar AND BPD.
Is this possible that the two can be co-morbid?

My GP thinks I have Bipolar Affects and then when in crisis I have BPD behaviours.

I'm seeing my psychiatrist on 9th April and want to ask him about this. I touched on this question with him 6 months ago at my last appt but was too scared to ask what he thought. This time I'm going to be more confidant and upfront with my questions.

When I saw my GP yesterday, he printed out my medical history going back to 2000. When I got home I went through the 17 pages (!!!) of computer notes and noted down on an Excel spreadsheet my periods of distress (self harm, hosp admissions) by month and year from 2000 up to present date.
There seems to be a pattern of distress over the summer months and the first few months of each year.

My GP and CPN have said that my distress seems to cyclical - which is indicative of Bipolar disorder. I do get highs (when last year I got a job and was on a high for a couple of months followed by a spectacular crash last summer).

I was under the impression that BPD moods are up and down all the time and they last hours or days where as my moods (high and low) last weeks (sometimes months).

After last summer's distress which ended mid Aug, I was fine from Sep to mid Dec then my mood dropped from Christmas to February.

When I'm distressed I have urges to self harm and suicide. Sometimes I act on these urges. I become more impulsive.

I'm doing DBT (group and individual) and am 6 months in to a year's program. One of the conditions of admittance to the dBT program is that you don't have Bipolar. At the group sessions I listen to the other ladies and I don't relate to them. They seem really angry and unstable. I don't feel like that. When I started my pre-DBT sessions last summer with my one to one therapist, I did the Zanarini BPD questionnaire and scored 20. 14 and above indicates BPD but I was in an episode then. I am convinced if I were to do the Zanarini scale now I wouldn't score over 14.

I don't want to talk myself out of DBT as I think it is really interesting and useful but I'm not sure i meet the criteria for BPD during my stable periods.

Does anyone else experience the same sort of thing where they have long periods of wellness and then episodes where they become unwell and self harm? The episodes being 6 months apart?

Sorry for going on. I've probably not made much sense, but I'm just trying to make sense of all this.

[sherlock holmes]

I can relate to a lot of what you've written. My diagnosis was BPD for a few years, then it was changed to bipolar. Now it's a bit up in the air again.

I guess you can have both, though the symptoms can be very similar/overlap.

If I look back over the year I can see a clear period of wellness, and also a long period of being unwell. But even within those periods I would have some mood swings on a daily basis sometimes.

I can especially relate to you saying when you are in distress you have some BPD like behaviours. That's the only time I exhibit those types of behaviours (impulsive, self harm, suicidal, desperate) but otherwise I don't have any BPD symptoms.

I guess if you feel the DBT is helpful then maybe ask that your diagnosis is left alone for the time being. Personally DBT was extremely helpful to me, and even though I no longer fit the full criteria for BPD, the skills I learned still continue to help me now with in dealing with general distress tolerance etc.

[Epicene]

From what you've said, it sounds like you have a pretty good understanding of each of the typical traits. I think the key distinction between each is not just the length of time between mood swings, but the emotions involved. Bipolar requires highs and lows, whereas BPD tends to flit between anger and sadness, with only occasional moments of feeling 'well' (and certainly not euphoric highs). So I think they can also be comorbid, but it would be quite a complicated presentation and would require assessment over a considerable length of time.

In terms of personal experience, I have BPD and have only ever had mania once when starting antidepressants. To me, things associated with mania like euphoric moods, boundless energy, creative bursts and risk taking seem completely foreign. If I take risks it is far more tied in with depressive symptoms and dissociative states. It might be worth you exploring how you feel when engaging in certain behaviours because it is a key aspect of diagnosis.

[random.swirls]

I have recently received my diagnosis after being under the team for 5 years and approaching discharge. In many ways I seem like you when depressed I can present as having BPD in terms of self harm/suicide but I know that if I was never depressed again I would never self injure again. Anyway my diagnosis is bipolar with traits of EUPD. When i asked what trait it was because I self injure.

That said it is possible to have bipolar and BPD co morbidly mood swings is just one symptom.

Definately talk it through with your psychiatrist and see what he says.

Ps I should say that the bipolar diagnosis has been my working diagnosis for years but the team I'm under don't diagnose properly until discharge.

[MissWay]

I totally identify with Bipolar affects and BPD

[Pomegranate]

Definitely possible. I am also diagnosed with Bipolar and traits of BPD. If your CPN has suggested it I imagine it would have been noted on rIo so possibly your psychiatrist has already been considering it. I don't think there is anything wrong with mentioning it.

[ashasphodel]

i'm diagnosed with both!

[sherlock holmes]

Yeah my current working diagnosis is bipolar with traits of emotionally unstable personality disorder (BPD)

[Cryptic.]

Totally possible to have both.

[ashasphodel]

^ what cryptic said!

[Wellingtons]

My diagnosis is Bipolar type 1. My CPN says there is no mention of a personality disorder on my file, however I believe I have traits which come out when I'm having a mixed episode (self harm and suicidal ideation). My CPN says this is possible as she believes most people have some traits of a personality disorder.