What is the difference between Borderline Personality Disorder and Bipolar Disorder? Which is worse?
Answers:
Both are serious and nooo fun having. Here is some INFO
Borderline personality disorder (BPD) is defined within psychiatry and related fields as a disorder characterized primarily by emotional dysregulation, extreme "black and white" thinking in some areas, and turbulent relationships.
The name originated with the idea that individuals exhibiting this type of behavior were on the "borderline" between neurosis and psychosis. This idea has since fallen out of favor, but the name remains in use, as noted in the Diagnostic and Statistical Manual of Mental Disorders; the ICD-10 has an equivalent called Emotionally Unstable Personality Disorder, borderline type. There is currently some discussion by the American Psychiatric Association about changing their name for the disorder to Emotional Dysregulatory Disorder, or Emotional Dysregulation Disorder in the next version of the DSM.
Psychiatrists and some other mental health professionals describe Borderline Personality Disorder as a serious mental illness characterized by pervasive instability in mood, interpersonal relationships, self-image, identity, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self. The majority of those diagnosed with this disorder appear to have been individuals abused or traumatized during childhood.
The DSM-IV-TR, a widely-used reference book for diagnosing mental disorders, defines Borderline Personality Disorder as a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
frantic efforts to avoid real or imagined abandonment. (not including suicidal or self-mutilating behavior covered in Criterion 5)
a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
identity disturbance: markedly and persistently unstable self-image or sense of self.
impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating; [not including suicidal or self-mutilating behavior covered in Criterion 5]).
recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
chronic feelings of emptiness.
inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
transient, stress-related paranoid ideation or severe dissociative symptoms.
DSM-IV-TR, 301.83.
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Mnemonic
A commonly used mnemonic to remember the features of the borderline personality disorder is PRAISE:
P - paranoid ideas
R - relationship instability
A - angry outbursts, affective instability, abandonment fears
I - impulsive behaviour, identity disturbance
S - suicidal behaviour
E - emptiness
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Symptoms
While a patient with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of depression, anxiety, or anger that may last only minutes, hours, or at most a day.[7] These may be associated with episodes of self-injury (including cutting), impulsive aggression, and drug or alcohol abuse. Difficulties in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, and values. Sometimes people with BPD view themselves as fundamentally bad or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone. Ironically, it is the desperate clinging to other people that often serves as the very catalyst for conflict that drives others away.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and trust for the other person, but when a separation or conflict occurs that others may see as slight, they can lose their sense of attachment and trust and may become withdrawn or angry. Even with family members, individuals with BPD can be highly sensitive to rejection, for example reacting with distress or anger to separations. These fears of abandonment may be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicidal attempts may occur along with anger at perceived abandonment and disappointments.
People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, attention deficit disorder, anxiety disorders, substance abuse, eating disorders and other personality disorders.
As a consequence of difficulties with emotional regulation and maintaining some social boundaries, people with BPD can sometimes make rapid and seemingly deep connections with others, marked by unrealistically high levels of mutual admiration. When very open and in need of reassurance and love, they can sometimes overwhelm others with praise, attention and intimacy. They can also feel overwhelmed by others or be taken advantage of. Due to the inherent instability of such relationships, and unresolved issues for the person with BPD, particularly in matters of trust and self-worth, they are prone to react strongly to apparent slights and reverse their over-positive view. This can be experienced by others as unexpected hostility or betrayal, and can also be confusing and painful for the person with BPD.
Treatments for BPD have improved in recent years. [8] People with BPD, who are often distressed by at least some of their symptoms, typically undertake a series of empirical trials of drugs to see whether anything helps them, and may end up taking no drugs at all.
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SSRI antidepressants
Since about 1989, Prozac and other selective serotonin reuptake inhibitor (SSRI) antidepressants have repeatedly been shown to improve the symptoms of BPD in some patients, which seems to be a separate effect to antidepressant as such, focussing more on affect regulation. This, however, is questioned by some psychiatrists who caution against use of SSRI and SNRI drugs due to risk and side-effects. Medication must be carefully monitored with BPD patients as the ultimate risk is suicide, and this can potentially be the direct result of prescription drug mismanagement.
The book Listening to Prozac describes some of these remarkable changes. In general, it takes a higher dose of an SSRI to treat BPD than depression. It also takes about three months for benefit to appear, compared to two weeks for depression. The previous antidepressants, the tricyclics, were often unhelpful; side-effects are generally difficult to tolerate and the drugs are often lethal in overdose. Increasing evidence implicates inadequate serotonergic neurotransmission as strongly related to impaired modulation of emotional and behavioral responses to everyday life, manifesting as "overreacting to everything". Even thinking is recruited by the intense (or underregulated) emotionality so that the world is perceived primitively in intense black-and-white terms.
Often, an SSRI or a SNRI drug is prescribed to a patient with BPD without proper supervision and involvement of family caregivers, or explanation or warning of side effects. The drugs often cause agitation and insomnia initially and for some people these problems may persist, which can pose problems in someone who may be suicidal when they begin therapy. Many people can experience withdrawal symptoms when stopping which can leadto the impression they are 'addicted ' to the medication.
The impulsivity, suicidality and possible lack of supports in borderline patients may render them much more vulnerable to self-harm than those without these vulnerablilies should these problems arise.
It may be difficult for the treating physician to make the distinction between side effects that are worsened by increase of dose and the symptoms that a patient is experiencing from the disorder. Increasing the dose to address the worsening symptoms can be dangerous if the symptoms are in fact a side effect of the drug.
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Mood stablilizers
Other pharmacological treatments are often prescribed for certain other specific target symptoms shown by the individual patient, especially for people with more than one psychiatric diagnosis. Mood stabilizers (lithium or certain antiepileptic drugs) may be helpful for explosive anger, impulsivity, or if there is an admixture of bipolar disorder.[9]
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Neuroleptics
Neuroleptics or antipsychotic drugs may also be used when there are distortions in thinking (e.g., paranoia).[10] Overall, medication has not been as effective for people who have only BPD (without any other mental illnesses) as it has been in many other psychiatric disorders, leading many researchers to focus on non-chemical treatments, such as Dialectical Behavior Therapy, for "pure" BPD patients.
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Dialectical Behavioral Therapy
In 1991, a new psychosocial treatment termed Dialectical Behavioral Therapy (DBT) was developed specifically to treat BPD, and this technique was the first to show any efficacy compared to a control group. Marsha Linehan, the developer of DBT, said in the early days that it took about a year to see substantial enduring improvement. Combining SSRIs and DBT (probably the standard treatment now) seems to give satisfying synergy and faster results.
Linehan's dialectical behavior therapy is based on negotiation between therapist and patient. The dialectic described in the treatment's name is of the therapists' acceptance and validation of patients as they are, combined with the insistence on the need for change. The idea is to give patients tools that they never acquired as children, typically to control and handle their emotions. Some patients, when asked after several years of treatment, why they have stopped inflicting self-injury, give answers to the effect of "I picture myself sitting with my psychotherapist, and we talk about why I want to injure myself."
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Other psychotherapies
Cognitive and behaviorally oriented group and individual psychotherapy are effective for many patients. Traditional psychoanalysis is usually avoided, because it has been known to exacerbate BPD symptoms.
Another relatively recent and exciting development is a variation on Jeffrey Young's 'Schema Therapy', entitled 'Mode Therapy'. Details can be obtained from his book.
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Recent research findings
Although the causes of BPD are uncertain, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits, possibly through the final common pathway of reduced central serotonergic neurotransmission. Studies show that many (but not all) individuals with BPD report a history of abuse, neglect, or separation as young children.[11] Between 40% and 71% of BPD patients report having been sexually abused, usually by a non-caregiver.[12] Many others have an apparently hereditary form of the disease.
Researchers believe that BPD results from a combination of individual genetic vulnerability and environmental stress, neglect or abuse as young children, and maturational events that trigger the onset of the disorder during adolescence or adulthood.
Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may be the result of vulnerabilities resulting from BPD (e.g., willingness to tolerate unsafe environments to avoid abandonment, tendency to form intense relationships) as well as impulsivity and poor judgment in choosing partners and lifestyles. Anger, impulsivity, and poor judgment may also explain why people with BPD are more likely than average to be arrested for and convicted of crimes ranging from petty theft to murder.
Neuroscience research examines brain mechanisms possibly underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.[13] The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of stress and/or drugs like alcohol. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.[14]
Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety and irritability. Drugs that enhance brain serotonin function sometimes improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings.
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Future progress
Studies that translate basic findings about the neural basis of temperament, mood regulation and cognition into clinically relevant insights which bear on BPD represent a growing area of research. Research is also underway to test the efficacy of combining medications with behavioral treatments like DBT, and gauging the effect of childhood abuse and other stress. Data from the first prospective, longitudinal study of BPD, which began in the early 1990s, is expected to reveal how treatment affects the course of the illness. It will also hopefully pinpoint specific environmental factors and personality traits that predict a more favorable outcome.
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The NonBP, or counter-Borderline
NonBP is a non-clinical term originally coined by Kreger & Mason in the book Stop Walking on Eggshells (ISBN 157224108X) in the mid-1990's. It has since come into widespread and popular usage. The term describes individuals who are in a consistent, and sometimes significant, relationship with a person exhibiting a Borderline character, aspects of Complex Post Traumatic Stress Disorder (C-PTSD), or a formally diagnosed Borderline Personality Disorder. These people can be friends, spouses, lovers, offspring, co-workers, and extended family members, among others.
While "NonBP" is a colloquial expression, and not a clinically defined condition or syndrome, the idea parallels that of the "roles" that people often take on in alcoholic families, or abusive relationships. It is also consistent with the idea of "roles" described in co-dependent relationships, such as "enabler", "counter-dependent", and/or "agent". Part of the value of this type of informal terminology is that it helps describe the manner in which others potentially behave when in relationship to a person whose social skills are inadequate, in what ever way that presents itself.
When talking about the Borderline relationship, the "Non-reactive NonBP" is considered to be a person who interacts with the Borderline character, while not being drawn into, or engaging, the chaos of the disorder. The "Reactive NonBP", however, both interacts with the Borderline character, and engages the Borderline behavior. This often throws the person off-center, and promotes a kind of parallel emotional dysregulation within them. The "Reactive" relationship style breaks down into two distinct sub-styles; transpersonal, or the "trans-Borderline", and counterpersonal, or the "counter-Borderline".
The "trans-Borderline" is an individual who engages the Borderline character, and is drawn only to the chaos of the disorder itself. Rather than being directly affected, s/he is more apt to stay focused on "cleaning up" after the Borderline personality. This is something akin to the "caretaker/enabler" role found in alcoholic relationships. In both cases, this person is characteristically co-dependent, or set up to be co-dependent in that relationship. S/he acts as enabler, or agent, or both.
The "counter-Borderline", on the other hand, not only reacts to and integrates the Borderline style, but reflects it, as well. This individual is the most negatively affected by his/her relationship to the Borderline personality. Very often, this person will begin to behave in a manner very similar to a person with a Borderline personality. This type of relationship is very treacherous and, when talking about chaotic relationships with Borderline personalities, this is the sort of situation to which most people are referring. This type of relationship often leaves the NonBP questioning his/her own sanity, and the "emotional hangover" of such a relationship can take a considerable amount of time from which to recover.
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References
DSM-IV Criteria for BPD from the BPD Resource Center
What is Borderline Personality Disorder? at My Borderline Life
Borderline Personality Disorder, Raising questions, finding answers (PDF) from the NIMH website
BPD Information page at The Doctors Lounge
Basics of BPD at BPD Central
Borderline Personality Disorder defined at Secret Shame
Dialectical Behavior Therapy detailed at Secret Shame
BD
Bipolar disorder (previously known as manic depression) is a diagnostic category describing a class of mood disorders in which the person experiences states or episodes of depression and/or mania, hypomania, and/or mixed states. Left untreated, it is a severely disabling psychiatric condition. The difference between bipolar disorder and unipolar disorder (also called major depression) — for the purpose of this introduction — is that bipolar disorder involves "energized" or "activated" mood states in addition to depressed mood states. The duration and intensity of mood states varies widely among people with the illness. Fluctuating from one mood state to another is called "cycling" or having mood swings. Mood swings cause impairment not only in one's mood, but also in one's energy level, sleep pattern, activity level, social rhythms and thinking abilities. Many people become fully disabled — for significant periods of time — and during this time have great difficulty functioning.
According to the US government's National Institute of Mental Health (NIMH), "There is no single cause for bipolar disorder—rather, many factors act together to produce the illness." [3] Let's return to this claim at the end of this section.
It is well established that bipolar disorder is a genetically influenced condition which can respond very well to medications (Johnson & Leahy, 2004; Miklowitz & Goldstein, 1997; Frank, 2005). Psychological factors also play a strong role in both the psychopathology of the disorder and the psychotherapeutic factors aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing prodromal symptoms before full-blown recurrence, and, practicing the factors that lead to maintenance of remission (Lam et al, 1999; Johnson & Leahy, 2004; Basco & Rush, 2005; Miklowitz & Goldstein, 1997; Frank, 2005). Modern evidence based psychotherapies designed specifically for bipolar disorder when used in combination with standard medication treatment increase the time the individual stays well significantly longer than medications alone (Frank, 2005). These psychotherapies are Interpersonal and Social Rhythm Therapy for Bipolar Disorder, Family Focused Therapy for Bipolar Disorder, Psychoeducation, Cognitive Therapy for Bipolar Disorder and Prodrome Detection. All except psychoeducation and prodrome detection are available as books.
Brain scientist Husseini K. Manji M.D. of the NIMH states that at their most basic level, the bipolar disorders involve problems in brain structure and function. He stated that these structural changes respond very well to treatment with lithium and valproate in a University of California, Los Angeles Neuropsychiatric Institute (NPI) Grand Rounds Talk given in 2003 (requires Real Player and a high-speed internet connection).
Early in the course of the illness brain structural abnormalities may lead to feelings of anxiety and lower stress resilience. When faced with a very stressful, negative major life event, such as a failure in an important area, an individual may have their first major depression. Conversely, when an individual accomplishes a major achievement they may experience their first hypomanic or manic episode. Individuals with bipolar disorder tend to experience episode triggers involving either interpersonal or achievement-related life events. An example of interpersonal-life events include falling in love or, conversely, the death of a close friend. Achievement-related life events include acceptance into an elite graduate school or by contrast, being fired from work (Miklowitz & Goldstein, 1997).
Veteran brain researcher Robert Post M.D. of the U.S. NIMH proposed the "kindling" theory [1] which asserts that people who are genetically predisposed toward bipolar disorder experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Eventually, the mood episode starts (and becomes recurrent) by itself. Not all individuals experience subsequent mood episodes in the absence of positive or negative life events, however.
Individuals with late-adolescent/early adult onset of the disorder will very likely have experienced childhood anxiety and depression. Childhood onset bipolar disorder should be treated early because according to Joseph Calabrese of Case Western Reserve University, childhood forms of the illness may be easier to treat than adult forms of the illness. (See his University of California, Los Angeles NPI Grand Rounds Talk on rapid-cycling in October 2003.)
It is becoming increasingly clear that bipolar and unipolar mood disorders have a genetic component. For example, a family history of bipolar spectrum disorders can impart a genetic predisposition towards developing a bipolar spectrum disorder[2]. Since bipolar disorders are polygenic (involving many genes), there are apt to be many unipolar and bipolar disordered individuals in the same family pedigree. This is very often the case (Barondes, 1998). Anxiety disorders, clinical depression, eating disorders, premenstrual dysphoric disorder, postpartum depression, postpartum psychosis and/or schizophrenia may be part of the patient's family history and reflects a term called "genetic loading".
So is bipolar disorder biological or psychological? The answer is that it's both and more. Since "many factors act together to produce the illness", bipolar disorder is called a multifactorial illness, because many genes and environmental factors conspire to create the disorder (Johnson & Leahy, 2004).
Since bipolar disorder is so heterogeneous, it is likely that people experience different pathways towards the illness (Miklowitz & Goldstein, 1997).
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Two personal descriptions of the bipolar experience
The following is a quote from a successfully treated individual with bipolar disorder (from the U.S. National Institute of Mental Health):
Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness which is biological yet looks and feels psychological, one that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide. I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate of having the friends, colleagues, and family that I do.[3]
In her book, Touched With Fire, Kay Redfield Jamison, Ph.D., writes:
The clinical reality of manic-depressive illness is far more lethal and infinitely more complex than the current psychiatric nomenclature, bipolar disorder, would suggest. Cycles of fluctuating moods and energy levels serve as a background to constantly changing thoughts, behaviors, and feelings. The illness encompasses the extremes of human experience. Thinking can range from florid psychosis, or "madness", to patterns of unusually clear, fast and creative associations, to retardation so profound that no meaningful mental activity can occur. Behavior can be frenzied, expansive, bizarre, and seductive, or it can be seclusive, sluggish, and dangerously suicidal. Moods may swing erratically between euphoria and despair or irritability and desperation. The rapid oscillations and combinations of such extremes result in an intricately textured clinical picture.
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History of the bipolar disorders
Varying moods and energy levels have been a part of the human experience since time immemorial. The words Depression (previously melancholia) and Mania have their etymologies in Ancient Greek. The word melancholia is derived from ‘melas’, meaning black, and ‘chole’, meaning bile, indicative of the term’s origins in pre-Hippocratic humoral theories (Malhi and Yatham 2004). Within the humoral theories, mania was viewed as arising from an excess of yellow bile (Mondimore 1999), or a mixture of black and yellow bile (Akiskal 2004). The linguistic origins of mania, however, are not so clear-cut. Several etymologies are proposed by the Roman physician Caelius Aurelianus, including the Greek word ‘ania’, meaning to produce great mental anguish, and ‘manos’, meaning relaxed or loose, which would contextually approximate to an excessive relaxing of the mind or soul (Angst and Marneros 2001). There are at least five other candidates, and part of the confusion surrounding the exact etymology of the word mania is its varied usage in the pre-Hippocratic poetry and mythologies (Angst and Marneros 2001).
The idea of a relationship between mania and melancholia can be traced back to at least the 2nd century AD. Soranus of Ephedrus (98-177 AD) described mania and melancholia as distinct diseases with separate aetiologies; however, he acknowledged that “many others consider melancholia a form of the disease of mania” (Cited in Mondimore 2005 p.49).
The earliest written descriptions of a relationship between mania and melancholia are attributed to Aretaeus of Cappadocia. Aretaeus was an eclectic medical philosopher who lived in Alexandria somewhere between 30 and 150 AD (Roccatagliata 1986; Akiskal 1996). Aretaeus is recognized as having authored most of the surviving texts referring to a unified concept of manic-depressive illness, viewing both melancholia and mania as having a common origin in ‘black bile’ (Akiskal 1996; Marneros 2001).
The contemporary psychiatric conceptualisation of manic-depressive illness is typically traced back to the 1850s. Marneros (2001) describes the concepts emerging out of this period as the “rebirth of bipolarity in the modern era”. On January 31st 1854, Jules Baillarger described to the French Imperial Academy of Medicine a biphasic mental illness causing recurrent oscillations between mania and depression. Two weeks later, on the 14th February 1854, Jean-Pierre Falret presented a description to the Academy on what was essentially the same disorder. This illness was designated folie circulaire (‘circular insanity’) by Falret, and folie à double forme (‘dual-form insanity’) by Baillarger (Sedler 1983).
Emil Kraepelin (1856-1926), a German psychiatrist considered by many (including Hagop Akiskal M.D.) to be the father of the modern conceptualization of bipolar disorder, categorized and studied the natural course of untreated bipolar patients long before mood stabilizers were discovered. Describing these patients in 1902, he coined the term "manic depressive psychosis." He noted in his patient observations that intervals of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals in which the patient was able to function normally.
After World War II, Dr John Cade, Psychiatrist, Bundoora Repatriation Hospital, Melbourne, Australia was investigating the effects of various compounds on veteran patients with manic depressive psychosis. In 1948, Dr John Cade discovered that Lithium Carbonate could be used as a successful treatment of manic depressive psychosis. This was the first time a compound or drug had been discovered that proved to be a successful treatment of any psychiatric condition. The discovery was perhaps the beginning of psychopharmacological treatments of psychiatric conditions. The discovery preceded the discovery of phenothiazines for the treatment of schizophrenia, and the discovery of benzodiazapines for the treatment of anxiety states, by about 4 years.
The term "manic-depressive illness" first appeared in 1958. The current nosology, bipolar disorder, became popular only recently and some individuals prefer the older term because it provides a better description of a continually changing multi-dimensional illness.
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Wikipedia Also has INFO. LOTS
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