Screening Tests Confuse Bipolar and Borderline DisordersWritten by: Rob Print This Article
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A study conducted by Rhode Island Hospital has shown that the common Mood Disorder Questionnaire (MDQ) test used for screening for bipolar disorder often results in a person who appears to be suffering from BPD (Borderline Personality Disorder) being diagnosed with Bipolar Disorder. Yet despite this confusion, these two conditions are very different. For one, there are no approved medications for BPD at present whereas there are medications approved for treating bipolar disorder. Additionally, psychotherapy programs such as DBT (Dialectical Behavior Therapy) which have been developed for use with BPD patients and shown to be effective are not commonly used with bipolar patients. Consequently, there is a significant risk that people wrongly diagnosed with bipolar disorder who are actually suffering from BPD may be prescribed ineffective medications that may have adverse side effects and will not receive psychotherapy that could help them manage their BPD.
Mood Shifts Common to Bipolar and Borderline Patients
One of the major reasons the two conditions are often confused is that both feature drastic shifts in mood that may on the surface appear similar. A patient may feel euphoric and alive then later depressed and suicidal. One major difference is that bipolar mood shifts tend to occur over the course of months, even years, whereas borderline mood shifts may occur over hours, minutes, or even seconds. About 5 to 15 percent of bipolar patients suffer from “rapid cycling” bipolar mood swings that occur more rapidly. By definition they occur at least four times per year. Yet this is still far less frequent than the rapid mood shifts common in borderlines.
Bipolar mood shifts tend to be less connected to current events than borderline mood shifts. Possibly they are related to biochemical imbalances or neurological differences that may stem from genetic variations. This may explain both why some medications successfully help reduce these mood shifts and that bipolar disorder tends to run in families. Shifts featuring overactive and/or euphoric changes in behavior are often called mania or manic episodes. Those featuring despair are often called depression. Bipolar disorder varies from regular varieties of depression most notably because of the manic episodes.
Borderline mood shifts tend to more often be related to the events of the day or even hour. A family member not answering the phone or a close friend arriving late for a meal may trigger hostile, aggressive behavior ranging from irrational irritability all the way to a rage. While the connection between the two may not appear reasonable or rational to an objective observer, in the mind of the borderline they are linked.
According to Dr. Friedel, director of the BPD program at Virginia Commonwealth University, there are two main differences between BPD and bipolar disorder:
1. People with BPD cycle much more quickly, often several times a day.
2. The moods in people with BPD are more dependent, either positively or negatively, on what’s going on in their life at the moment. Anything that might smack of abandonment (however far fetched) is a major trigger.
3. In people with BPD, the mood swings are more distinct. Marsha M. Linehan, professor of psychology at the University of Washington, says that while people with bipolar disorder swing between all-encompassing periods of mania and major depression, the mood swings typical in BPD are more specific. She says, “You have fear going up and down, sadness going up and down, anger up and down, disgust up and down, and love up and down.”
Borderline Mood Shifts May Be More Private
Further complicating the differentiation is that often borderline mood shifts are tied to feelings of abandonment that occur within close relationships and are often not seen by therapists until they have worked with a patient for years. Yet the family of the patient may be seeing perceived abandonment induced mood shifts manifest as rages, risky behaviors, compulsive lying, or other disruptive behaviors multiple times per day. It’s not uncommon for a borderline to be raging about a loved one being 10 minutes late without calling, berating them for half an hour for being worthless and inconsiderate, and then several minutes later acting like nothing ever happened. It is much less common for a bipolar patient to do the same.
Providing Input to Therapists and Doctors
While there is no sure-fire cure for either bipolar or borderline conditions, there are treatments that are more likely to be effective for each. It is therefore very important to improved outcome to accurately diagnose the condition. If you’re seeing your loved one suffer from mood shifts, think about what triggers them, how long these shifts last, and how often they occur. When a person suffers from both rapid and slow mood shifts, it is a possible sign that the person suffers from both bipolar and borderline disorders and thus the patient may benefit from both medicines for bipolar disorder and DBT therapy for borderline disorder.
Finding a way to discretely provide input on all of these behavior patterns to your loved one’s therapists and doctors may greatly aid them at providing effective treatment while helping to keep you from being targeted by your love one’s blaming behaviors and denial. Borderlines often despise being told they are mentally ill and will deny it vehemently. It’s common for them to claim they are normal and everybody else is sick. They are particularly likely to engage in blaming and attacks against a person close to them who suspects they may have BPD and voices that suspicion. Therefore it’s best to relay information to therapists and doctors privately and to explain your concerns why you are doing so. A therapist or doctor familiar with BPD should welcome the additional input and understand such concerns.