I think people with mental illnesses have a love/hate relationship with labels. For instance, some people I know are almost proud that they are bipolar 1 rather than bipolar 2 (which they consider bipolar ‘lite.’) They feel like they’ve earned the distinction, what with having front row seats to the burning pyre that is mania. Then there are disorders we don’t want to have attached to us. For instance, when I went to get my clonazepam prescription filled, I was aghast to see that among the diagnoses of PTSD and Bipolar 1 was Borderline Personality Disorder (BPD).
I have nothing against people with Borderline Personality Disorder as a whole but if you look at the diagnostic criteria, given the right subset, it adds up to a person who could possibly be emotionally untrustworthy, easily angered and potentially dangerous. There is a stigma within the Bipolar community against people with BPD because of this. Also, the systematic misdiagnosis of Bipolar Disorder in people who have BPD somehow dilutes the Bipolar diagnosis. So in the DSM V, they split the baby down the middle and put BPD on the Bipolar spectrum. This has been a highly contentious decision and has yet to be fully substantiated.
Why was I so offended by this diagnosis? Firstly because it is incorrect. All of the borderline symptoms I have are attributable to my Bipolar Disorder–the mood swings, the self-destructive behavior and the bouts of depression. Others can be accommodated by my PTSD–intense fear of being abandoned as well as stress-related paranoia. They may read the same on paper but in behavior they manifest differently. I don’t have short bursts of depression. No mister. My depressive episodes are looong and drawn out. My self-destructive behavior happens only during periods of mania and hypomania. My ups and downs are long periods–months, weeks even a year. I don’t cycle repeatedly during the space of a day as is typical for people with BPD.
In Borderline Personality Disorder moods wings can hinge on extreme reactions to external triggers. Bipolar Disorder can sink your battleship any day of the week and for no discernible reason. For those with BPD, a single mood such as anger or disgust can fluctuate wildly within a given day. In Bipolar Disorder, those things move up and down but only within the overall mood. There are days in which my depressed disgust can go up or down but there is a ceiling and there is a floor.
I think that ultimately the reason bipolar people have problem conceding diagnostic territory to BPD is because what the mainstream world thinks of as bipolar is really borderline behavior. On TV it’s sexy and dangerous–fast and dramatic mood swings, fits of rage followed by giddiness, disproportionate reaction to stimuli (burning someone’s house down because they were cheating on you), the hot/cold response. Colloquially this behavior is referred to as bipolar even though it’s not–it’s not even borderline, it’s a caricature thereof.
Although people with BPD may be dangerous to themselves and others at times, it is usually related to a perceived slight or fear of abandonment. With bipolar patients, the potential for harm is different. It comes from the misfiring of chemicals and manifests as psychosis, self-delusion and suicidal ideation. These can be diminished by lithium or any of the various other drugs they use to keep us from jumping of the top buildings because we think that we can fly.
Mostly the distinction is important because one disorder is genetic and organic to the sufferer, the other has been afflicted on her. Bipolar Disorder requires medication, and most likely very long term treatment. The activity of the disorder can be visualized on a cat scan. Also, because it occurs over extended cycles, Bipolar takes a long time to accurately diagnose simply from self-reporting and observation. Bipolar is a disorder that it doesn’t go away. It’s something we live with like diabetes or narcolepsy. It probably won’t end our lives but it complicates them and will continue to do so no matter how much therapy we have. For people with Borderline Personality Disorder, there is the potential to heal.