I Feel Like I’m Going To Lose My Mind: Borderline and the Bipolar Spectrum

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.

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6 thoughts on “I Feel Like I’m Going To Lose My Mind: Borderline and the Bipolar Spectrum

  1. I love that you addressed this issue in your post. My ex-husband was misdiagnosed multiple times with multiple different variations of mental health diseases that he did not even meet the criteria for. When I met him, his diagnosis was simply “Acute Social Anxiety Disorder”. I don’t know where the doctors came up with this, other than lack of proper attempts to diagnose him. He had violent outbreaks, bouts of anger, self-loathing, self-harm, and was violent to others, both verbally, and physically. He had turned to alcohol, which made his issues MUCH worse. Because he never admitted his alcohol use to doctors (when he would bother to go to one), it further hindered their ability to diagnose him.
    He had a psychiatrist that actually did diagnose him with Bipolar Disorder just a couple of years before we separated. By this time, he had become an abusive husband, and father. The doctor was never able to give him any type of CAT scans, or other testing, because he claimed that part of his “anxiety” was further aggravated by doctor visits/procedures. At one point, the doctor and I discussed the possibility with him of Borderline Personality Disorder, which, according to my reading on the subject, fit him very well.
    One of the main things that both the doctor and I agreed on was that he put people he loved on a pedestal, and expected them to “do no wrong” in his eyes. When we did not meet up to his expectations, he would just LOSE IT, and go through various episodes of anger, violence, and self-loathing. These were all consistent with many of the symptoms of people with BPD. His emotions cycled quickly, sometimes going through 4 or 5 stages in a day. The doctor also pointed this out as a symptom, as I believe you noted as well.
    Ultimately, his bipolar disorder diagnosis is what stuck, because he refused further care from the doctor. Within a few months, he no longer had any medications at all left to take, and before long the abuse spiraled out of control. I never knew when, or where he would blow up. After multiple threats to my life, and a couple violent episodes, I had no choice but to get out of the situation. From my understanding, he is still not receiving ANY treatment for ANY mental illness.
    Again, I really like this post. The subject is a touchy one, and I appreciate your writing it so honestly.

    • Thanks! I was a little wary to post it because I’m not really out to offend people with BPD. I tend to attract them like one of those stick flypapers. Something to do with me having a big empathy magnet in my forehead.

      Because the tendency someone with BPD has for an all or nothing attitude about a person, place or thing those friendships have been largely damaging. Because one day they would decide I had abandoned them or offended them in some way and they would disappear from my life.

      The most difficult thing about psychiatric diagnoses is that they are based on the patient’s self-reporting and the doctor’s observation. I think it can take years to properly diagnose someone with Bipolar. After all, most patients don’t go see their doc when they’re hypomanic. I’m pretty sure my doc didn’t really form his diagnosis until he saw me crazy. The depressive bouts are usually so freakin long and like the others when I was hypomanic or manic the last thing I wanted to do was see my doctor. Anxiety is hard to see as is depression but BP and BPD take more than one visit, definitely.

      I’m sorry to hear you had to on the receiving end of that!

      • I would not have minded as much if he had not refused to see a doctor for the first 8 years, then try to use his anxiety as a reason why he couldn’t see them when it got to the point that the behavior was too difficult to deal with. It’s not like he was in denial about having the issues, he knew he had them, and LOVED to throw in my face how he “couldn’t help” his behavior, but he COULD have chosen to go see the Psychiatrist, and do what he needed to do to ATTEMPT. He just wouldn’t. I didn’t mind helping him through the worst things, until I “fell off the pedestal”, and like you said, that all or nothing thing kicked in, so he either loved me to the point of squeezing me to death, or hated me to the point of throwing me into a wall & threatening to “splatter my brains”….

      • Ouch! Sure, mental illnesses can be incapacitating in their own special ways even if you get help but it’s not an excuse for harming another person emotionally or physically. If my husband were to fly off into a manic episode (he’s BP too) and start with a verbal shit-storm I’d cart his ass to the ER. But then again, we are both self-aware when it comes to our illnesses and see our doctors regularly and take our medicine religiously.

        I think men do have a harder time with confronting their emotional problems but that’s not a good enough excuse.

      • His thing was less confronting it, and more using it as an excuse. As long as he could say his anxiety was too much to go to a doctor, he could pawn EVERY little thing off on his illness. It was more a crutch he used as an excuse for all of his inappropriate behaviors than anything, and I think that is what bothered me so much about it. He knew he had problems, and LOVED to tell people, he just didn’t want help unless it was Xanax, or something similar….basically, a drug he could feel immediately, and end up abusing. Addict tendencies, you know.
        You are right though, it seems to be harder for most men to confront emotional disorders. My ex just used them as a way to not work, and make it ok to be abusive to other people, or act basically any way he wanted without consequence…Like an overgrown 2 year old with tantrums, lol. People like him are why people who have mental problems have such a bad rep in some people’s eyes, ya know?

  2. That’s a shame. It’s that type of behavior that adds to the stigma associated with mental illness. It also make it difficult for people to get the medications they need, particularly benzos. Most of us who need them don’t abuse them but those who do make my life more difficult. I have pretty severe anxiety. It’s a common comorbidity with BP and not having clonazepam can mean I have a REALLY bad night. I’m certainly glad you got away from the abuse.

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