Wednesday, March 13, 2013

Borderline Personality Disorder versus Bipolar Disorder: Types of Bipolar


Before I start my compare and contrast of Bipolar vs. Borderline Personality Disorder I wanted to elaborate on the different subtypes of Bipolar Disorder. It’s necessary because some of them are quite similar to BPD while others are extremely similar. ::wink:: So let’s get to it.

Criteria and Subtypes in Bipolar Disorder

Bipolar I Disorder

 
Bipolar 1 is the standard expression of Bipolar that people recognize as Manic-Depression. It’s categorized by having one or more manic episodes. A depressive or hypomanic episode is not required for diagnosis, but periods ranging from mania to depression are common. Most people are in their teens or early 20s when symptoms first appear. 

According to WebMD People in manic episodes may spend money far beyond their means, have sex with people they wouldn't otherwise, or pursue grandiose, unrealistic plans. In severe manic episodes, a person loses touch with reality. They may become delusional and behave bizarrely.
Untreated, an episode of mania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months. Depression may follow shortly after, or not appear for weeks or months.

Many people with bipolar I disorder experience long periods without symptoms in between episodes.

Depressive episodes in bipolar disorder are similar to "regular" clinical depression, with depressed mood, loss of pleasure, low energy and activity, feelings of guilt or worthlessness, and thoughts of suicide. Depressive symptoms of bipolar disorder can last weeks or months, but rarely longer than one year.


Bipolar II disorder

Bipolar II is characterized as having no manic episodes, but one or more hypomanic episodes and one or more major depressive episode. Essentially it’s the same as Bipolar 1 except the “ups” never reach full mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes. Hypomanic episodes do not go to the full extremes of mania (i.e., do not usually cause severe social or occupational impairment, and are without psychosis), and this can make bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing, crippling depression.
In between episodes of hypomania and depression, many people with bipolar II disorder live normal lives.

People experiencing hypomanic episodes are often quite pleasant to be around. They can often seem like the "life of the party" -- making jokes, taking an intense interest in other people and activities, and infecting others with their positive mood.

What's so bad about that, you might ask? Hypomania can also lead to erratic and unhealthy behavior. People in hypomanic episodes might spend money they don't have, seek out sex with people they normally wouldn't, and engage in other impulsive or risky behaviors.

Also, the vast majority of people with bipolar II disorder experience significant depressive episodes. These can occur soon after hypomania subsides, or much later. Some people cycle back and forth between hypomania and depression, while others have long periods of normal mood in between episodes.

Untreated, an episode of hypomania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months.

Depressive episodes in bipolar II disorder are similar to "regular" clinical depression, with depressed mood, loss of pleasure, low energy and activity, feelings of guilt or worthlessness, and thoughts of suicide. Depressive symptoms of bipolar disorder can last weeks, months, or rarely years.

It’s been suggested to me before that perhaps I was Bipolar II because while I’m chronically depressed, I have a long cycle of reaching an even deeper depression at a very specific point every year. It was believed that this could just be one long bipolar depressive cycle. As it turns out… no. Those “ups”, even to a milder extent never really get over the mildly depressed stage. At least not without medication.

Cyclothymia

Cyclothymia -- or cyclothymic disorder -- is a relatively mild mood disorder. In cyclothymic disorder, moods swing between short periods of mild depression and hypomania, an elevated mood. The low and high mood swings never reach the severity of major depression or mania. Cyclothymia is a "bipolar-like" illness. People with cyclothymic disorder have milder symptoms than in full-blown bipolar disorder. A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes is necessary. There is a low-grade cycling of mood which appears to the observer as a personality trait, and interferes with functioning. For most people the pattern of mood fluxuation is irregular and unpredictable. Not really a pattern at all.

Cyclothymia can straddle the line between mental illness and normal variations in mood and personality. Some people with mild symptoms are highly successful in life, driven by their hypomania to express individual talents. On the other hand, chronic depression and irritability can ruin marriages and professional relationships.


Mixed bipolar  

Mixed bipolar episodes are periods that simultaneously involve the full symptoms of both a manic and a full depressive episode. It's marked by grandiose feelings with racing thoughts. At the same time, the person is irritable, angry, moody, and feeling bad.
           

This next one is my favorite.

Rapid-Cycling Bipolar Disorder

Rapid-cycling bipolar disorder is characterized by four or more mood episodes that occur within a 12-month period. Episodes must last for some minimum number of days in order to be considered distinct episodes.  Some people also experience changes in polarity from high to low or vice-versa within a single week, or even within a single day -- the full symptom profile that defines distinct, separate episodes may not be present (for example, the person may not have a decreased need for sleep), making such "ultra-rapid" cycling a more controversial phenomenon. Rapid cycling can occur at any time in the course of illness, although some researchers believe that it may be more common at later points in the lifetime duration of illness. Women appear more likely than men to have rapid cycling. A rapid-cycling pattern increases risk for severe depression and suicide attempts. Antidepressants are thought to trigger and prolong rapid cycling in bipolar disorder. However, that theory is controversial and is still being studied.
           
Bipolar disorder NOS (not otherwise specified)

This is a catchall category, diagnosed when the disorder does not fall within a specific subtype. Bipolar NOS can still significantly impair and adversely affect the quality of life of the patient.



So you see… the impulsivity and risky behavior, the erratic mood swings, potential for  promiscuity, especially with the hypomanic “life of the party”, rapid-cycling shifting moods, and the same time up and down elements of Mixed Episode, co-morbid depression and anxiety, it’s easy to see how the similarities can be confused with Borderline Personality Disorder…. Which we shall get to next ;) 

6 comments:

  1. Could you, sometime, talk about learned helplessness. It's a new subject for me this week, and ....I value your words. You do this thing to me, and I think it's because you're so knowledgeable. You know ....smart is sexy. Good work. Hi from me and bye for now.

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    1. I actually have talked about Learned Helplessness in the past. Here's the link to that post.

      http://www.downwardspiralintothevortex.com/2011/06/whats-point-learned-helplessness.html

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  2. For those who suffer from cyclothymia and those who live with them, it's really not quite as "mild" as you describe. I personally don't see anything "normal" about the variations in mood and personality. Yes people with cyclothymia are high functioning in that they can hold down jobs and are often very successful, but I find it hard to believe that they are as equally high functioning in their personal relationships. It can be a very destructive illness and it is most certainly a very painful one.

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    1. I'm just going off of what Wiki, WebMD, and the host of other medical sites tell me cyclothymia is. I don't have it so that's all I can do. Maybe you could do a guest post describing it?

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    2. When places like WebMD classify something as "mild", it's almost always comparative. The symptoms experienced aren't mild in themselves, just mild compared to other forms of the same or a similar condition.

      It's like classifying lack of motivation and inability to maintain ADL's as "mild depression". Compared to major depression, it's kinda mild. However, it's not mild to the person experiencing it.

      I hope that helps?

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  3. I'm going to link to this article. I have BiPolar Type 1 myself, and I'm pretty familiar with it and self-aware (which bugs the doctors; they like their patients helpless and dependent...) and on medication that I take religiously ever since a doctor actually bothered to listen long enough to work with me on finding the right one.

    I also know about BiPolar from a clinical standpoint, as an area of study; I'm working towards becoming a mental health nurse (much study ahead, but manic phases do have their uses *wink*)

    However, it's hard to explain to other people in simplified terms without resorting to affect, DSM, presentations, cycles, diagnostic criteria, etc etc etc. Your article manages to be concise and understandable whilst also covering the essentials. I think you explain it better than me.

    So I'm going to link back to this article (primarily for the benefit of my girlfriend, who is trying her hardest to understand me with the limited "layman" info available). Thanks!

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Leave me a comment! It makes me feel good and less paranoid about talking to myself =)

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