borderline or bipolar?

Borderline symptoms

1. irritability
   
2. emptiness
   
3. mood instability
   
4. avoiding abandonment
5. impulsivity
   
6. self harm & suicidal thoughts
   
7. splitting
8. unstable identity & sense of self
   
9. dissociation

Hypomania symptoms:

1. abnormally and persistently elevated, expansive, or irritable mood that lasts at least 4 days

This period of abnormal mood must be accompanied by at least three additional symptoms from a list that includes:

2. inflated self-esteem or grandiosity
3. decreased need for sleep
4. pressure of speech
5. flight of ideas
6. distractibility
7. increased involvement in goal-directed activities or psychomotor agitation
8. excessive involvement in pleasurable activities that have a high potential for painful consequences (this is what I consider to be a manifestation of impulsivity).

If the mood is irritable rather than elevated or expansive, at least four of the above symptoms must be present.

There are six symptoms that BP and BPD can share: irritability, impulsivity, changes in self image, suicidal thoughts, mood fluctuations and emptiness (related to depression in BP). Only five symptoms are needed for a borderline diagnosis. Four or five symptoms are needed for hypomania, and for Bipolar II mood fluctuations (depression/hypomania) are also required. So, there can be a lot of overlap. The difference is the duration of symptoms and if other symptoms are present. BPD symptoms are meant to be consistent over different situations and many years, but moods last no more than a few days and usually for less than a day (with many moods in a day). Hypomania symptoms occur in a cluster and last for four days or more. Depression in bipolar II lasts 2 weeks or more and is also a cluster of symptoms.

The symptoms that differentiate borderline from bipolar are avoiding abandonment, splitting and dissociation. The ones that differentiate bipolar from borderline are agitation, decreased need for sleep, distractibility and pressured speech.

I have experienced all the symptoms that go with BPD and BP at some point in time, as well as anxiety, so the important thing is how the symptoms cluster together and how long they last for.

I can identify some definite clusters that have lasted more than a few days:

Cluster 1: elevated mood, decreased need for sleep, increased involvement in goal-directed activity, flight of ideas, inflated self esteem (maybe).

This period lasted about a week. I was staying up late writing, and writing almost continuously throughout the day. When I wasn't writing I was researching how to make money online. I felt great. I got it into my head that I could make money on the internet with my writing. I wrote fast, ideas spilling out. I thought that what I was writing was really important and I had to get it out there. It was definitely goal-directed - I wanted to write things that people would read and make money from it. I felt energised without much sleep. I wrote about 6000 words, but a lot of it had been deleted and rewritten. It was coherent and everything, but I wasn't thinking all that clearly. At the time I was sure that everything I was writing was correct and well-informed, and to most people it might have seemed that way, but I was writing about science and philosophy, and it wasn't all that well-informed or correct. This was a very distinct period which started and ended abruptly. It was a persistent state over the week, though. As for the inflated self esteem, I didn't think I was the messiah. But I did think I had some important things to say. The whole thing was just very unlike me. I don't write much, unless I really make the effort. I also usually need to sleep a lot and still feel tired (although that is related to depression). I also usually wouldn't have the confidence to write and publish my writing. I don't usually come up with ideas that easily, unless I've been in a similar state. Even then, it's usually hard to get my ideas out. I am usually not that motivated to achieve goals, and even when I'm not depressed my mood is not so elevated.

Cluster 2: elevated mood, increase in goal-directed activity, excessive involvement in pleasurable activities that have a high potential for painful consequences, inflated self esteem.

I'm not sure how long this period lasted for, but it seemed to be most of 2007. I was addicted to exercise, the goal being weight loss. Pleasurable activities included drinking, drugs and casual sex. I thought that everyone must love me and I just felt great. I had periods of euphoria without drugs.

I had a similar experience at the beginning of 2004. I had just moved to a new city by myself, away from home for the first time, starting uni, meeting all new people. It was an exciting time for me. I felt high a lot of the time. I wanted to be social all the time. I felt great about myself for the first time. I started drinking dangerous amounts and generally just being wild and impulsive, wanting to party all the time. My goals were to meet people and make friends, and that I did.

It may have been a few different periods in 2007 (all more than a few days) which were broken up by normal moods and other periods of dealing with negative consequences: heart break, failing uni etc. My worst depressive episode came on gradually, starting at the end of 2007. My depression got worse and worse, but I still had some periods of relief. I was depressed for most of 2008 and 2009.

In the second half of 2008 I first experienced agitation while depressed. I didn't know what it was at the time, but I couldn't just lie in bed and stare at the ceiling as I wanted. I had some sort of energy or drive, but it didn't feel good. Nothing could satisfy the drive because I couldn't focus on anything. I couldn't just read or watch tv. So I started drinking more, and taking phenergan to help me sleep.

I got some relief from depression in early 2009, while living with my mum and taking a break from everything. I might have had another cluster of hypomanic symptoms: goal-directed activity (learning spanish and keyboard and planning to go overseas to teach english), decreased need for sleep, slightly elevated mood... not enough to fulfill the criteria, though.

I haven't included distractibility because I'm not sure about it. I think I'm always pretty distractible. Of course, I have had times when I've been functioning normally and have been able to study without getting distracted, so I think it's related to both depression and agitation.

After I started working again in 2009 I became severely depressed again. Sometimes I had agitation too. My job ended and I was still depressed. The agitation got worse in early 2010. I called lifeline and considered going to hospital, but I figured they would send me away.

Even in the two years I spent mostly depressed, I had some periods of partying and excitement and doing some really stupid things. I met some random people on the street one night and brought them to a party when it was about 2am and the party was almost over. There were probably six of them, from two different groups of people I met. I got in a lot of trouble with the party host. All I wanted to do was have a good time, and I didn't want it to end. I would talk to anyone and everyone in these periods. Sometimes I just had boundless energy. When I was out with friends, walking to the next pub, I wanted to run, not walk! This was more apparent in 2007, I think, before I got so depressed.

That agitation has continued to be a problem. It's activation, pressure to do things, unwelcome energy. When I'm in a good mood and I get agitated it doesn't really feel like a bad thing. But if I feel at all any sort of negative mood or emotion, agitation is horrible.