If I were to go by the ICD, there's no way I could be borderline! For starters, I would need 3 of:
1. marked tendency to act unexpectedly and without consideration of the consequences;
2. marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized;
3. liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions;
4. difficulty in maintaining any course of action that offers no immediate reward;
5. unstable and capricious mood.
AND 2 of:
1. disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual);
2. liability to become involved in intense and unstable relationships, often leading to emotional crisis;
3. excessive efforts to avoid abandonment;
4. recurrent threats or acts of self-harm;
5. chronic feelings of emptiness.
AND these would have to be chronic, pervasive and present across all situations.
The only of the first section that I could possibly have are unstable mood and tendency to act without consideration of the consequences. Definitely not the others. And I do consider consequences, I just decide that I don't care at the time. I'm obviously capable of maintaining a course of action that has no immediate reward. I just also tend to really enjoy things that give an immediate reward.
Showing posts with label diagnosis. Show all posts
Showing posts with label diagnosis. Show all posts
Saturday, May 15, 2010
DSM stuff
So according to the DSM, having a personality disorder means that you do not feel or behave the way you're supposed to ("as expected") in your culture. I guess it's just another way of saying that you deviate from "normal" in some ways, which is necessary for any psychiatric diagnosis. I don't know why it's emphasised for personality disorders. It's as if they're still thinking of these disorders as being a manifestation of moral weakness. But, they're only called "personality" disorders, I assume, because they are "pervasive and inflexible", have an "onset in adolescence or early adulthood", and are "stable over time". This means that the symptoms are always there, and they have been since a young age, and they are there in many different situations. Personality is supposedly like this, although you would call them traits, not symptoms. Also, a personality disorder must involve "distress or impairment", which is what makes it a disorder.
I went to borders to check out some books, and I found one called borderline personality disorder: a therapist's guide to taking control, by freeman and fusco. For every DSM criterion there were vignettes to demonstrate it and a series of questions to ask to see how much the patient has problems with that criterion. I found that the only ones I scored high on were impulsivity, suicidal thoughts and emptiness (the first mainly applies when I feel stimulated, the last two only apply when I'm depressed). I didn't even score that high on self harm or emotional instability. I have a little bit of all of the criteria, but not enough, I don't think. I have at times frantically tried to avoid abandonment, but this doesn't happen in every relationship and I think that I exhibit a pretty mild form of "frantic" compared to the vignettes. In my first ever relationship in high school I probably acted exactly like someone with BPD. I may still be a little bit like this. It doesn't mean I have BPD.
I don't idealise people as much as just become obsessed/fall in love easily. I certainly don't devalue anyone afterwards.
I don't have the identity disturbance that was described in the book. I definitely have a normal amount of identity disturbance for a young person.
I could relate to some of the questions about anger, but they only applied to when I'm feeling agitated.
I'm not that emotionally unstable since I can go through long periods of stability, and I usually have a general mood which lasts more than a few days.
I've experienced dissociation and I'm sometimes paranoid. I'm not paranoid about being abandoned as much as being judged, though. And mostly I've experienced dissociation randomly, not during stress. I think it's pretty normal to have experienced some sort of dissociation. It's not a problem for me, I don't lose time or space out. I think the paranoia is related to social anxiety, or maybe the agitation.
So the criteria I actually fulfill are impulsivity and irritability when agitated or stimulated, and emptiness and suicidal thoughts when depressed. I may experience some dissociation and some paranoia when I'm agitated. I do fear abandonment, but this only comes out when I'm depressed. My relationships improve as I get older. None of the criteria that I fulfill are constant for me. They are not stable over time. They're not pervasive and inflexible. The identity disturbance and abandonment fears have improved over time, like you would expect. I don't see any way that a personality disorder could explain my symptoms.
On the other hand, I looked at a book about understanding the DSM. The section on bipolar was interesting. Mania was described more clearly: elevated mood interrupted by irritable outbursts, increase in goal-directed activity which can appear like unrelievable restlessness (exactly what I experience), thoughts & mental activity speed up (for me, reading and writing fast), high level of verbal output (in speech OR writing), loosening of inhibitions, foolish ventures e.g. business decisions, spending, sex.
Instructions were given to confirm presence of mania or hypomania by looking for changes in: sleeping and eating patterns, energy levels, restlessness, increased activities especially risky or destructive ones, problems concentrating, easily distracted, instances of extreme feelings of happiness, laughing inappropriately (usually accompanied by agitation), increased talking, pressured talking, racing thoughts - unable to keep up with the influx, impaired judgment, grandiose ideas, inflated self esteem, increased irritability or impatience, easily excitable, lack of interest in personal relationships, hallucinations, incoherent speech, violence, disorientation. Also important is a history of alcohol and drug use, medical conditions and medications.
Hypomania was described as increase in energy or irritability, decreased need for sleep, increase in activities (including spending), increase in pressured verbalisation, and the tendency to become quite creative.
Cyclothymia was described as having milder mood episodes but being chronic, lasting at least 2 years with no symptom-free periods lasting more than 2 months.
BP-II patients have a strong family history of bipolar OR depression.
The book also had an interesting case study of a bipolar woman. She had a complicated history of social and behavioural problems. Her mania manifested as delusions, compulsions, being argumentative, paranoia, dissociation, anxiety and obsessions. Her symptoms started at age 16 but she wasn't diagnosed properly until she was 34 (she was diagnosed with depression at age 30). She has tried over 15 meds, none of which stabilised her. She apparently had depression, low self esteem and attachment issues since childhood. She has a history of childhood abuse and parental abandonment. She has been married 3 times and had multiple abortions. She has violent mood swings and deep depressions, which she always thought was caused by PMS. She self medicated with marijuana every day from age 16 tp 36. She has always felt inferior and continues to. She has casual sex and has had numerous troublesome relationships. She idealises men and feels rejected when relationships end. She has no social or recreational interests. She excelled in school when she applied herself but always had trouble with concentration, attentiveness and social skills. She is generally suspiscious of people. She dropped out of school, and later attempted further study, but couldn't complete the degree. She has had many types of jobs, and self doubt and social fears stop her from following through on career decisions. Compulsive shopping binges lead to financial trouble. She has had chronic insomnia problems, increased appetite and weight gain. At the time of the assessment she reported depressed mood but she seemed talkative and her speech was pressured and non-goal-directed. She has had inappropriate judgement in the past and reports poor concentration, although she was alert during the interview.
It's interesting that no one ever tried to give her a borderline diagnosis! According to this book for a proper diagnosis of bipolar you need to identify mood episodes and then see if they meet the criteria AND see if they affect many areas of functioning. Current and past behaviours must be considered.
I went to borders to check out some books, and I found one called borderline personality disorder: a therapist's guide to taking control, by freeman and fusco. For every DSM criterion there were vignettes to demonstrate it and a series of questions to ask to see how much the patient has problems with that criterion. I found that the only ones I scored high on were impulsivity, suicidal thoughts and emptiness (the first mainly applies when I feel stimulated, the last two only apply when I'm depressed). I didn't even score that high on self harm or emotional instability. I have a little bit of all of the criteria, but not enough, I don't think. I have at times frantically tried to avoid abandonment, but this doesn't happen in every relationship and I think that I exhibit a pretty mild form of "frantic" compared to the vignettes. In my first ever relationship in high school I probably acted exactly like someone with BPD. I may still be a little bit like this. It doesn't mean I have BPD.
I don't idealise people as much as just become obsessed/fall in love easily. I certainly don't devalue anyone afterwards.
I don't have the identity disturbance that was described in the book. I definitely have a normal amount of identity disturbance for a young person.
I could relate to some of the questions about anger, but they only applied to when I'm feeling agitated.
I'm not that emotionally unstable since I can go through long periods of stability, and I usually have a general mood which lasts more than a few days.
I've experienced dissociation and I'm sometimes paranoid. I'm not paranoid about being abandoned as much as being judged, though. And mostly I've experienced dissociation randomly, not during stress. I think it's pretty normal to have experienced some sort of dissociation. It's not a problem for me, I don't lose time or space out. I think the paranoia is related to social anxiety, or maybe the agitation.
So the criteria I actually fulfill are impulsivity and irritability when agitated or stimulated, and emptiness and suicidal thoughts when depressed. I may experience some dissociation and some paranoia when I'm agitated. I do fear abandonment, but this only comes out when I'm depressed. My relationships improve as I get older. None of the criteria that I fulfill are constant for me. They are not stable over time. They're not pervasive and inflexible. The identity disturbance and abandonment fears have improved over time, like you would expect. I don't see any way that a personality disorder could explain my symptoms.
On the other hand, I looked at a book about understanding the DSM. The section on bipolar was interesting. Mania was described more clearly: elevated mood interrupted by irritable outbursts, increase in goal-directed activity which can appear like unrelievable restlessness (exactly what I experience), thoughts & mental activity speed up (for me, reading and writing fast), high level of verbal output (in speech OR writing), loosening of inhibitions, foolish ventures e.g. business decisions, spending, sex.
Instructions were given to confirm presence of mania or hypomania by looking for changes in: sleeping and eating patterns, energy levels, restlessness, increased activities especially risky or destructive ones, problems concentrating, easily distracted, instances of extreme feelings of happiness, laughing inappropriately (usually accompanied by agitation), increased talking, pressured talking, racing thoughts - unable to keep up with the influx, impaired judgment, grandiose ideas, inflated self esteem, increased irritability or impatience, easily excitable, lack of interest in personal relationships, hallucinations, incoherent speech, violence, disorientation. Also important is a history of alcohol and drug use, medical conditions and medications.
Hypomania was described as increase in energy or irritability, decreased need for sleep, increase in activities (including spending), increase in pressured verbalisation, and the tendency to become quite creative.
Cyclothymia was described as having milder mood episodes but being chronic, lasting at least 2 years with no symptom-free periods lasting more than 2 months.
BP-II patients have a strong family history of bipolar OR depression.
The book also had an interesting case study of a bipolar woman. She had a complicated history of social and behavioural problems. Her mania manifested as delusions, compulsions, being argumentative, paranoia, dissociation, anxiety and obsessions. Her symptoms started at age 16 but she wasn't diagnosed properly until she was 34 (she was diagnosed with depression at age 30). She has tried over 15 meds, none of which stabilised her. She apparently had depression, low self esteem and attachment issues since childhood. She has a history of childhood abuse and parental abandonment. She has been married 3 times and had multiple abortions. She has violent mood swings and deep depressions, which she always thought was caused by PMS. She self medicated with marijuana every day from age 16 tp 36. She has always felt inferior and continues to. She has casual sex and has had numerous troublesome relationships. She idealises men and feels rejected when relationships end. She has no social or recreational interests. She excelled in school when she applied herself but always had trouble with concentration, attentiveness and social skills. She is generally suspiscious of people. She dropped out of school, and later attempted further study, but couldn't complete the degree. She has had many types of jobs, and self doubt and social fears stop her from following through on career decisions. Compulsive shopping binges lead to financial trouble. She has had chronic insomnia problems, increased appetite and weight gain. At the time of the assessment she reported depressed mood but she seemed talkative and her speech was pressured and non-goal-directed. She has had inappropriate judgement in the past and reports poor concentration, although she was alert during the interview.
It's interesting that no one ever tried to give her a borderline diagnosis! According to this book for a proper diagnosis of bipolar you need to identify mood episodes and then see if they meet the criteria AND see if they affect many areas of functioning. Current and past behaviours must be considered.
stuff
http://imbound.blogspot.com/2004/12/help.html
A very illuminating blog post. I can see myself being diagnosed as borderline, being put on more antipsychotics, and never really understanding what goes on in my head. This might not be what would happen. If I was diagnosed with BPD, I'd get to go to the centre for psychotherapy and be in a really good program. But, I have to be currently self harming to get into the program. I'm not going to self harm just so I can get in! That's the thing, I don't self harm much at all. So really, I'd be left with seeing some psychologist once every 3 weeks and trying to convince the psychiatrist to put me on something other than antipsychotics.
Right now I'm thinking, how could I possibly be borderline when on a day like today I am completely fine? Not elated, irritable, depressed, sad, lonely, empty, or even agitated. There are plenty of things I could feel crap about. I go through quite long periods of doing really well, and being completely stable.
I will definitely not accept a diagnsosis that I don't agree with. There are a few options for if it comes to it and I need a second opinion, most of which are in sydney and cost more money: the good mood clinic, the black dog insitute, insight psychology, the hills clinic, the lawson clinic, wesley hospital.
All of these would need a GP referral for the medicare rebate, but I could call and ask them all how long the waiting list is and then decide which one to go with.
There are also more psychologists in newcastle. There are 3 places I can call that use medicare. I'm just going to have to be persistent in finding the right treatment.
I think that for some periods of time I fit the diagnosis of generalised anxiety disorder, but it's not a constant in my life. I can sometimes relax and forget my troubles.
I'm worried about uni and whether I should drop the cognitive psych course. I just really haven't done enough, and it's the end of semester. I don't think I really have the time now to do everything I need to pass this course. It's difficult, because it's the last course I need to finish my first degree. I just need to be realistic about it, though. Could I complete an assignment and study for the exam in 3 weeks, as well as do the assignment and study for abnormal psych? Maybe. I just don't know! And I'm worried about what will happen if I don't complete the course. It will be another time I'm failing, and another opportunity missed to finish this degree. I have had such a hard time, though, and it's been such a struggle. I've been going through depression, anxiety, agitation and med changes. I haven't had any consistent treatment at all. If I don't have this degree I don't mind so much, I guess it's more about what other people will think. People will think I have failed yet again. Or maybe not, maybe they will understand that I've been having a hard time. Maybe it doesn't matter as much as I think it does, since it is my life and everything. I'm living completely independently, so I don't exactly need to rely on other people, so what they think shouldn't really matter.
I guess I always worry that everything will fall apart if things don't go to plan. Maybe it was unrealistic to try to do more than one subject in the first place. I knew I was in a bad place. Going back to uni was a good way to get me out of depression, but too much is too much. Maybe not much for someone else is too much for me right now.
So, what if I drop the course? What if I won't be graduating soon? Maybe I shouldn't focus so much on the what ifs. Or the shoulds, for that matter. I could just take it as it comes. I could focus on completing the abnormal psych course, and doing well. I've already got an HD for the first assignment, imagine if I did really well overall in the course? I suspect I will since I already know so much from my own research. If I can just focus on the one course I could do so much better. I have plenty of time to complete other courses.
So, looking at this non-judgementally, I started off doing 3 courses, stuff got in the way, and I ended up completing one course. That's not really so bad.
Things happen. Most of the time they are neither all good nor all bad. This is a good thing for me to learn, I think.
A very illuminating blog post. I can see myself being diagnosed as borderline, being put on more antipsychotics, and never really understanding what goes on in my head. This might not be what would happen. If I was diagnosed with BPD, I'd get to go to the centre for psychotherapy and be in a really good program. But, I have to be currently self harming to get into the program. I'm not going to self harm just so I can get in! That's the thing, I don't self harm much at all. So really, I'd be left with seeing some psychologist once every 3 weeks and trying to convince the psychiatrist to put me on something other than antipsychotics.
Right now I'm thinking, how could I possibly be borderline when on a day like today I am completely fine? Not elated, irritable, depressed, sad, lonely, empty, or even agitated. There are plenty of things I could feel crap about. I go through quite long periods of doing really well, and being completely stable.
I will definitely not accept a diagnsosis that I don't agree with. There are a few options for if it comes to it and I need a second opinion, most of which are in sydney and cost more money: the good mood clinic, the black dog insitute, insight psychology, the hills clinic, the lawson clinic, wesley hospital.
All of these would need a GP referral for the medicare rebate, but I could call and ask them all how long the waiting list is and then decide which one to go with.
There are also more psychologists in newcastle. There are 3 places I can call that use medicare. I'm just going to have to be persistent in finding the right treatment.
I think that for some periods of time I fit the diagnosis of generalised anxiety disorder, but it's not a constant in my life. I can sometimes relax and forget my troubles.
I'm worried about uni and whether I should drop the cognitive psych course. I just really haven't done enough, and it's the end of semester. I don't think I really have the time now to do everything I need to pass this course. It's difficult, because it's the last course I need to finish my first degree. I just need to be realistic about it, though. Could I complete an assignment and study for the exam in 3 weeks, as well as do the assignment and study for abnormal psych? Maybe. I just don't know! And I'm worried about what will happen if I don't complete the course. It will be another time I'm failing, and another opportunity missed to finish this degree. I have had such a hard time, though, and it's been such a struggle. I've been going through depression, anxiety, agitation and med changes. I haven't had any consistent treatment at all. If I don't have this degree I don't mind so much, I guess it's more about what other people will think. People will think I have failed yet again. Or maybe not, maybe they will understand that I've been having a hard time. Maybe it doesn't matter as much as I think it does, since it is my life and everything. I'm living completely independently, so I don't exactly need to rely on other people, so what they think shouldn't really matter.
I guess I always worry that everything will fall apart if things don't go to plan. Maybe it was unrealistic to try to do more than one subject in the first place. I knew I was in a bad place. Going back to uni was a good way to get me out of depression, but too much is too much. Maybe not much for someone else is too much for me right now.
So, what if I drop the course? What if I won't be graduating soon? Maybe I shouldn't focus so much on the what ifs. Or the shoulds, for that matter. I could just take it as it comes. I could focus on completing the abnormal psych course, and doing well. I've already got an HD for the first assignment, imagine if I did really well overall in the course? I suspect I will since I already know so much from my own research. If I can just focus on the one course I could do so much better. I have plenty of time to complete other courses.
So, looking at this non-judgementally, I started off doing 3 courses, stuff got in the way, and I ended up completing one course. That's not really so bad.
Things happen. Most of the time they are neither all good nor all bad. This is a good thing for me to learn, I think.
Friday, May 14, 2010
ICD-10 criteria
http://www.fortunecity.com/campus/psychology/781/icd.htm
"F30.0 Hypomania
"F30.0 Hypomania
Hypomania is a lesser degree of mania, in which abnormalities of mood and behaviour are too persistent and marked to be included under cyclothymia but are not accompanied by hallucinations or delusions. There is a persistent mild elevation of mood (for at least several days on end), increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency. Increased sociability, talkativeness, overfamiliarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection. Irritability, conceit, and boorish behaviour may take the place of the more usual euphoric sociability.
Concentration and attention may be impaired, thus diminishing the ability to settle down to work or to relaxation and leisure, but this may not prevent the appearance of interests in quite new ventures and activities, or mild over-spending.
Diagnostic Guidelines
Several of the features mentioned above, consistent with elevated or changed mood and increased activity, should be present for at least several days on end, to a degree and with a persistence greater than described for cyclothymia. Considerable interference with work or social activity is consistent with a diagnosis of hypomania, but if disruption of these is severe or complete, mania should be diagnosed."
http://www.fortunecity.com/campus/psychology/781/cycloicd.htm
"F34.0 Cyclothymia
A persistent instability of mood, involving numerous periods of mild depression and mild elation. This instability usually develops early in adult life and pursues a chronic course, although at times the mood may be normal and stable for months at a time. The mood swings are usually perceived by the individual as being unrelated to life events. The diagnosis is difficult to establish without a prolonged period of observation or an unusually good account of the individual's past behaviour. Because the mood swings are relatively mild and the periods of mood elevation may be enjoyable, cyclothymia frequently fails to come to medical attention. In some cases this may be because the mood change, although present, is less prominent than cyclical changes in activity, self-confidence, sociability, or appetitive behaviour. If required, age of onset may be specified as early (in late teenage or the twenties) or late.
Diagnostic Guidelines
The essential feature is a persistent instability of mood, involving numerous periods of mild depression and mild elation, none of which has been sufficiently severe or prolonged to fulfil the criteria for bipolar affective disorder or recurrent depressive disorder. This implies that individual episodes of mood swings do not fulfil the criteria for any of the categories described under manic episode or depressive episode."
back to the borderline/bipolar distinction
I think that borderline personality disorder and bipolar disorder are two different things, they can just really look like each other, especially when comparing BPD and BP-II. I'm worried about getting the wrong diagnosis. I have a long-standing pattern of extreme sensitivity to rejection, and mood/emotional reactivity/lability/instability, whatever you want to call it. I also sleep more and overeat when depressed, and I get that leaden feeling in my body. All if this is what defines atypical depression, but the first two could also point to BPD. In a previous post I went through the BPD criteria, but now I'm starting to wonder about it again...
1. Do I frantically avoid real or imagined abandonment? Not at the moment. I'm in a very stable relationship. I have in the past, but really I think it was more about rejection than abandonment. I also don't worry about being abandoned by most people. All of my stalking behaviours were related to becoming obsessed easily... this could be related to many things. Anyway, for me, it's more about fear/avoidance of rejection than anything else.
2. Splitting. Okay, I do tend to idealise people. But when do I devalue them? It's common to idealise people when one has low self esteem, but I definitely do not devalue people, especially not openly. Like I said before, I feel hurt very easily by people, but that's due to my sensitivity to criticism and rejection.
3. I may not be as impuslive as I think. I still manage to plan some things. I'm only really impulsive when I'm in a more manic-like state.
4. Unstable self image and sense of self. These have really improved with age, and I feel much more like my own person the older I get. I don't change my identity in any extreme way.
5. I really don't self harm that often.
6. Mood instability. Mostly my mood goes between depressed, normal and elated. I'm only irritable when I'm agitated.
7. Chronic emptiness. I don't always feel this way. It's only when I'm depressed, so I wouldn't say it's chronic.
8. I'm not really an angry person at all.
9. Paranoid ideation, delusions or dissociation. I've never been delusional. Any paranoia I've had was related to social anxiety or caused by drugs. I've only ever experienced the sort of depersonalisation that most people have experienced before.
I just think that even if I do have some of the symptoms, I don't have them often enough or across enough different situations. I also don't really have the most characteristic features. Maybe the psychiatrist is biased towards BPD, just like he's biased towards prescribing atypical antipsychotics.
1. Do I frantically avoid real or imagined abandonment? Not at the moment. I'm in a very stable relationship. I have in the past, but really I think it was more about rejection than abandonment. I also don't worry about being abandoned by most people. All of my stalking behaviours were related to becoming obsessed easily... this could be related to many things. Anyway, for me, it's more about fear/avoidance of rejection than anything else.
2. Splitting. Okay, I do tend to idealise people. But when do I devalue them? It's common to idealise people when one has low self esteem, but I definitely do not devalue people, especially not openly. Like I said before, I feel hurt very easily by people, but that's due to my sensitivity to criticism and rejection.
3. I may not be as impuslive as I think. I still manage to plan some things. I'm only really impulsive when I'm in a more manic-like state.
4. Unstable self image and sense of self. These have really improved with age, and I feel much more like my own person the older I get. I don't change my identity in any extreme way.
5. I really don't self harm that often.
6. Mood instability. Mostly my mood goes between depressed, normal and elated. I'm only irritable when I'm agitated.
7. Chronic emptiness. I don't always feel this way. It's only when I'm depressed, so I wouldn't say it's chronic.
8. I'm not really an angry person at all.
9. Paranoid ideation, delusions or dissociation. I've never been delusional. Any paranoia I've had was related to social anxiety or caused by drugs. I've only ever experienced the sort of depersonalisation that most people have experienced before.
I just think that even if I do have some of the symptoms, I don't have them often enough or across enough different situations. I also don't really have the most characteristic features. Maybe the psychiatrist is biased towards BPD, just like he's biased towards prescribing atypical antipsychotics.
Thursday, May 13, 2010
more on diagnosis
http://www.springerlink.com/content/4af1prhmcw75n6df/
Apparently atypical depression can be an indicator of bipolar. Atypical depression involves a long-standing pattern of extreme sensitivity to rejection. This, I think, could be the equivalent of frantic attempts to avoid abandonment in borderline personality disorder.
Note: there is another way to interpret this. Atypical depression involves mood reactivity as well, and both mood reactivity and hypersensitivty to rejection could be equivalent to the mood reactivity in BPD.
So there is another way in which BP and BPD can overlap. That just leaves dissociation and splitting to differentiate BPD from BP. Although, a science direct search yields a lot of articles for "dissociation in bipolar disorder", and it makes sense that it could occur since bipolar disorder can involve psychotic symptoms, and dissociation is a sort of sub-threshhold psychotic symptom. As for splitting, it may be the one thing that really characterises BPD. I read some of a clinical guide on treating BPD and a lot of it seemed to be about dealing with splitting. Mostly it was about dealing with the difficulties that the patients bring, such as being insulted.
Plus there is the diagnostic category of bipolar not otherwise specified, which includes full hypomanic symptoms without depression, or a history of depression with hypomania that doesn't last for four days. Cycling between depression and hypomania throughout the day can be classified as BP-NOS. Wouldn't this look exactly like BPD, especially if the person had a long-standing pattern of hypersensitivity to rejection?
Of course there are still many other things that could differentiate BP: agitation, racing thoughts, increased activity in general and especially goal-directed activity, decreased need for sleep, flight of ideas, pressured speech, distractibility. None of these should really happen in BPD, at least not in a cluster. If they do happen in a cluster that also involves elated or irritable mood, even if the symptoms don't last that long, I guess that would indicate BP or BP-NOS. This is one way to differentiate BP from BPD, but it still leaves the problem of differentiating BPD from BP. BP can still "look like" BPD.
Apparently it's common for people with BPD to also have Axis I disorders like major depression. You can even have both BP and BPD. It's all very confusing. Obviously mental health diagnosis is not an exact science.
Apparently atypical depression can be an indicator of bipolar. Atypical depression involves a long-standing pattern of extreme sensitivity to rejection. This, I think, could be the equivalent of frantic attempts to avoid abandonment in borderline personality disorder.
Note: there is another way to interpret this. Atypical depression involves mood reactivity as well, and both mood reactivity and hypersensitivty to rejection could be equivalent to the mood reactivity in BPD.
So there is another way in which BP and BPD can overlap. That just leaves dissociation and splitting to differentiate BPD from BP. Although, a science direct search yields a lot of articles for "dissociation in bipolar disorder", and it makes sense that it could occur since bipolar disorder can involve psychotic symptoms, and dissociation is a sort of sub-threshhold psychotic symptom. As for splitting, it may be the one thing that really characterises BPD. I read some of a clinical guide on treating BPD and a lot of it seemed to be about dealing with splitting. Mostly it was about dealing with the difficulties that the patients bring, such as being insulted.
Plus there is the diagnostic category of bipolar not otherwise specified, which includes full hypomanic symptoms without depression, or a history of depression with hypomania that doesn't last for four days. Cycling between depression and hypomania throughout the day can be classified as BP-NOS. Wouldn't this look exactly like BPD, especially if the person had a long-standing pattern of hypersensitivity to rejection?
Of course there are still many other things that could differentiate BP: agitation, racing thoughts, increased activity in general and especially goal-directed activity, decreased need for sleep, flight of ideas, pressured speech, distractibility. None of these should really happen in BPD, at least not in a cluster. If they do happen in a cluster that also involves elated or irritable mood, even if the symptoms don't last that long, I guess that would indicate BP or BP-NOS. This is one way to differentiate BP from BPD, but it still leaves the problem of differentiating BPD from BP. BP can still "look like" BPD.
Apparently it's common for people with BPD to also have Axis I disorders like major depression. You can even have both BP and BPD. It's all very confusing. Obviously mental health diagnosis is not an exact science.
Tuesday, May 11, 2010
borderline or bipolar?
Borderline 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.
- irritability
- emptiness
- mood instability
- avoiding abandonment
- impulsivity
- self harm & suicidal thoughts
- splitting
- unstable identity & sense of self
- dissociation
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.
Monday, May 10, 2010
Another D Word
I forgot one: disarray. Although, I don't know if it describes depression or my life in general. Yes, I think I must have BPD. It will be hard to find out if do. I can't wait for my assessment. I want to know what's wrong with me, and I want to know now. Every doctor has a different theory about what my problem is. "Depression is a vicious cycle, you just have to break the cycle", "people who have had these problems for a long time often don't respond to antidepressants, but a tiny dose of effexor might make you feel better", "effexor is one of the best medications for depression", "people who have similar problems to you often don't respond to antidepressants or mood stabilisers; you are more unstable than someone with bipolar; diagnosis isn't important; here, have some abilify."
I'm quite sick of these wishy-washy theories. There are good reasons for diagnoses, and doctors know this. They could just admit that they don't know exactly what my problem is. Why are they all so sure of themselves, yet they all think different things?
So, the last doctor I saw suggested (indirectly) borderline personality disorder. Subsequently I've done my research. I knew what he meant when he became interested in my childhood and self harm, asked me if people take advantage of me, and suggested that my moods are more unstable than someone with bipolar. I confronted the idea and he said that it's a possibility, but of course diagnosis isn't important. After all this research I've decided that, either way, DBT seems like a really good option for me. If I don't have BPD, I definitely have borderline tendencies:
1. Frantically avoiding abandonment. Definitely. I could even be considered a stalker. I sometimes can't handle being alone, I can be needy and clingy, and desperately try to get people to stay with me.
2. My problem is idealisation. Devaluation happens, but it's not as intense. I don't suddenly hate someone, I might just become indifferent of feel extremely hurt. I've had some pretty bad relationships with friends and boyfriends and flings. By bad I mean up and down, crazy relationships. Maybe a couple of them were borderline themselves. I do tend to think of things as all good or all bad (including people), but generally my relationships are pretty stable. I just feel hurt very easily.
I guess there have been 3 crazy relationships. The first was my high school boyfriend. I kept going from liking him to hating him, I started fights for no reason to test him, I was jealous for no reason. I wanted out so I started a fight and he dumped me, but then I was devastated and begged him to take me back. He was not my type at all. I didn't want him when I was with him, and then when he dumped me I wanted him back for months. Sigh.
The next one was my best friend in year 11 and 12. Maybe she was the crazy one, I don't know. It was intense, more like a romantic relationship than a friendship. I won't even bother going into it now, but it was a roller coaster friendship, which I ended abruptly when she pissed me off one time too many.
The last one was a short, intense fling. In the few days we were together I went through extremes of obsession and indifference. He apparently went through the same thing and dumped me. Similar situation to my high school boyfriend. I stalked him over the internet and begged him not to leave me. Wow, talk about a lesson in how pathetic I am.
- Unstable self-image and sense of self. Most definitely. I have tried to base my personality on other people's for most of my life. I have basically tried to be someone else - using different friends as the mould, whoever I was idealising at the time. I act differently around different people. I don't know who I am at all, and sometimes I don't even recognise my face in the mirror. My life plans are chaotic and always changing.
- Implsivity in all areas except reckless driving, because I have never driven a car. Drinking, drugs, casual sex, food (bingeing/purging), spending. I always act on impulse. In fact, planning doesn't come into my life much at all. I don't like committing to things and I find it hard to carry out plans. I basically rely on impulse. It makes it difficult to get anything done in life.
- Self harm, suicidal thoughts.
- Mood instability. Intense emotions lasting a few hours. I get intense sadness, anxiety, and sometimes joy and excitement. Other emotions are jealousy and guilt. The moods are not supposed to last more than a few days, but I guess the depression could be a separate thing.
- Feeling chronically empty. I always feel like something is missing, but I don't know what. I often see life as being essentially meaningless. Intractalbe boredom can be a big problem. I see other people as being empty too, sometimes, because their lives don't have any meaning either. I sometimes feel such a void inside of me that I try to fill it by doing the impulsive things outlined above.
- Angry outbursts. Most of my anger is internal. I can be very irritable, though. I'm never aggressive, and I avoid conflict at all costs. I bottle up anger, or I take it out on myself, or I rage in private. I also get frustrated extremely easily, which can cause a mini rage.
- Stress-related paranoid ideation, delusions or dissociation. I do get paranoid quite a bit. No one has ever told me that I'm delusional, but I do think some pretty warped things sometimes. I have experienced dissociation before, usually when I'm listening to a fight. It's hard to tell because dissociation can involve memory loss, and I do have some strange memory gaps. I've also experienced derealisation and depersonalisation. When I was younger, sometimes I would wake up in the morning and have to remind myself of who I was and what my current situation was. It wasn't that I'd forgotten, I just felt very strange.
I'm quite sick of these wishy-washy theories. There are good reasons for diagnoses, and doctors know this. They could just admit that they don't know exactly what my problem is. Why are they all so sure of themselves, yet they all think different things?
So, the last doctor I saw suggested (indirectly) borderline personality disorder. Subsequently I've done my research. I knew what he meant when he became interested in my childhood and self harm, asked me if people take advantage of me, and suggested that my moods are more unstable than someone with bipolar. I confronted the idea and he said that it's a possibility, but of course diagnosis isn't important. After all this research I've decided that, either way, DBT seems like a really good option for me. If I don't have BPD, I definitely have borderline tendencies:
1. Frantically avoiding abandonment. Definitely. I could even be considered a stalker. I sometimes can't handle being alone, I can be needy and clingy, and desperately try to get people to stay with me.
2. My problem is idealisation. Devaluation happens, but it's not as intense. I don't suddenly hate someone, I might just become indifferent of feel extremely hurt. I've had some pretty bad relationships with friends and boyfriends and flings. By bad I mean up and down, crazy relationships. Maybe a couple of them were borderline themselves. I do tend to think of things as all good or all bad (including people), but generally my relationships are pretty stable. I just feel hurt very easily.
I guess there have been 3 crazy relationships. The first was my high school boyfriend. I kept going from liking him to hating him, I started fights for no reason to test him, I was jealous for no reason. I wanted out so I started a fight and he dumped me, but then I was devastated and begged him to take me back. He was not my type at all. I didn't want him when I was with him, and then when he dumped me I wanted him back for months. Sigh.
The next one was my best friend in year 11 and 12. Maybe she was the crazy one, I don't know. It was intense, more like a romantic relationship than a friendship. I won't even bother going into it now, but it was a roller coaster friendship, which I ended abruptly when she pissed me off one time too many.
The last one was a short, intense fling. In the few days we were together I went through extremes of obsession and indifference. He apparently went through the same thing and dumped me. Similar situation to my high school boyfriend. I stalked him over the internet and begged him not to leave me. Wow, talk about a lesson in how pathetic I am.
- Unstable self-image and sense of self. Most definitely. I have tried to base my personality on other people's for most of my life. I have basically tried to be someone else - using different friends as the mould, whoever I was idealising at the time. I act differently around different people. I don't know who I am at all, and sometimes I don't even recognise my face in the mirror. My life plans are chaotic and always changing.
- Implsivity in all areas except reckless driving, because I have never driven a car. Drinking, drugs, casual sex, food (bingeing/purging), spending. I always act on impulse. In fact, planning doesn't come into my life much at all. I don't like committing to things and I find it hard to carry out plans. I basically rely on impulse. It makes it difficult to get anything done in life.
- Self harm, suicidal thoughts.
- Mood instability. Intense emotions lasting a few hours. I get intense sadness, anxiety, and sometimes joy and excitement. Other emotions are jealousy and guilt. The moods are not supposed to last more than a few days, but I guess the depression could be a separate thing.
- Feeling chronically empty. I always feel like something is missing, but I don't know what. I often see life as being essentially meaningless. Intractalbe boredom can be a big problem. I see other people as being empty too, sometimes, because their lives don't have any meaning either. I sometimes feel such a void inside of me that I try to fill it by doing the impulsive things outlined above.
- Angry outbursts. Most of my anger is internal. I can be very irritable, though. I'm never aggressive, and I avoid conflict at all costs. I bottle up anger, or I take it out on myself, or I rage in private. I also get frustrated extremely easily, which can cause a mini rage.
- Stress-related paranoid ideation, delusions or dissociation. I do get paranoid quite a bit. No one has ever told me that I'm delusional, but I do think some pretty warped things sometimes. I have experienced dissociation before, usually when I'm listening to a fight. It's hard to tell because dissociation can involve memory loss, and I do have some strange memory gaps. I've also experienced derealisation and depersonalisation. When I was younger, sometimes I would wake up in the morning and have to remind myself of who I was and what my current situation was. It wasn't that I'd forgotten, I just felt very strange.
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