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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 45. This is the beginning of the thread.
Posted by MM on July 23, 2001, at 1:15:29
Does anyone have experience with BPD? What about the connection with bipolar? I've read some stuff, but it's kind of unclear what it is. Is it borderline schizophrenia? Is it a valid dx? If I identify with some of the traits, does that mean I have it, or should I just stick with the BPII dx? Just kinda want thoughts on BPD. I'm still amazed at how MUCH you guys know (being that it seems like most of you are not psychiatrists, but patients).
Posted by geekUK on July 23, 2001, at 4:01:01
In reply to questions-borderline personality disorder, posted by MM on July 23, 2001, at 1:15:29
well it seems there is a lot of links between BPD and BP. I have came in the oposite direction to you BPD- >BPII. On to the questions.
BPD is not borderline schitz. The term was used for that in the 1960's to do with adoption studies on schitz. children and kinda stuck for a bit. In the modern sense it is a distinct clinical entity (as much as psych. has them!)
BPD falls into the catagory of personality disorder, (along with histrionic PD, avoidant PD, narcistic PD, and others) The PD label tends to suggest a primary symptom to be psychological, not biochemical (as in mood disorders -BPII). But this is debateable, there has been research into low seretonin concentrations in spinal fluid, but It is probably one of many reports.
I have never had a diagnosis, but I did used to think I was BPD. the instability of mood, impulsive, chronic emptyness,sounded alot like me (after all I was never manic), then I found out about BPII and this fits me better. So well I dont even ask the docs to qualify it (though it would be nice). The net result being I am switching to mood stabilizers and they seem to be having some effect.
So If your treatment is working then Keep to that, but there is no reason not to explore BPD. It may mean better treatment. Which is a reason not to be rigid.
finally, its pointed to a lot on this group but
http://www.mentalhealth.com/fr20.html
is a great source of information.
I hope this helps
MC
> Does anyone have experience with BPD? What about the connection with bipolar? I've read some stuff, but it's kind of unclear what it is. Is it borderline schizophrenia? Is it a valid dx? If I identify with some of the traits, does that mean I have it, or should I just stick with the BPII dx? Just kinda want thoughts on BPD. I'm still amazed at how MUCH you guys know (being that it seems like most of you are not psychiatrists, but patients).
Posted by Else on July 23, 2001, at 7:20:08
In reply to questions-borderline personality disorder, posted by MM on July 23, 2001, at 1:15:29
They tried to pin that Dx on me too. I would say stick with whatever dx gets you the most effective meds. In your case though, the same drugs would probably be effective for both conditions (BPD and BDII): anti-convulsants, ADs,etc...
In Europe they tend to consider BPD as borderline schizophrenia. In the US, it is commonly considered a form of mood disorder. One (perhaps quacky) doctor thinks it is related to epilepsy at www.mhsanctuary.com. (not completely irrational, BPD ressembles the so-called Explosive or Epileptoid personality and some epileptics can be quite labile. I don't know how much credibility can be given to the theory though. Others specialists think it is related to PTSD (I personally share that opinion considering the high rate of sexual and physical abuse in BPD patients). Another possibility is that it's the *female* version of ADD. The two disorders share impulsivity, emotional lability, tendency toward anger and inconsistency as personnality traits (not all of them, but I think a paralell can be drawn). More likely though, is that it is a one-size-fits-all diagnosis and should only be made when everything else has been eliminated as a dx possibility. Anyway, good luck sorting this out. These are muddy waters. I would stick to BPII, n it's much simpler.
> Does anyone have experience with BPD? What about the connection with bipolar? I've read some stuff, but it's kind of unclear what it is. Is it borderline schizophrenia? Is it a valid dx? If I identify with some of the traits, does that mean I have it, or should I just stick with the BPII dx? Just kinda want thoughts on BPD. I'm still amazed at how MUCH you guys know (being that it seems like most of you are not psychiatrists, but patients).
Posted by MM on July 23, 2001, at 8:21:09
In reply to Re: questions-borderline personality disorder, posted by Else on July 23, 2001, at 7:20:08
Thanks, both of you. I think I'll just keep that I identify with borderline to myself, stick with BPII dx, but read about it. Any book reccomendations?
BTW the thinking that it is the female version of ADD is really interesting.
Posted by Elizabeth on July 23, 2001, at 16:44:10
In reply to questions-borderline personality disorder, posted by MM on July 23, 2001, at 1:15:29
> Does anyone have experience with BPD? What about the connection with bipolar?
Some doctors feel that many people who are diagnosed as "borderline" are, in reality, suffering from a variant bipolar disorder, with dysphoric or mixed mania or hypomania (if this is what's going on, an anticonvulsant is more likely to help than lithium is). Certainly, drugs used in the treatment of mania and depression can be effective for this group. There is also some connection to ADHD, and some "borderlines" respond positively to stimulants. Although antipsychotics are often used, I think they're probably unnecessary in most cases.
Borderline-like behavior is occasionally linked to temporal lobe epilepsy. (In this case, it's sometimes called interictal dysphoria.)
> I've read some stuff, but it's kind of unclear what it is. Is it borderline schizophrenia?
No, it has nothing to do with schizophrenia (although a certain group of patients was once viewed as somewhere in between "neurosis" and "psychosis," hence the name "borderline").
> Is it a valid dx?
It's probably overused, but I think it is real.
> If I identify with some of the traits, does that mean I have it, or should I just stick with the BPII dx?
The latter choice seems like a better idea. Almost everybody identifies with at least some of the "borderline" traits.
-elizabeth
Posted by Else on July 23, 2001, at 18:13:04
In reply to Re: questions-borderline personality disorder, posted by MM on July 23, 2001, at 8:21:09
> Thanks, both of you. I think I'll just keep that I identify with borderline to myself, stick with BPII dx, but read about it. Any book reccomendations?
> BTW the thinking that it is the female version of ADD is really interesting.
This is my theory and don't read too much into this. It's just that I think female ADD sufferers tend to be under-diagnosed and are considered BPD while the same symptoms in men would be considered to be ADD. There is this unconscious bias in doctors. More men are supposed to have ADD and more women are supposed to have BPD and there is enough overlap between the two disorders to allow for considerable confusion. Also there are differences in emotional behavior between men and women which might blur the picture even more. I am not saying I'm convinced of this but that it is probably a common misdiagnosis.
Posted by MM on July 23, 2001, at 23:31:07
In reply to Re: questions-borderline personality disorder » MM, posted by Else on July 23, 2001, at 18:13:04
If stimulant medications make me feel better, does that suggest ADD? (I've never tried them, closest is caffine I think) What do SSRI's do for people with ADD?
Posted by Mitch on July 24, 2001, at 10:37:05
In reply to Re: questions-borderline personality disorder, posted by MM on July 23, 2001, at 23:31:07
MM,
I have comorbid ADHD and BPII. It is possible you could also have that condition (I read that your current dx is BPII). There are *tests* for ADHD that you can take (from a psychologist for instance). If your BPII is currently fairly well controlled and you still test very positive for ADHD then you would have your answer. Pstims usually help anybdoy concentrate and focus better, plus when you start taking them there is some startup euphoria/insomnia you may experience for a few days. SSRI's tend to worsen ADHD symptoms in my experience (and from what I have read). The only exception I have found is Prozac (it boosts norepinephrine and dopamine quite a bit). I really liked Prozac, but I got toxic on it and had nighttime hallucinations, etc., so it was dx'ed.
Mitch
> If stimulant medications make me feel better, does that suggest ADD? (I've never tried them, closest is caffine I think) What do SSRI's do for people with ADD?
Posted by Else on July 24, 2001, at 20:02:43
In reply to Re: questions-borderline personality disorder, posted by MM on July 23, 2001, at 23:31:07
Stimulants make everyone feel better. Have you heard of cocaine? If you've never been able to finnish a book in your life (just an example) and you can do it on a stimulant, that might suggest ADD. But just feeling better on uppers is pretty much a universal reaction unless you're prone to psychosis (then it might make you feel a lot worse).
> If stimulant medications make me feel better, does that suggest ADD? (I've never tried them, closest is caffine I think) What do SSRI's do for people with ADD?
Posted by MM on July 24, 2001, at 23:40:56
In reply to Re: questions-borderline personality disorder » MM, posted by Else on July 24, 2001, at 20:02:43
So how do they diagnose ADD in someone who has BP? Don't they look a lot alike? The fact that I'm a girl makes it less of an obvious choice I guess, but I've taken several online tests/questionaires and it's usually pretty suggestive of ADD. My brother was also dxd ADD, but does fine with no stimulants. It's just hard to accept the BPII dx since I don't fit the criteria well. I guess I'm atypical. I want to find the best possible meds, ya know? After trying so many SSRI's (no MAOI's, or anything) and them being kind of a disaster, I don't want to go through that again.
Posted by Elizabeth on July 26, 2001, at 23:54:42
In reply to Re: questions-borderline personality disorder, posted by MM on July 23, 2001, at 23:31:07
> If stimulant medications make me feel better, does that suggest ADD?
Not necessarily. Stimulants have antidepressant effects in some people, for example; see early research on what is now known as atypical depression. The lines between these categories can be quite blurred, of course.
I think that euphoria is seldom a side effect when people start taking them for ADD, for example: the doses used are simply too low. And anyway, not everyone finds stimulants euphoric or even pleasant.
-elizabeth
Posted by Else on July 27, 2001, at 6:26:38
In reply to Re: questions-borderline personality disorder » MM, posted by Elizabeth on July 26, 2001, at 23:54:42
> > If stimulant medications make me feel better, does that suggest ADD?
>
> Not necessarily. Stimulants have antidepressant effects in some people, for example; see early research on what is now known as atypical depression. The lines between these categories can be quite blurred, of course.
>
> I think that euphoria is seldom a side effect when people start taking them for ADD, for example: the doses used are simply too low. And anyway, not everyone finds stimulants euphoric or even pleasant.
>
> -elizabethMaybe not everyone, but a lot of people do, that's why they are controlled substances. They do directly stimulate the "pleasure" center in the brain. Even at low doses, they would help almost anyone concentrate, not just people with ADD. They've been used for decades by students who needed to put in a little extra effort before an exam. That's not to say they are not useful for ADD but the simple fact that they help someone does not necessarily indicate any underlying pathology.
Posted by MM on July 27, 2001, at 7:28:31
In reply to Re: questions-borderline personality disorder, posted by Else on July 27, 2001, at 6:26:38
I was reading about borderline last night and came across a site that says some things about regions in the brain. It didn't exactly say how or if it was related to borderline, but it mentioned that there's an excess blood flow in the pthyolomus (or something like that heh) region on the right side of the brain, that's responsible for panic, agoraphobia etc. I've mentioned to people several times that I have this weird feeling on the right side of my head, sort of above the neck. It's not painful, necessarily, but uncomfortable, almost like blood is leaking or it's twitching or something. does anyone know anything about this?
And BTW Else, I think there might be something to your theory that ADD in women is dxd BPD because something like 80% of BPD's are women. Wouldn't that make it one of two mental disorders (or w/e) that's much more prevalent among one sex? The other being ADD (which is more prevalent among men) A HEM. And like you mentioned, the fact that women and men express/feel etc. so differently would make it seem like maybe it's the same thing, but just looks different.
Posted by Elizabeth on July 27, 2001, at 20:34:13
In reply to Re: questions-borderline personality disorder, posted by Else on July 27, 2001, at 6:26:38
> > I think that euphoria is seldom a side effect when people start taking them for ADD, for example: the doses used are simply too low. And anyway, not everyone finds stimulants euphoric or even pleasant.
>
> Maybe not everyone, but a lot of people do, that's why they are controlled substances.Sure. But the amount that people take for ADD is generally lower than the amount you'd need to get high.
> Even at low doses, they would help almost anyone concentrate, not just people with ADD.
True. Some people find them unpleasant, though (same is true of opioids, alcohol, etc.).
> They've been used for decades by students who needed to put in a little extra effort before an exam. That's not to say they are not useful for ADD but the simple fact that they help someone does not necessarily indicate any underlying pathology.
Agreed. I think ADD is a real thing, but there's a continuum from "normal" to "disordered," and the line that demarcates them is not so clear.
-elizabeth
Posted by Elizabeth on July 27, 2001, at 20:37:53
In reply to Re: questions-borderline personality disorder, posted by MM on July 27, 2001, at 7:28:31
> ... it mentioned that there's an excess blood flow in the pthyolomus (or something like that heh)
"hypothalamus?"
> And BTW Else, I think there might be something to your theory that ADD in women is dxd BPD because something like 80% of BPD's are women.
And BPD is very much a fad diagnosis. At some hospitals, it seems like just about every depressed young woman is dx'd with BPD, regardless of symptoms.
> Wouldn't that make it one of two mental disorders (or w/e) that's much more prevalent among one sex?
I'd look at it as a single disorder that manifests somewhat differently depending on gender.
> And like you mentioned, the fact that women and men express/feel etc. so differently would make it seem like maybe it's the same thing, but just looks different.
I agree. Some of the differences may be culture-bound.
-elizabeth
Posted by margaretmarburg on July 28, 2001, at 5:10:08
In reply to Re: questions-borderline personality disorder » MM, posted by Elizabeth on July 27, 2001, at 20:37:53
nobody's mentioned the comparison between antisocial personality (in men) and borderline (in women). I had to bring it up, since there's a lot more literature suggesting that borderline is the female antisocial personality disorder, than that borderline is the female ADHD.
I've always thought it's a stupid association, because antisocial and borderline are fundamentally different in their core traits (one is self-destructive attention-seeking, the other aggressive). The only serious similarity to me is impulsiveness. And if that's so important, then why not group mania and ADHD with borderline and antisocial personality?
I was particularly annoyed that in Kay Jamison's book "night falls fast" she overtly equates antisocial and borderline. Especially since she positions herself as a spokesperson for bipolar disorder, and doesn't bother to acknowledge (in any of her books) that there's a possible relationship between borderline and the mood disorders (especially bipolar).
IMO borderline is just dysphoria (which could be related to any mood disorder) + disinhibition. Most people with depression will relate to the URGE to do what borderlines are diagnosed by doing: self-injury, self-destructive acts, needy and desperate cries for attention, fear of abandonment, seeing everything as evil and black, etc. An inhibitied depressive doesn't follow through. A borderline does, and doesn't see why that's a problem.
If it's disinhibition (or impulsivity) that's key - then that would explain the overlap between ADHD and borderline. Also bipolarity and borderline.
Which brings me to stimulants. I see how stimulants would help with focus even in normals, but I don't see how they help with the impulsivity/disinhibition. But they seem to in ADHD - I've seen it in a friend of mine. If they ahve that effect in normals too, then I could see how they would be useful for borderline. But in normals, I thought stimulants tended to be disinhibiting. Not true?
Posted by MM on July 28, 2001, at 6:11:51
In reply to Re: BPD/antisocial/bipolar/Jamison/stimulants...., posted by margaretmarburg on July 28, 2001, at 5:10:08
The times I've most resembled borderline are when I was on/withdrawing from SSRI's (and an SNRI), so that makes a lot of sense (dysphoria + disinhibition) because the SSRI's made me less inhibited (I didn't care, which is an effect many people get), and more anxious/dysphoric (hypomania is what it's being called right now). I may have had the thoughts/urges before, but never acted on them, until the SSRI's. Haven't acted on them since being off the SSRI's (besides withdrawl) either. Not sure what that all means, but you make a lot of sense.
Posted by MM on July 28, 2001, at 6:36:27
In reply to Re: BPD/antisocial/bipolar/Jamison/stimulants.... » margaretmarburg, posted by MM on July 28, 2001, at 6:11:51
The fact that so many women are dxd BPD and so many men are dxd ADD jumps out at me like DUH, it must be the same thing, just presented differently. I'm in NO way an expert tho. The depression/anxiety that is often comorbid with ADD.....wouldn't that be dysphoria + impulsivity? I think you and Zo both make a lot of sense. Borderline seems so.....hopeless, which scares me personally, because I have some of the traits and it's good to hear/read some thoughts that don't sound so despairing.
Posted by jojo on July 31, 2001, at 1:51:50
In reply to Re: questions-borderline personality disorder » MM, posted by Elizabeth on July 26, 2001, at 23:54:42
> > If stimulant medications make me feel better, does that suggest ADD?
>
> Not necessarily. Stimulants have antidepressant effects in some people, for example; see early research on what is now known as atypical depression. The lines between these categories can be quite blurred, of course.
>
> I think that euphoria is seldom a side effect when people start taking them for ADD, for example: the doses used are simply too low. And anyway, not everyone finds stimulants euphoric or even pleasant.
>
> -elizabethI recently read that 60% of depressives fit the definition of "Atypical". I realize that
those who prefer "Logic" to "History" will have trouble with that, but what can I say?
As Robert DeNiro said in The Deer Hunter, "This is this". If it turns out that the
symptoms described as "Atypical Depression" happen to be more typical than those
we ascribe to "Depression', we either have to live with the logical consequences
(calling it what it ain't), or try to rename these syndromes, and always explain which
nomenclature we're using.
Looks like this time it's easier running into conflict with logic than revising history.RE: not
everyone finds stimulants euphoric or even pleasant." It may be helpful to
someone here to be aware that there was a publication many years ago stating that
those who experienced "euphoria" on amphetamines responded to imipramine as an
AD, but not amitriptyline, but those who experienced no euphoria responded to
amitriptyline, but not imipramine. Worked with me.
"jojo
Posted by Elizabeth on July 31, 2001, at 18:31:51
In reply to Re: questions-borderline personality disorder » Elizabeth, posted by jojo on July 31, 2001, at 1:51:50
> I recently read that 60% of depressives fit the definition of "Atypical".
That's interesting. I would expect the percentage to be high, but not that high. It is a misnomer: atypical depression is very common.
> It may be helpful to
> someone here to be aware that there was a publication many years ago stating that
> those who experienced "euphoria" on amphetamines responded to imipramine as an
> AD, but not amitriptyline, but those who experienced no euphoria responded to
> amitriptyline, but not imipramine. Worked with me.Another interesting factoid. Were the results replicated?
-elizabeth
Posted by Zo on August 1, 2001, at 17:56:14
In reply to Re: BPD/antisocial/bipolar/Jamison/stimulants...., posted by margaretmarburg on July 28, 2001, at 5:10:08
BPD dx, in my understanding, requires a real "Splitting" be going on. The inability to hold the grey area, but to *truly* be capable of seeing things ONLY in black and white.
Borderline traits are pretty sexist-ly (?) (!) the way women get upset. Forget all that horses**t. Borderlines suffer in their Object Relations, they do not have Object Constancy, and that's a real early developmental stage. . .one which, whether through trauma or chemistry, didn't take place. So that growing up never really happens. They're stuck there.
That means, as is true in all Personality Disorders, the person is wired up wrong, hard wired, and that's very difficult to change.
Zo
Posted by MM on August 2, 2001, at 1:37:18
In reply to Re: Borderline Personality Disorder, posted by Zo on August 1, 2001, at 17:56:14
Zo, could you possibly explain Object Relations/Constancy to me?
I read one book on BPD (kind of an old one, by melissa someone? I think it was called borderline and beyond?) a while ago, but it didn't explain much to me.
Posted by MM on August 3, 2001, at 1:41:44
In reply to Re: Borderline Personality Disorder » Zo, posted by MM on August 2, 2001, at 1:37:18
Don't know if anyone's still reading this thread, but I also was wondering about the symptom of chronic emptiness in BPD. Isn't that a symptom of just regular depression too?
Posted by Mitch on August 3, 2001, at 11:36:11
In reply to Re: Borderline Personality Disorder, posted by MM on August 3, 2001, at 1:41:44
> Don't know if anyone's still reading this thread, but I also was wondering about the symptom of chronic emptiness in BPD. Isn't that a symptom of just regular depression too?
MM,
Yes, I would think so. I mean can someone more clearly define what "chronic emptiness" is? Sure sounds like depression to me. I think Elizabeth is right about this being a fad diagnosis and it being "overcalled" especially with women. I wouldn't be surprised that in the future it gets eliminated from the DSM. Nearly any person with clear-cut uncomplicated bipolar disorder already will have some of the "traits". And if you have one or more of the anxiety disorders you will have some of those "traits" as well. I think it is just a "catch-all" for something that pdocs have trouble treating. In my opinion, it is either/both a subset of ADHD patients, or a subset of bipolar patients with "mixed" symptoms.
Mitch
Posted by Elizabeth on August 3, 2001, at 18:19:40
In reply to Re: Borderline Personality Disorder » MM, posted by Mitch on August 3, 2001, at 11:36:11
[MM:]
> > Don't know if anyone's still reading this thread, but I also was wondering about the symptom of chronic emptiness in BPD. Isn't that a symptom of just regular depression too?I was never clear on what "emptiness" is supposed to mean anyway. I guess that it might be something like boredom or inability to feel okay/comfortable/at ease/fulfilled. This might contribute to the impulsive sensation-seeking that is commonly seen in BPD -- an attempt to fill the void.
[Mitch:]
> Yes, I would think so. I mean can someone more clearly define what "chronic emptiness" is? Sure sounds like depression to me.The overlap is substantial. I think that BPD probably does exist as a distinct entity (one that's prevalent, in particular, in women who were abused as children), but it's way overdiagnosed in people (especially women) who might really have ADHD, PTSD, bipolar disorder, atypical depression, substance dependence, etc., without first ruling out these disorders. And a primary diagnosis of personality disorder often prevents people from getting adequate medical treatment, since there's a general feeling that "personality disorders" don't respond to medication.
In fact, a variety of medications have been employed successfully in BPD: antidepressants (but not tricyclics), antipsychotics (mainly in low doses), anticonvulsants, lithium, psychostimulants, etc. This doesn't prove that these patients "really" have an axis I (or III) disorder and not BPD (for example, response to Depakote doesn't mean that a person is really suffering from bipolar disorder or temporal lobe epilepsy), but it does mean that pharmacotherapy should at least be considered. People with this disorder suffer a great deal, and their treaters often make it worse by getting irritated with them and labelling them with derogatory adjectives such as "manipulative," "attention-seeking," "immature," "demanding," etc., and by assuming that medication will not help.
Marsha Linehan (a psychologist who designed a modified form of cognitive-behavioural therapy specifically for BPD) thinks that one causative factor can be invalidation of a person's feelings and experiences in childhood. Reexperiencing that invalidation in the treatment setting can hardly be expected to help.
> I wouldn't be surprised that in the future it gets eliminated from the DSM.
I think it might be assimilated into the mood disorders category, perhaps as "affective reactivity disorder" or something like that. IMO, the primary feature of BPD is excessive sensitivity or mood reactivity.
> Nearly any person with clear-cut uncomplicated bipolar disorder already will have some of the "traits".
The difference is that in a personality disorder, they're enduring traits, not symptoms of a manic, depressive, or mixed episode. When you get into mixed mania, rapid cycling, and "soft" bipolar disorders (cyclothymia and bipolar II), though, the waters become muddy.
> And if you have one or more of the anxiety disorders you will have some of those "traits" as well.
Yes. I think the criteria should be more restrictive. Clinicians are often hasty to diagnose an Axis II condition based on a person's behaviour during a brief hospital stay. I think this is a serious problem. They seem to forget the general rule that personality disorders have to be enduring -- trait, not state -- and that the signs and symptoms must present in a variety of contexts (not just, for example, in the hospital). I also suspect that a lot of adolescent girls are diagnosed with BPD when in fact they're just going through the usual stuff that teenagers have to deal with.
> I think it is just a "catch-all" for something that pdocs have trouble treating.
Well, it's a way of blaming the patient for failing to get better, rather than blaming the doctor for failing to cure the patient. I don't think it's especially helpful in most cases, and it's quite stigmatising.
> In my opinion, it is either/both a subset of ADHD patients, or a subset of bipolar patients with "mixed" symptoms.
I think that is probably true in many cases.
-elizabeth
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