Borderline Personality Disorder and other mood lability disorders...

[sylvester212]

Many of us began with a diagnosis of Bipolar. Maybe Bipolar I was downgraded to Bipolar II. Some are Cyclothymic. I am certainly a fairly rapid cycler.

I was diagnosed in 2000. HIV was 1995. So I feel like I was doomed from long ago.

In 2001, it was suggested that I might also suffer from Borderline Personality Disorder. That was just coming into popularity: these diagnoses do have a popularity quotient, and that must always be kept in mind.

You yourself can help the diagnostic process by keeping a journal. Or a ledger - everything you spend and where and when. I did this for over 5 years. I learned amazing things about my illnesses. I think I suffer from both illnesses, which is sad: because recovery from both is not easy to achieve.

If you have had several suicide attempts, you will probably be considered for Borderline Personality Disorder. This used to be the domain of the Bipolar (Manic/Depressive) patient. Not anymore.

It is important that "consumers" read about both illnesses, and compare notes - to your own. The reason?The treatments differ. Or, at least they should.

Example: antidepressant therapy needs to be used carefully with Bipolar patients, or patients who cycle fast. I am such an example. I have done all kinds of stupid things high on a new antidepressant. Some of these things happen in the first day or two of therapy - a danger zone for me.

I look at the trail of trouble left behind me. And if I was my own psychiatrist, I would probably NOT put me on antidepressants. But my psychiatrist is kind, easy-going and writes for things I ask for. The reason is that my life is really tough: and she sees this.

The Borderline part of me is often suicidal: chronically suicidal. And the underlying problems have more to do with feelings of low self-esteem, worthlessness, "why bother?", "I can't wait to die." If there is an underlying    feeling of emptiness, then Borderline Personality Disorder might be a good suspect to add to the mood disorder.

Working with both issues is not easy: for you must take something to raise your spirits, or the suicide attempt will take place. On the other hand, hypomania can become severe enough to lead to risky behaviors - and this looks a lot like mania when money is spent, drugs are used, or some other unusual activity takes place.

BPD is a very nasty thing to be labeled. Some clinicians refuse to work with Borderlines, because some are very manipulative. There are over 300 types of Borderlines, if you use the DSM criteria as a starting point. Not everyone is manipulative. Some are extremely fragile: others are tough as nails.

I heard this on YouTube from an MD: "The Borderline patient is often seen as a sponge with horns."

Anyone who has been in a DBT program (therapy for BPD) might understand why that can be said. BPD is one of the most dramatic of the "personality disorders." And some clinicians see BPD as a mood disorder, too (which implies that there is a chemical imbalance in the brain - not just a behavioral problem that is learned/unlearned).

The diagnosis is being given out more liberally today, and it is very important for clinicians to be on the same page: because often, two people cannot agree on the definition of a Borderline Personality!

Bipolar is much more cut/dry.

Imagine how hard it is to be called this: almost like an accusation at times - in certain hospital settings. I made many psychiatrists turn hot in the face, because I am not always Mr. Co-operation. Being "institutionalized" does not feel very good.

The approach to the Borderline patient is best done gently. Using hard methods that derive from Cognitive Behavioral Therapy approaches, and Marsha Linehan's Dialectical Behavioral Therapy can be helpful for one patient, and disastrous for the next.

Some patients need a lot of trust work: supportive talk therapy with no agenda works best for these patients. I have such a therapist - my psychiatrist. She has been successful to a degree with me because I have stuck with her for 11 years. That is a long time for a Borderline, or a Bipolar person.

She makes it easy - by using real examples from her own life to check against mine. We might talk about subjects that seem like B.S. - what's on Broadway, or a favorite old song. But these are clinically helpful, because the fragile patient needs to feel liked by the therapist.

I have had therapists, additional ones, with whom I got nowhere. I did not feel like they cared about me, the person. And if that is coupled with no knowledge, it is a waste of time. There is absolutely no substitute for genuinely caring for the patient the clinician is trying to help.

And I am always amazed at how many consumers like me have seen therapists who are more keen on the clock than anything. If you don't have the feeling that you are somehow really cared for by your therapist, and that therapist is not teaching you anything anyway - shop around.

Good luck to all who have mood disorders plus HIV. This is extremely challenging: sometimes you may want to stop HAART therapy. I'm lucky that I seem to take my HIV meds so automatically (since 1996) that I swallow them before I think about quitting.

Always ask for help long before the problem gets out of hand.
I should have stayed in the hospital for August - I knew it - and I was right. I had a terrible and dangerous August. I went to Bellevue, but I was not suicidal at the time I saw an MD. I should have said more: I was unsafe - I was in danger - I needed to be observed & a med change was and is in order.

But they don't always ask the right questions - and some of us slip through. Be honest, and press hard if you think that there is any danger of your hurting yourself (not just a suicide type of event, anything that is harmful to the body - and unusual for you).

peace from sylvester
please forgive my length. I type very fast some nights.

[Theyer]

As you say sylvester a lot to deal with. Hope life is settling for you and the problems in August are past.
Take care
t

[garywales]

Hi Sylvester,

Just read your thread and found it really interesting. Retired Mental health Nurse here.  Yours sounds like a difficult struggle.  Just thought I,d say hi

Gary

Wales