The Prisoner’s Dilemma paradigm separates the two, but that’s not practical as a clinical tool.
Borderline or Bipolar: Can 3 Questions Differentiate Them?
January 10, 2017 | Bipolar Disorder, Mood Disorders
By James Phelps, MD
Treatments for borderlinity and bipolarity are quite different. Which approach should you consider for a patient with impulsive risk-taking, episodes of irritability and hostility, fractured relationships, substance use problems, and severe depressions with brief phases of remission (maybe too good?) in between?
The Prisoner’s Dilemma paradigm separates the two,1 but that’s not practical as a clinical tool. What if you could pluck just 3 items from a standard bipolar screening questionnaire and increase your diagnostic certainty by 30% when faced with this common differential? That may be possible, based on a new study from Nassir Ghaemi and colleagues, led by Paul Vöhringer.2
Of course, replication studies will be needed before we can declare a new diagnostic approach is at hand. But in the meantime, I hope you might be curious: what 3 items from the good old Mood Disorders Questionnaire (MDQ)3 were so discriminating?
Vöhringer et al2 obtained an MDQ from 260 patients whose diagnosis was then established by structured interview (the usual gold standard in this kind of study). Then they analyzed the individual MDQ items looking for those that discriminate well between bipolar disorders and borderline personality disorder. They found 3, a “clinical triad,” that had remarkable statistical power:
1. Elevated mood: “You felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble?”
2. Increased goal-directed activities: “You were much more active or did many more things than usual?”
3. Episodicity of mood symptoms: “If you checked YES to more than one of the above, have several of these ever happened during the same period of time?”
Living with mental illness: Learning to accept your positive traits with the rest
Mental health blogger Fiona Kennedy looks at the positive traits associated with BPD
I came across an image on Twitter recently, listing the positive traits of people with borderline personality disorder (BPD). Among them were: passionate, empathetic, creative, artistic, intuitive, resilient, intelligent, witty, spontaneous, intense, devoted… You get the idea.
A few months ago, when I was firmly of the conviction that BPD was an illness, something I’d have for the rest of my life, I would have found this very reassuring. So much of what’s written about BPD paints people with this diagnosis in an extremely negative light, it’s always refreshing to come across something more positive. There would also have been a little niggling feeling of something not sitting right though – that BPD defined every aspect of who I am, good, bad and indifferent, that it was all out of my control.
However, in recent months I’ve been coming to a very different understanding of the term ‘mental illness’ and all that it entails. This is very new to me, and I’m still learning, so forgive me if I’m not making a whole lot of sense. I’m struggling to grasp the extent of it myself. But here’s a thought – what if what we know as mental illness isn’t actually an illness? The symptoms are very, very real, and I’m not denying those for a second. But what if those symptoms point to something more than just a label? What if they point to a reason for the label?
Let me try and explain. I’ve recently started working with a therapist who has some very interesting theories, the most significant of these being that two of the most common mental health difficulties, depression and anxiety, are not in fact illnesses, but emotion(s) tied to events from our past that our brains haven’t processed. Please don’t stop reading!! I was really, really sceptical too. But the more I’m learning about it, and actively experiencing the therapy, the more sense it makes.
“Borderline personality disorder is a relatively new diagnosis, which was officially described for the first time in 1980,” she continues a little later. “It was first suggested as a possible cause of van Gogh’s condition in the late 1990s.”
Author sheds light on van Gogh’s illness
Reviewed by Aaron W. Hughey
“On the Verge of Insanity: Van Gogh and His Illness” by Nienke Bakker, Louis van Tilborgh and Laura Prins. New Haven: Yale University Press, 2016. 176 pages, $30.
“The dramatic moment when Vincent van Gogh cut off his ear and his subsequent suicide are among the best-known events in his life and, for many, the most fascinating,” Nienke Bakker explains in “Van Gogh’s Illness: The Witnesses Recall,” her contribution to “On the Verge of Insanity: Van Gogh and His Illness,” the new book she co-wrote with Louis van Tilborgh and Laura Prins. “His self-harm marked the beginning of a series of mental breakdowns, which have prompted widely diverging interpretations and medical diagnoses.”
Like many readers, I have known about the troubled genius van Gogh since early childhood. His story, like many who have come to occupy a prominent place in the cultural lexicon, has an enduring quality that is simultaneously difficult to explain and undeniably self-evident. His portfolio includes more than 2,100 works of art, including about 860 oil paintings – most of which were completed in a little more than 10 years. He is so well-known today it is hard to believe he actually sold only one painting during a life spent struggling with personal demons in abject poverty, supported primarily by his younger brother Theo. He only achieved worldwide acclaim after he committed suicide at age 37. To this day, he remains the embodiment of “misunderstood genius.”
Regina has been engaging in self-harm and struggling with suicidal thoughts since she was a child. Now, as an adult, she has a diagnosis: Borderline Personality Disorder (BPD). Through following Regina in her day to day life, sitting inside of her therapy sessions, and interviews with doctors, the documentary Borderline lets us learn about her relationship with BPD, and gives us a glimpse as to what life is like with it.
Regina holds nothing back as the documentary crew follows her, allowing the film to be very raw and authentic. Watching her inner-battle is both fascinating and heartbreaking. She has a strong presence, and her openness immediately adds a sense of intimacy, creating the sense that we personally know her just within the first five minutes.
She goes back and forth between denying her diagnoses with BPD and being consumed by it. It impacts her work and love lives and her ability to maintain any stable relationships. When she feels emotion, she feels it at it’s strongest degree. Aware of her situation, she is constantly finding herself seeking help, but only to later deny it’s impact.
Matthew had borderline personality disorder. In 2013, he shot himself to death using an unregistered gun he bought online.
Mental Health Bill: Rick Warren and Wife Kay ‘Grateful’ to Congress for Passing 21st Century Cures Act
By SUZETTE GUTIERREZ-CACHILA
Many rejoiced when the Senate recently passed the controversial 21st Century Cures Act, and pastor Rick Warren and his wife Kay were among them.
Rick and Kay, co-founders of California-based Saddleback Church, said they are thankful that the Cures Act was passed because they believe it will help save lives.
“We are so grateful that Congress passed the Cures Act, which invests in saving lives by addressing the opioid epidemic, cancer research, biomedical research, mental health reform, and the drug developmental process,” Rick and Kay said in a statement.
Having had a son who suffered from mental illness, the Warrens were especially grateful that the legislation will provide funding for mental health treatment.
“Mental health is a deeply personal issue for us because our son, Matthew, lived with mental illness for most of his life,” they said.
Matthew had borderline personality disorder. In 2013, he shot himself to death using an unregistered gun he bought online. It was a devastating time for the Warrens, during which they turned to the only comfort they knew: the Bible.
Since their son’s death, they became involved in raising awareness about mental illness. They also encourage communities to be more accepting of people suffering from mental illness.