Anything to Stop the Pain – BPD and Non-BPDs

It was widely reported in the press after Britney Spear’s “breakdown” and stand-off with the police over the return of her children that she has “a bipolar disorder.” See this excerpt from TMZ.com:

TMZ reported that Spears’ friends “have known for a while that Britney has a very serious mental condition — likely a bipolar disorder that is now in the red zone.”

I think the language here is quite important. Borderline Personality Disorder is so maligned that not a single celebrity has come out and stated that they have the disorder. Bipolar disorder, on the other hand, is not considered just the result of “bad behavior” – it is considered biological in nature – and therefore many celebrities have come out and admitted they have bipolar disorder. Bipolar is an Axis I disorder, BPD an Axis II.

Unfortunately, this distinction is a fallacy. Experts are considering changing the name of BPD to Emotional Regulation Disorder (or emotional dysregulation disorder) and making it Axis I. Why? Because clearly a large part of BPD is biological.

One of the main differences between bipolar and BPD is the length of the mood swings. In the case of Bipolar Disorder the length of the manic and depressive episodes (and mixed episodes) usually lasts days or weeks, if not longer. There is the case of Bipolar II in which a person may experience hypomania – which is possibly why the media has reported Britney to  have “a” bipolar disorder, rather than just “bipolar disorder” (although some of the media has removed the “a” from in front of the reported disorder). Substance abuse and suicide are both common with Bipolar Disorder and it effects about one half to 1 and one half of a percent of the population.

Borderline Personality Disorder is actually more common than bipolar disorder – some estimates say that it is up to 5% of women and about 2% of the population at large. It is characterized by wildly swinging emotions – not moods. Although many want to classify it as a subclass of mood disorders (like Cyclothymia), it is more a dysregulation of the emotional system. Emotions are immediate and the behaviors, impulsiveness, rage, “moods”, etc. only last for HOURS, not days or weeks. The DSM-IV says this about BPD:

Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

Substance abuse is so common with BPD sufferers that most estimates say it is co-morbid in over 75%. Also, self-destructive impulses are common (like cutting, over-eating, eating disorders, shopping, shoplifting, sexual deviance or inappropriateness) with BPD. As are suicidal gestures and thoughts, but these are usually impulsive. Impulsivity is a major problem with BPD and here is what the DSM-IV says about that:

Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

While I am not a doctor and not knowledgeable enough to diagnose Britney, I suspect that she may have BPD (or bipolar II) and, if she does have BPD, I would hope that she could be the first celebrity to come out and say so. It’s not her fault. It’s not just “bad behavior”. It is a serious mental illness and should be taken care of immediately. What I don’t understand is why she doesn’t get herself a “helper” to aid her in the regulation of her obviously dysregulated and impulsive behavior.

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