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Borderline or Bipolar: Can 3 Questions Differentiate Them?

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?”


Personality disorders affect one in seven adults

Borderline personalities are unpredictable, self-destructive and often see things in black and white.

Personality disorders affect one in seven adults

By Fred Cicetti

Q. A friend who uses a lot of psychobabble described a new woman in our retirement community as having a “personality disorder.” I would call this woman a pain in the neck. What’s the difference between a personality disorder and just a lousy personality?

A. People with a personality disorder are more than just pains in the neck. They have serious trouble getting along with others. They are usually rigid and unable to adapt to the changes life presents to all of us. They simply don’t function well in society.
People with personality disorders are more likely to commit homicide and suicide, and suffer from social isolation, alcohol and drug addiction, depression, anxiety, eating disorders, and self-destructive behavior such as excessive gambling.

About one in seven U.S. adults has at least one personality disorder, and many have more than one. Personality disorders are usually first noticed around the teen years. However, personality disorders can surface at any time, including old age. About one in ten older adults living at home may have a personality disorder. This figure is even higher among adults living in nursing homes.

Childhood experiences and your genes play major roles in personality disorders. However, personality changes can be brought on in older adults if they have trouble handling the losses of family and friends, other major life changes or their own medical problems.


I am more than my _____

Like every other movement working against stigma, pride is a powerful primary tool. Self-acceptance comes first.

I am more than my _____

BY LAUREN DIAZ | NOVEMBER 19, 2015, 11:50 AM

“How about I hold up a sign that says, ‘I AM MORE THAN MY BPD?’”

“How about you don’t?”

This is a brief exchange I had with myself at the 2015 photo campaign for Active Minds at Columbia University, entitled “My Mental Health Matters.” The table was littered with an array of paper signs to choose from, but I was drawn to the one with the blank. This could have been my coming out, but the stigma-fearing answer was “no.” I put down the sign and grabbed a new one that read “NO SHAME”. I smiled for the picture. I tried to look pretty, tried to look normal, but the words I held up were a lie.

On October 9, 2015 I was diagnosed with Borderline Personality Disorder. Fear of abandonment, unstable and intense relationships, lack of a sense of self, dissociation, impulsive behavior, self-harm, suicidal gestures–it goes on and on. I fit the profile, but this did not upset me much, since doctors had shared their suspicions with me for some time now. As a matter of fact, I was relieved. “Yes,” I thought, “I finally get to put a name to the thing. Put a name to the thing, control the thing”.

After speaking with my doctor and doing my own research, it became clear that BPD was “the bad one” that you didn’t want to get slapped with. It was the disorder no one liked to talk about, except implicitly in horror movies. I am the woman in “Single White Female,” “Fatal Attraction,” “The Roommate,” and many more disturbing stories of psychotic women. Or rather, they are caricatures of me. I am not a murderous, manipulative, or obsessive stalker. I and many other borderlines would be more likely to hurt ourselves out of pure emotional pain rather than hurt someone else.

BPD is inherently complex and misunderstood, and so are Borderlines. Aspiration-driven Columbia pretends to be open and accepting of mental illness, but how often is this really addressed and publicized, and does it truly cover a wide enough spectrum? We are growing more comfortable addressing depression openly, but unfortunately, BPD is categorized as a personality disorder, not a mood disorder. These we are less comfortable with. The assumption is that these people are intrinsically screwed up. They are crazy and volatile to the very core and fit neatly into a box provided by the Diagnostic and Statistical Manual of Mental Disorders. This false belief is ultimately damaging.


Is Donald Trump Actually a Narcissist? Therapists Weigh In!

As his presidential campaign trundles forward, millions of sane Americans are wondering: What exactly is wrong with this strange individual? Now, we have an answer.

Is Donald Trump Actually a Narcissist? Therapists Weigh In!


For mental-health professionals, Donald Trump is at once easily diagnosed but slightly confounding. “Remarkably narcissistic,” said developmental psychologist Howard Gardner, a professor at Harvard Graduate School of Education. “Textbook narcissistic personality disorder,” echoed clinical psychologist Ben Michaelis. “He’s so classic that I’m archiving video clips of him to use in workshops because there’s no better example of his characteristics,” said clinical psychologist George Simon, who conducts lectures and seminars on manipulative behavior. “Otherwise, I would have had to hire actors and write vignettes. He’s like a dream come true.”

That mental-health professionals are even willing to talk about Trump in the first place may attest to their deep concern about a Trump presidency. As Dr. Robert Klitzman, a professor of psychiatry and the director of the master’s of bioethics program at Columbia University, pointed out, the American Psychiatric Association declares it unethical for psychiatrists to comment on an individual’s mental state without examining him personally and having the patient’s consent to make such comments. This so-called Goldwater rule arose after the publication of a 1964 Fact magazine article in which psychiatrists were polled about Senator Barry Goldwater’s fitness to be president. Senator Goldwater brought a $2 million suit against the magazine and its publisher; the Supreme Court awarded him $1 in compensatory damages and $75,000 in punitive damages.

But you don’t need to have met Donald Trump to feel like you know him; even the smallest exposure can make you feel like you’ve just crossed a large body of water in a small boat with him. Indeed, though narcissistic personality disorder was removed from the most recent issue of the Diagnostic and Statistical Manual of Mental Disorders, for somewhat arcane reasons, the traits that have defined the disorder in the past—grandiosity; an expectation that others will recognize one’s superiority; a lack of empathy—are writ large in Mr. Trump’s behavior.

“He’s very easy to diagnose,” said psychotherapist Charlotte Prozan. “In the first debate, he talked over people and was domineering. He’ll do anything to demean others, like tell Carly Fiorina he doesn’t like her looks. ‘You’re fired!’ would certainly come under lack of empathy. And he wants to deport immigrants, but [two of] his wives have been immigrants.” Michaelis took a slightly different twist on Trump’s desire to deport immigrants: “This man is known for his golf courses, but, with due respect, who does he think works on these golf courses?”


A Horrifying Week with My Borderline Personality Disorder

I google “how to hang yourself from a radiator” in the waiting room before ducking out for a quick cry.

BON: I stumbled on this over the weekend. It’s worth the time to read. It really captures the desperation of BPD.

A Horrifying Week with My Borderline Personality Disorder

by Heather Sleepy
OCT 23, 2015

I was diagnosed with Borderline Personality Disorder last December, but that was only the beginning of my troubles. This is my diary of what came after.


Monday is relatively chill. I manage to make it to work for 10 AM, only 30 minutes late. I’m 100 percent sure my boss thinks I’m a dick. He most definitely treats me unfavorably and this is most definitely because I’m late nine times out of 10, recurringly incapable of hitting deadline, and I’m pretty sure he’s aware I allocate too much of the working day to sobbing in the bathroom. Nethertheless, he doesn’t say anything to me.

Before 1pm I’ve already puked once from anxiety and deleted my Facebook profile for the zillionth time this week. Around 3 PM I phone my ex-boyfriend and beg him to come back. He says no and asks me to go to the bathroom, stuff my hands in my pants and send him a photo. I do. It stops the shaking and sweating till about 6.30 PM when I get back home. My room’s a mess. Swollen with moldy plates, grubby underwear, and flies. I slink into bed, whack on Rick and Morty, neck some sleeping pills and wake up on Tuesday.


Work is impeccably whack today. I manage to make it in on time and even sneak in a two hour lunch. By midday I’m feeling unbearably anxious so I convince a friend to meet me for lunch. We hit a restaurant called Lyle’s and I have a bottle of wine, goat’s heart, and brisket. I check my phone 42 times but am feeling far less anxious upon my return to work despite being undeniably turnt and unable to do anything productive for the remaining duration of the day.


Borderline personality disorder: Study shows stigma a barrier to those seeking treatment

She struggled to regulate her emotions and often found herself getting very upset and angry over small issues

Borderline personality disorder: Study shows stigma a barrier to those seeking treatment

By Tegan Osborne

Kylie Travers was just 16 years old when she first tried to kill herself.

Afterwards she was treated for depression and ADHD.

But it was not until many years later, when she was finally diagnosed with borderline personality disorder (BPD), that she finally began to understand why she felt the way she did.

“In 2010, my stepmother was reading a book called Stop Walking on Eggshells (a book about BPD) and she recommended that I read it, just in general for dealing with people,” she said.

“As I read it, I realised that a lot of the attributes in this were very similar to what I’d been told that I was like, and issues that I had. And so then I went and got tested.”

Before Ms Travers began treatment, she struggled to regulate her emotions and often found herself getting very upset and angry over small issues.

“There was significant anger issues … it was like a light switch,” she said.

“I was classed as very high-functioning BPD, so I could put on the face for public and do everything really well and it didn’t seem like there was anything wrong with me at all.

It’s being really aware of my environment around me … knowing what are the sort of things that do upset me, and then having methods in place to help calm myself down, or know how to talk to myself.

“But I often had suicidal thoughts, even though I didn’t express them, going from extremely depressed to extremely happy.”

After years of weekly visits to a psychologist, Ms Travers has now recovered.