In the past ten years, it has become increasingly obvious that often Borderline Personality Disorder doesn't seem to be a Personality Disorder at all . Or, looking at it from another direction, what is called Bipolar II is, in over 75% of the cases, difficult to distinguish from Borderline Personality. The treatments for BPD are identical to those for BP, from the particular types of drugs to the particular types of psychotherapies. Symptom and Behavioral ranges are the same.

Also, while Bipolar II is already known to be genetic, both BD and BPD are known to be associated with emotionally traumatic childhoods. It is thought that Bipolar is likely to be triggered by aggravating life circumstances.

Bipolar II disorder DSM-IV definition 'needs widening'

3 January 2007

And international team of researchers argue that the DSM-IV definition of bipolar II disorder should be widened to give greater emphasis to temperamentally based mood and anxious reactivity, which is likely to result in better genotyping.

Bipolar II disorder is characterized by depression and hypomania in DSM-IV, with scant attention paid to Affective Instability, which is often linked to anxiety disorder comorbidities, primarily Panic Disorder and Agoraphobia (PDA).

Noting that this has implications for genetic–familial associations, Hagop Akiskal, from the University of California at San Diego, and colleagues studied 107 patients classified on DSM-IV as having a major depressive episode with atypical features, dividing them into groups depending on whether they met the co-occurring criteria for Panic Disorder and Agoraphoria (PDA).

The patients were also examined using the Atypical Depression Diagnostic Scale, the Hopkins Symptoms Check-list, and the Hamilton Rating Scale for Depression, the team reports in the Journal of Affective Disorders.

The criteria for DSM-IV Panic Disorder and Agoraphoria (PDA) were met by 46.7% of the patients. Patients with PDA were significantly more likely to be female and have hypomanic episodes and stressors, in addition to which, they were significantly more likely to have bipolar II disorder and be cyclothymic than were patients without Panic Disorder and Agoraphoria (PDA).

The results also show that patients who had Panic Disorder and Agoraphoria (PDA) had significantly higher ratings of Reactivity, Somatization, Obsessive–Compulsive Disorder, and Phobic Anxiety than non-PDA individuals.


In all, 75.5% of patients met the criteria for bipolar II disorder, which was characterized by PDA and Borderline Personality features, as well as cyclothymic and hyperthymic temperaments.

"To summarize, our substantive findings in our attempt to redefine the phenomenology of Bipolar II Disorder indicate that Mood Instability along Cyclothymic Temperamental lines and associated Panic Attacks are significantly associated phenotypic characteristics," the team writes.

"The soft bipolar spectrum needs to be redefined by its Anxious-Sensitive, Impulse Dyscontrol, Addictive and Binge-Eating expressions, representing "Overlapping Diatheses" (i.e., "inherited as a package deal" - Teri)instead of being considered independent 'comorbidities'."

Diatheses -
A hereditary predisposition of the body to a disease, a group of diseases, an allergy, or another disorder. - The Medical Dictionary


Source: Journal of Affective Disorders 2006; 96: 239–247

Very interesting! Thanks for sharing. I am BP II.


Hugs, Nikko

Hi, Nikko .. so am I.

And before treatment for my Bipolar, I was frantically terrified of rejection to the point of the deveopment of physical illness that manifested whenever I was rejected. And some negative BPD-type behaviors of clinginess. I had an emtionally traumatic childhood. I was impulsive - high on the scale. I had some very disturbing self-mutilation fantasies in the past, and have had periods of suicidal gestures.

I had my first irritable rageful hypomanic episode when I was face to face with gross parental abuse when I was least able to do anything about it, when I needed them them the most. Up until then, my only hypomanic episodes were lovely highs (all 3-4 of them during my lifetime) - cheerfully positive, high accomplishment, creative and loving the world. Boy. do I miss them.

But since I've been on a mood stabilitzer, I have more moderate and manageable responses to emotionally distressing events, my impulsive behaviors greatly diminished - I have the ability to FEEL the impulsiveness, but to control its expression.

I am more able, for instance, to WRITE that impulsive email, but instead of pressing send, I am now able to save it to file so I have the time to rethink it. Mostly it is forgotten or greatly edited to hardly sound the same - certainly not likely to cause a major emotional event that ends up biting me in the butt.

There is more - but maybe I was short by one, maybe two, of the criteria of being BPD... but I AM on the Borderline Personality spectrum - no doubt.

Two of my sisters have lived on ADs for decades. One satisfies the BPD criteria. I haven't asked her, but she is now so stabilized and even, that I have to wonder if she is on a mood stabilizer. My younger daughter - I have been breaking my mind for years to figure out - is she bipolar or is she borderline or is she both? But I think her early bipolar (diagnosed in high school) has worsened to where she now acts borderline.

They know a great deal about the inheritability of the propensity to develop bipolar. They know an increasing amount about how the brain looks and functions in bipolar. The know there is a seeming inheritability of propensity component of BPD, that the brain looks & functions in PTSD (the development of which is considered to a major cross-over step to what is recognized as BPD.

And is also either recognized or suspected as one of the precipitating life-stress events in the first frank break-thru of completely recognizable bipolar.

It makes a great deal of sense. BPD is now seen as "curable" -- not in terms of not having to live on meds!!! But that mood stabilizing meds and ADs, plus cognitive therapy, DOES reduce symptomatology to where BPDs definitely and simply are not behaviorally recognizable as BPD at all.

Can't do that with other PDs. Yes, ADs can help depression they may have, but there remain PD'd. PDs are considered to be total depth PERSONALITIES, not an illness like bipolar. Certainly something to think about.

Teri

Terri,

I never exactly knew which I was but thanks to your post I know I am
Bipolar II.

I also like your idea of saving the email before hitting the send button. I need to do that a lot.

befuddled2

Dear Teri,
thank you for posting this.
I am interested in what you said about bipolar turning into borderline....
Do you think this could happen to all of us if triggered?

bizi

Thank you for the article. I am also BP II and I am trying to learn all I can about it. I was just diagnosed a few months ago. To know that my agoraphobia, my anxiety issues and my binge eating are all part of this is helpful to me. While knowing that it is also genetic comforts me somewhat, I can't tell my family any of this God-forbid there might be something "wrong" with them too! I don't speak to either of my parents or my sister, nor any of my extended family because of my health issues that they don't understand so to tell them I have BP would just mean more denial from them.
Thank you again for the article.