Three Easy Ways to Differentiate Bipolar and Borderline Disorders

Bipolar or Borderline? A widely-used diagnostic is getting it wrong.

Published on March 25, 2010 by Randi Kreger in Stop Walking on Eggshells

While bipolar disorder (formerly manic depression) and borderline personality disorders share some clinical featuresprimarily unstable moods and impulsive actions--they are two different diagnoses with different treatments (although
psychiatrists may use medications to treat BPD as well as bipolar). They're even categorized differently in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Bipolar is grouped in Axis I, clinical syndromes,
and BPD is parked squarely in Axis II, personality (at least for now).
Yet that doesn't keep them from getting confused. Anecdotally, many family members tell me their loved one has
been diagnosed with bipolar by a clinician when it appears to them that borderline personality disorder as described
in the DSM-IV-TR seems to be a much better fit.
Now we've learned there may be more to this than a simple confusion.
A study from Rhode Island Hospital has shown that a widely-used screening tool for bipolar disorder may incorrectly
indicate borderline personality disorder rather than bipolar disorder.
In the article that appears online ahead of print in the Journal of Clinical Psychiatry, the researchers question the
effectiveness of the Mood Disorder Questionnaire (MDQ). The MDQ is the most widely-used and studied screening
tool for bipolar disorder. It is a brief questionnaire that assesses whether a patient displays some of the characteristic
behaviors of bipolar disorder.
The research team interviewed nearly 500 patients using the Structured Clinical Interview for Diagnostic Statistical
Manual IV (DSM-IV) and the Structured Interview for DSM-IV for personality disorders. The patients were also asked
to complete the MDQ.
The research team then scored the questionnaires and found that patients with a positive indication for bipolar
disorder using the MDQ were as likely to be diagnosed with borderline personality disorder as bipolar disorder when
using the structured clinical interview.
Further, their findings indicate that borderline personality disorder was four times more frequently diagnosed in the
group who screened positive on the MDQ.
Principal investigator Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital, says that
these findings raise caution for using the MDQ in clinical practice because of how differently the disorders are treated.
(You can find more info here: http://www.eurekalert.org/pub_releases/2010-03/l-iir032510.php)
BPD and bipolar are often misdiagnosed as each other. Some people diagnosed with BPD actually have bipolar; the
reverse is also true.
While only a qualified clinician can make a diagnosis of one or the other (or if both are present) there are three simple
ways to distinguish bipolar disorder from borderline personality disorder.
Bipolar disorder causes dramatic mood swings, from overly "high" and/or irritable to sad and hopeless, and then back
again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these
changes in mood. The periods of highs and lows are called episodes of mania and depression.
A cycle is the period of time it takes for a person to go through one episode of mania and one of depression. The
frequency and duration of these cycles vary from person to person, from once every five years to once every three
months. People with a subtype of bipolar (rapid--cycling bipolar) may cycle more quickly, but much less quickly than
people with BPD (shifts can even last minutes/seconds).
According to Dr. Friedel, director of the BPD program at Virginia Commonwealth University, there are two main
differences between BPD and bipolar disorder:

1. People with BPD cycle much more quickly, often several times a day.
2. The moods in people with BPD are more dependent, either positively or negatively, on what's going on in their life
at the moment. Anything that might smack of abandonment (however far fetched) is a major trigger.
3. In people with BPD, the mood swings are more distinct. Marsha M. Linehan, professor of psychology at the
University of Washington, says that while people with bipolar disorder swing between all-encompassing periods of
mania and major depression, the mood swings typical in BPD are more specific. She says, "You have fear going up
and down, sadness going up and down, anger up and down, disgust up and down, and love up and down."

http://www.psychologytoday.com/blog/stop-walking-eggshells/201003/three-easy-ways-differentiatebipolar-and-borderline-disorders