Coping With Two Diagnoses
I was diagnosed with bipolar disorder almost seven years ago. I was in my first year of university, studying classics, and had the world at my feet. Within a few short months however, my life crumbled around me. I found myself emerging from an inpatient stay, medication in hand and appointments filling my days.
Learning to cope with bipolar has been one of the hardest tasks I’ve been faced with, but slowly I’ve built up a recovery tool kit to help me overcome the challenging situations that the disorder has thrown at me.
However, my diagnosis and thus my life are further complicated by my secondary diagnosis — borderline personality disorder (BPD) (also known as emotionally unstable personality disorder or EUPD in the UK). I’ve only had the diagnosis confirmed in the past couple of years; however a personality disorder is something that was suspected for a long time.
Doctors were reluctant to label me as having borderline personality disorder as this is, unfortunately, often stigmatized within the mental health field, and can also mean the patient is harder to treat.
BPD can often entail the temper being lost to extremes, with the sufferer clinging desperately to people in attempts to avoid rejection, or pushing everyone around them away, suddenly impatiently sick of those they professed to love only days ago.
Whilst exact figures are challenging to pin down, there is believed to be a high number of cases of bipolar disorder and borderline personality disorder existing alongside each other. Some doctors estimate that the actual number may even be higher than published figures, as BPD is often under-diagnosed, possibly due to the associated stigma.
Distinguishing Between Disorders
One of the hardest challenges I have found from having both bipolar disorder and BPD is distinguishing the mood swings. My bipolar is rapid cycling and so it is often difficult to ascertain whether a sudden burst of hyperactive behaviour, overspending and/or irritability is the short, sharp hit of BPD, which often passes in a few days, or the warning signs of a bipolar related manic episode emerging.
There are a couple of ways I can usually distinguish between them — for example a BPD flare-up will hit hard and fast, almost immediately, whereas with a hypomanic/manic episode it takes a while for irritability and other mood symptoms to set in. Another way I can usually identify the cause of the way I am feeling is the length of time; borderline episodes never seem to last past a few days at their most intense, so if anything continues beyond that point it is important that I alert my medical professionals immediately.
There are definite complexities that have arisen from having the two disorders concurrently. There is a much higher risk of suicide amongst people with bipolar and BPD, and having the two alongside each other can exacerbate this risk even further. It is important therefore that I monitor my moods and their changes effectively, and alert the relevant professionals and those around me if I begin to feel unwell.
People with a diagnosis of both bipolar and borderline personality disorder are also more likely to suffer with substance abuse issues than the general population, or those who have the disorders separately. This could be due to attempts to fill the chronic empty feelings that the BPD can leave someone with.
There is a risk of these behaviours becoming a vicious cycle where the sufferer seeks out new experiences, sensations and highs to fill the void that they feel. The use of stimulants runs the risk of triggering a hypomanic episode, which can lead to repeated relapses, and is therefore something that must be monitored effectively if you have a dual diagnosis.
Next Page: Potential Complications and Learning to Cope