In a world where mental health is still highly stigmatized, another struggle also plagues the mental health community — a lack of accurate diagnoses. Patients struggling with their mental health, even after taking their first initial step toward seeking treatment from someone with experience in the broad spectrum of psychiatric disorders, still struggle in getting a proper diagnosis for their symptoms. Sometimes this is due to simple lack of awareness by general practitioners, and other times, it is because symptoms overlap to such an extent that it becomes difficult to distinguish one disorder from another. One example of that is in the misdiagnoses seen in bipolar disorder and other similar depressive and personality disorders, particularly borderline personality disorder, or BPD.
Dealing with any mental health disorder and getting a proper diagnosis is challenging, but it can become even harder to get a clear diagnosis when the disorder you are dealing with is highly related to shifts in mood. Tilly Grove, for example, a 24-year-old journalist in the U.K., shared part of her story with BPD in a recent article from The Guardian. “I battled to get a diagnosis for two years,” she says, recounting her struggle in trying to get a mental health professional to take her chaotic mood swings seriously. To make matters more complicated, BPD is oftentimes highly confused with bipolar and a number of other disorders, as in the case of Maggy van Eijk, a journalist who had been misdiagnosed with unipolar depression, bipolar, and even PTSD, all before clinicians landed on a proper diagnosis of BPD. Both bipolar and BPD are presumed to be caused by a combination of genetics and environment, both involve mood fluctuations, and both can be harmful to the individual and the people around them. So how does one tell the two disorders apart when they are so similar?
A main distinguishing factor is the frequency of the mood swings and their intensity, and the individual’s sleep patterns throughout the mood swings. Whereas patients with BPD can experience mood changes quite rapidly, bipolar patients, especially those with Bipolar I, tend to have extended periods of depression followed by periods of mania, where the symptoms are quite pronounced and can lead to dangerous behaviors. BPD mood swings also appear to be triggered situationally, by experiences, as opposed to bipolar, where there may or may not be a situational trigger that sends one into a manic or depressive phase. Because of this, BPD sufferers are more likely to see the effects of their disorder in their unstable personal relationships.
How do these factors impact diagnosis, and why is it important to take this into account? In many cases, a proper diagnosis can mean the difference between returning to a normal routine of life or receiving improper medication that potentially makes the condition worse. Bipolar patients for example, when mislabeled with depression and given antidepressants for treatment, can actually be triggered into a manic episode as a side effect of the medication.
Even still, however, lack of awareness on a clinician’s part cannot account for all of the error in pinning down specific mood disorders. This diagnostic issue is also a reflection on the mental health community and the stigma mood disorders in particular can carry, and a lack of urgency for treatment. Perhaps the common link shared by bipolar and BPD, sudden shifts in mood, is viewed by patients and their families as something less detrimental than, for example, schizophrenia or another mental illness related to psychosis and hallucinations. After all, when are you more likely to go to the doctor, or when is a loved one more likely to push you to seek medical help — when you are feeling upset and hopeless, something that is arguably “easier” to cover up with a smile or a forced laugh, or when you are hearing voices in your head and having psychotic hallucinations? While mental disorders related to psychosis are seen as mental illness in their “purest form,” perhaps mood disorders are viewed both by the patients themselves and their family members as something less serious, or at least not serious enough to seek help for. After all, controlling one’s mood is seen as something much more accessible to most people than quieting voices in their head, or “unseeing” frightening images from a hallucination. Not only is it important for clinicians to be more aware and alert for early stages of depression, bipolar, or BPD, but it is also important for the patients themselves, and their family members, to realize that something detrimental and life-altering does not need to occur before medical help is sought. It is true that not all mental illnesses are created equal, but they all have the potential to be equally dangerous and equally life-altering. It is our responsibility to be just as vigilant aware of our own mental health, and that of others, as we expect our clinicians to be.
Reynolds, E. Borderline personality disorder: ‘One GP told me I wasn’t ill, just a bad person.’ Retrieved on November 12, 2017, from https://www.theguardian.com/healthcare-network/2017/oct/27/borderline-personality-disorder-stigmatised-misunderstood-misdiagnosed
Van Eijk, M. What it’s really like to have Borderline Personality Disorder in the workplace. Retrieved on November 12, 2017, from https://inews.co.uk/opinion/really-like-go-work-borderline-personality-disorder/
Duckworth, K. Borderline Personality Disorder And Bipolar Disorder: What’s The Difference? Retrieved on November 12, 2017, from https://www.nami.org/Blogs/NAMI-Blog/June-2017/Borderline-Personality-Disorder-and-Bipolar-Disord
NHS Choices. Borderline Personality Disorder. Retrieved on November 12, 2017, from https://www.nhs.uk/conditions/borderline-personality-disorder/
Bushak, L. Bipolar vs. Borderline Personality Disorder: The Differences Between The Two And How To Avoid Misdiagnosis. Retrieved on November 12, 2017, from http://www.ibtimes.com/bipolar-vs-borderline-personality-disorder-differences-between-two-how-avoid-2610556