BPD can have pretty dramatic mood swings but is it possible to experience mania in Borderline Personality Disorder?
The answer to this question is quite complex and an answer of “Yes” or “No” requires more information because it not as simple as black or white, yes or no. So I am to give you the best and most accurate answer to this common question, in an effort to settle the debate once and for all. Before we go further though, we must understand a few mental health conditions and symptoms.
The answer to this question is quite complex and an answer of “Yes” or “No” requires more information because it not as simple as black or white, yes or no. So I am to give you the best and most accurate answer to this common question, in an effort to settle the debate once and for all. Before we go further though, we must understand a few mental health conditions and symptoms.
What Is Borderline Personality Disorder?
Borderline Personality Disorder, or simply “BPD”, is a Personality Disorder that develops in a persons life, typically in response to trauma. While it is common for people who are diagnosed with BPD to have a family history of mental illness, the cause of the disorder is believed to be emotional trauma, with some being genetically more inclined to develop the disorder. Some experts even argue that BPD is actually a form of Post-Traumatic Stress Disorder. But BPD symptoms are basically grouped into two categories; intense inappropriate emotions, and the coping mechanisms that follow (which are inherently unhealthy as it defines the disorder). The experience of living with BPD typically involves having extreme emotional episodes which last for (typically) only hours, accompanied by unhealthy habits and poor coping mechanisms.
In order to be diagnosed with Borderline Personality Disorder, you must meet 5 of the 9 symptoms. Because of the variety of symptoms, there are roughly 256 different possible symptom combinations. This mean that each person with BPD is different than the last. Here are the 9 symptoms off Borderline Personality Disorder:
- Deep fear of abandonment and frantic efforts to avoid it
- Unstable relationships which includes a pattern of on and off again
- Unstable self image
- Impulsive and often self destructive behavior
- Intentional self harm
- Emotional mood swings, lasting hours or 1 day
- Chronic feelings of emptiness
- Uncontrollable anger
- Stress induced paranoia and/or disassociation
While there are varieties of symptom manifestations, there are common features which are found in most cases. Some of these are:
- Fearing abandonment which is almost always present and is typically the focal point of their unhealthy coping mechanisms.
- It is said that “most of self harmers have BPD and most of those with BPD self harm”. A history of self harm is usually present in 60-80% of cases. Source
- Experiencing emotional invalidation in childhood is a common experience of those who develop BPD and some see it as a major factor in the development of Borderline Personality Disorder. Source and Source
- 2 out of 3 people with BPD have had, or current struggle, with addiction problems. Source
- Black and white thinking is extremely common, which is when the person with BPD alternates between deep love and raging hate, towards their partner, family, or even situations.
For the most part, the average person who has BPD has a history of self-harm, dramatic emotional mood swings of severe depression, rage, and/or anxiety which usually last for less than one day, suicidal behavior, a likely history of at least emotional abuse/neglect (if not more), and has unhealthy coping mechanisms which served them well in their traumatic childhood, but are now inappropriate and unhealthy.
One of the goals of treatment for Borderline Personality Disorder is to teach the person how to cope with their chaotic and often painful emotions. Usually, their experience with trauma caused them to have emotions that are simply off the charts and the method of treatment is learning to cope.
One of the goals of treatment for Borderline Personality Disorder is to teach the person how to cope with their chaotic and often painful emotions. Usually, their experience with trauma caused them to have emotions that are simply off the charts and the method of treatment is learning to cope.
Borderline Personality Disorder is usually severe and can greatly impact a persons life. It is common for people to find great relief in therapy or simply improve with age and maturity, so this disorder typically impacts 20-30 year olds though that number drops over time as people age and mature.
Borderline Personality Disorder is one of the few severe mental illnesses that can be diagnosed, and then “undiagnosed“ at a later date (not cured, but no longer debilitating) and as much as 50% of patients no longer meet the diagnostic criteria ten years after diagnosis. This is usually the result of very intensive and specialized therapy programs. BPD is not really based on brain abnormalities or chemical imbalances but rather leftover emotions and maladaptive behavior which greatly impacts their life.
For the most part, BPD is learned behavior, which can be replaced with healthier behavior over time through therapy programs. Medication is not typically prescribed for the symptoms of BPD although most patients have a comorbid disorder (Depression, Bipolar, ADHD) that requires medication.
Borderline Personality Disorder is one of the few severe mental illnesses that can be diagnosed, and then “undiagnosed“ at a later date (not cured, but no longer debilitating) and as much as 50% of patients no longer meet the diagnostic criteria ten years after diagnosis. This is usually the result of very intensive and specialized therapy programs. BPD is not really based on brain abnormalities or chemical imbalances but rather leftover emotions and maladaptive behavior which greatly impacts their life.
For the most part, BPD is learned behavior, which can be replaced with healthier behavior over time through therapy programs. Medication is not typically prescribed for the symptoms of BPD although most patients have a comorbid disorder (Depression, Bipolar, ADHD) that requires medication.
What is Bipolar Disorder?
Bipolar Disorder is widely recognized as a genetic and inherited disorder that is caused by a chemical imbalance in the brain. There is also evidence of brain differences in Bipolar Disorder when studied on an MRI. More Information
Bipolar Disorder is called such because it represents the two polars of extreme mood; mania and depression. The up and down dramatic mood swings of Bipolar can bring many debilitating symptoms and greatly impact a persons quality of life.
Manic or Hypomanic Episodes
In order for a person to have an official diagnosis, a person must have manic or hypomanic episodes. Depression is not always present in Bipolar so while it is a symptom of the disorder, it is not always part of the diagnosis.
A Classic Manic Episode must last for at least 7 days or result in a hospitalization, to qualify for a diagnosis of Bipolar I Disorder. These are the symptoms of a Classic Manic episode in Bipolar Disorder, of which you must have at least 3 symptoms to qualify for a diagnosis:
- Abnormally upbeat, jumpy, or wired
- Increased energy and activity
- Exaggerated self-esteem
- Decreased need for sleep
- Extremely talkative
- Racing thoughts
- Easily distracted
- Impulsive behavior like shopping sprees or drug use
- Psychotic or delusional thoughts, paranoia
- Can be found in Bipolar I Disorder in conjunction with classic mania
- Also found in Bipolar II Disorder when only hypomania is present (no classic manic episodes)
- Hypomania has the same symptoms as classic mania, and the same requirement of at least 3 symptoms of mania.
- The biggest difference between mania and hypomania is the persons ability to function in society. Classic mania is always severe and causes great problems in the persons work, social, or home life. Hypomania, however, can often go undetected by the person but especially goes under the radar for those around them. Hypomania can be described as having “the best week of my life” for no explainable reason. Many people continue to function in society while in a hypomanic episode.
- The length requirement for a hypomanic episode is at least four days continuously.
- Hypomanic episodes can, and often do, last for a much shorter length of time than the diagnostic criteria of four days although shorter episodes are not recognized as official and cannot count towards a diagnosis.
- The symptoms of hypomania can often be described as “watered down mania” where a person in a classic manic episode may abuse substances or end up in jail, a person with hypomania may just be super productive at work and overly social.
Rapid Cycling in Bipolar Disorder
Bipolar Disorder has an episode frequency amount of 0-4+ distinct manic, hypomanic, or depressive episodes in a 12 month period. If a person is experiencing more than 4 episodes a year, they are said to be in the temporary phase of “Rapid Cycling”. This frequent episode experience is common in those just beginning to seek treatment and not having a good medication combination yet. If the episode frequency is seen in the form of months or weeks, it is sometimes called “Ultra Rapid Cycling”. Experiences of frequent mood episodes that shift in days or hours is called “UltraUltra Rapid Cycling”.
A person may seek treatment for Bipolar Disorder while experiencing rapid cycling Bipolar Disorder, but find a great combination of medication, and then go on to experience 0 episodes for years. This lack of episodes does not mean they are “cured”, but it is instead called “in remission” which means that a persons symptoms are at a manageable level that they can fully participate in life.
Many people on medication for Bipolar Disorder only experience a simple decline in episode frequency, length, and severity, but still continue to experience defined Bipolar episodes. It is common for medication to lose its effectiveness over time and many people experience a Bipolar crisis every few years which typically indicates a need to adjust medication. Bipolar is a lifelong condition with no cure, though it is usually managed with medication.
Many people on medication for Bipolar Disorder only experience a simple decline in episode frequency, length, and severity, but still continue to experience defined Bipolar episodes. It is common for medication to lose its effectiveness over time and many people experience a Bipolar crisis every few years which typically indicates a need to adjust medication. Bipolar is a lifelong condition with no cure, though it is usually managed with medication.
Can I Have A Manic Episode In Borderline Personality Disorder?
This is really the big question and exactly what brings us to this article. But in order to explain the answer, we had to learn a few things. So let’s summarize:
- Bipolar Disorder - Inherited chemical imbalance which causes dramatic mood swings of mania and (usually) depression. The episodes of Bipolar are distinct and defined dramatic mood swings, and while many have the symptoms of mania and depression, people with Bipolar are typically symptom-free in between manic/depressive episodes.
- Borderline Personality Disorder - A pattern of emotional episodes of depression, anxiety, and rage, accompanied by unhealthy coping mechanism such as drug use, shopping sprees, and usually self-harm. The symptoms are developed unhealthy coping mechanisms which the person uses to cope with their extreme emotions and dramatic mood swings, and meet their emotional needs.
The mood swings of BPD are reactive responses to situations like conflict or stress. The mood swings of Bipolar Disorder are sudden brain chemistry shifts which cause unprompted and dramatic mood episodes of mania or depression.
How Are Mania and Borderline Personality Disorder The Same?
There are several overlapping features that are common in both Bipolar mania and Borderline Personality Disorder. Some of these features are:
- Improved mood episode
- Higher than usual self-esteem
- Overly social and chatty
- High energy
- Substance abuse
- Impulsive decisions
Many of these are stand-alone symptoms in BPD and not linked to a specific mood episode. But those with Bipolar Disorder would usually only experience the majority of these symptoms while experiencing a distinct mood episode of mania or depression.
For example, a person with Bipolar Disorder would likely only make impulsive and dangerous choices while manic, but a person with BPD would have a pattern and history of being impulsive throughout their life. The self esteem of a person with BPD is typically very poor, but they may experience their self esteem increasing temporarily due to emotional validation, attention, or a similar positive experience where their emotional needs are met. However, this is often very short-lived and not nearly as long as the 3-7+ days episode length of Bipolar Disorder.
Bipolar Disorder has a dramatic and unusual rise of self esteem that not only includes the person having extraordinarily high self esteem, but it also often includes them having “grandiose beliefs”. This is when a person believes they are “a genius” and often view their manic-driven work (writing, art, music) as flawless, “a masterpiece”, or otherwise a groundbreaking, world changing discovery. These grandiose beliefs are not present in Borderline Personality Disorder.
A person with BPD may make impulsive and dramatic life changes (leaving a job, changing their college major) in a similar way to how a manic person would make big, impulsive life decisions, but the reason behind the behavior is different.
Suddenly quitting a job can be seen in BPD due to their often impulsive behavior, lack of clear sense of self, and a constant need to fill the void, which translates into frequently changing hobbies, careers, and relationships. A person with Bipolar Disorder typically only has impulsive behavior while in an episode, which is usually mania or hypomania. If a person with Bipolar Disorder is on a good medication regiment, they may not experience impulsivity at all due to the lack of mood episodes.
The “elevated mood” experience of Borderline Personality Disorder can appear to be the same as a manic episode, more specifically though, a hypomanic episode (no psychosis, no hospitalization). The person still appears “wired” and overly emotional, though there are several things that set a manic episode and an “elevated mood episode” in BPD apart:
For example, a person with Bipolar Disorder would likely only make impulsive and dangerous choices while manic, but a person with BPD would have a pattern and history of being impulsive throughout their life. The self esteem of a person with BPD is typically very poor, but they may experience their self esteem increasing temporarily due to emotional validation, attention, or a similar positive experience where their emotional needs are met. However, this is often very short-lived and not nearly as long as the 3-7+ days episode length of Bipolar Disorder.
Bipolar Disorder has a dramatic and unusual rise of self esteem that not only includes the person having extraordinarily high self esteem, but it also often includes them having “grandiose beliefs”. This is when a person believes they are “a genius” and often view their manic-driven work (writing, art, music) as flawless, “a masterpiece”, or otherwise a groundbreaking, world changing discovery. These grandiose beliefs are not present in Borderline Personality Disorder.
A person with BPD may make impulsive and dramatic life changes (leaving a job, changing their college major) in a similar way to how a manic person would make big, impulsive life decisions, but the reason behind the behavior is different.
Suddenly quitting a job can be seen in BPD due to their often impulsive behavior, lack of clear sense of self, and a constant need to fill the void, which translates into frequently changing hobbies, careers, and relationships. A person with Bipolar Disorder typically only has impulsive behavior while in an episode, which is usually mania or hypomania. If a person with Bipolar Disorder is on a good medication regiment, they may not experience impulsivity at all due to the lack of mood episodes.
The “elevated mood” experience of Borderline Personality Disorder can appear to be the same as a manic episode, more specifically though, a hypomanic episode (no psychosis, no hospitalization). The person still appears “wired” and overly emotional, though there are several things that set a manic episode and an “elevated mood episode” in BPD apart:
- Manic/hypomanic episodes are primarily “out of the blue” and come on within minutes. This is because of the chemical imbalance in the brain which is faulty, thus causing dramatic chemical-caused mood swings of abnormal mood and behavior.
- Manic/hypomanic episodes typically last for at least a few days. It is possible to have shorter episodes, but if a person never has a hypomanic episode that lasts for at least three days (or manic, 7 days), they do not qualify for a Bipolar Disorder diagnosis.
- Manic episodes are typically observable from the people in their life. It is common for a person to experience a manic episode, but believe they are “fine”, while the family around them believe otherwise. Hypomanic episodes are especially difficult to see, but are usually still observable to some degree at least.
A person with Borderline Personality Disorder typically has mood swings of severe depression, anxiety, and rage. The symptoms surrounding the disorder are primarily negative and unpleasant symptoms. Some people with BPD report experiencing “mania”, however, this experience is different than classic mania or hypomania associated with Bipolar Disorder. Some of these differences are:
- BPD mood episodes almost always have a trigger. There may have been an argument, an embarrassing moment, or even flashbacks of trauma. The mood swings are a direct result as a response to heightened emotions.
- The mood swings of BPD are usually unpleasant, like severe anxiety and depression though some with BPD report having episodes of an “elevated mood”.
- Mood episodes of BPD last anywhere from a few hours to a day. An episode lasting longer than a couple days is typically looked at for another possible cause.
- While some symptoms of mania are there, like feeling energetic and having a temporary inflated self esteem, there are several defining features of mania which are not present in a BPD episode. This includes a lack of grandiose thinking, maintaining a mostly normal sleeping pattern, lack of irritability, lack of paranoia and/or psychosis, and often a lack of racing thoughts and pressured speech. Without these features, the episode is not considered a manic episode and is instead investigated for BPD.
A Bipolar Manic episode and a BPD episode differ in length, cause, symptoms, and severity. While the two may appear similar, the defining features of mania are not present in BPD, thus it is not a true manic episode. Even if a person experiences an elevated mood episode related to BPD, it is not at the severity and debilitating nature of bipolar mania, so it is often not the focal point of therapy as other moods (depression, rage, anxiety) are much more impactful on their ability to function in life.
Some symptoms, like impulsive behavior relating to self-harm, suicidal behavior, or drug use, are targeted in therapy for BPD, though these symptoms are not just limited to a specific mood episode, as is true in bipolar disorder. Often, a person with bipolar disorder may experience suicidal thoughts but they are usually limited to a distinct depressive episode and the thoughts go away once the depressive episode has ended. Suicidal thoughts in BPD are often much more frequent and constant, not limited to one mood, and are historically acted on more often than bipolar disorder due to the impulsivity that accompanies BPD which is not typically present in a Bipolar depression.
What Else Can Cause Mania Symptoms?
Aside from the similar symptoms in BPD, there are several other situations which may cause mania-like symptoms. Some of these situations are:
- Drug and substance abuse
- ADHD
- A very small percentage of people with neurological disorders (multiple sclerosis) or brain tumors, may experience some symptoms of mania.
A Bipolar Mixed Episode
Some people who experience Bipolar Disorder also experience a unique mood which is called a “mixed state”. Nicknamed “agitated depression”, this mood state typically involves symptoms of depression (suicidal thoughts, hopelessness) accompanied with the energy and fast thought process of mania. Typically, the person in a mixed episode experiences an “energetic” suicidal episode. Due to the high energy of these episodes, the risk is very high as unlike depression, where the person has severe fatigue and low energy, the person experiencing a mixed episode has the desire to act on suicidal thoughts, but also the energy and impulsivity of mania. Many people in a mixed episode end up being hospitalized. Mixed episodes are seen in both Bipolar I and Bipolar II though episodes of mania/hypomania must be present as well to qualify for a Bipolar diagnosis.
Depression With Mixed Features
New to the DSM, this diagnosis recognizes the people that experience depression and symptoms of mania at the same time (mixed episodes), but lack hypomanic or manic episodes. Instead, they experience symptoms of mania during their depressive episodes. Depression with mixed features includes having the diagnostic criteria for clinical depression, as well as at least 3 symptoms of mania, at the same time. Commonly, the symptoms that accompany Depression with mixed features are distractability (59%), irritability (57%), and psycho-motor agitation (36%). Source The symptoms of euphoria (18%) and grandiosity (6%) are uncommon features of Depression with mixed features.
If a person purely experiences depression with mixed features, they still fall under the depression umbrella and are not recognized as having bipolar disorder. Usually, the manic symptoms that accompany depression with mixed features are general agitation, discomfort, racing thoughts, and increased energy.
Psychotic Depression or Depression With Psychosis
Experiencing psychosis, or losing touch with reality, does not always accompany mania. Depression with psychosis is usually a severe disorder and requires frequent hospitalization. The psychotic symptoms, also found in Bipolar mania, are in addition to clinical depression but no other manic-like symptoms are present. If psychosis is present in Bipolar Disorder, it is often specified as “Bipolar I, With Psychotic Features”.
Cyclothymia
Cyclothymia is when a person has some symptoms of bipolar, but not enough to qualify for a bipolar diagnosis. Cyclothymia typically involves rapid cycling “not quite depression” with “not quite hypomania/mania” and it must be a persistent condition for at least one year, for a diagnosis (two years for children). Most people with Cyclothymia are able to function in society with little intervention. Some may take an antidepressant, but symptoms are generally not severe and it is common for people to have this disorder, but never become aware of it in their lifetime. Those who go untreated will likely experience mood fluctuations frequently, but it lacks the criteria and severity to qualify for Bipolar I or Bipolar II.
Schizoaffective Disorder
Schizoaffective Disorder translates to schizophrenia with the mood features and symptoms of Bipolar Disorder or Major Depressive Disorder. The main features of the disorder are the psychotic and schizophrenic symptoms, and the mood fluctuations come and go. Some refer to this disorder as “Schizophrenia with a dash of Bipolar/Depression”.Medication-induced Mania
The majority of people seek treatment for their mental health when they are depressed. Depression is usually present in people who struggle with mental illness, so prescribing a simple antidepressants is usually the first step in treatment. However, some people experience a manic episode which is induced by taking an antidepressant alone. Without an accompanying mood stabilizer (anticonvulsant or lithium), people with Bipolar Disorder will typically become manic if given an antidepressant alone. If a person has never experienced a manic episode, becomes manic due to taking an antidepressant alone, they are still considered to have the Bipolar Diagnosis, but some psychiatrists may specify in their notes that it was a medication induced episode which lead to a Bipolar diagnosis.
Can You Experience Mania In Borderline Personality Disorder?
The short and official answer is “no”. However, the detailed answer includes the possibility of experiencing manic-like symptoms in some cases of BPD, but not enough to qualify as a true manic or hypomanic episode. There are other reasons that a person can experience mania-like symptoms like Bipolar Disorder, however, it is not true mania as it does not meet the qualifications for a true manic or hypomanic episode.
A person can have both diagnoses of Bipolar Disorder and Borderline Personality Disorder at the same time and the diagnosis of both is seen in 20% of cases.
A person can have both diagnoses of Bipolar Disorder and Borderline Personality Disorder at the same time and the diagnosis of both is seen in 20% of cases.
If a person who has Borderline Personality Disorder, is experiencing a full, true, manic or hypomanic episode, they should be evaluated for other possible diagnoses, specifically Bipolar Disorder.
True manic and hypomanic episodes are exclusive to Bipolar and Bipolar related disorders (such as Schizoaffective Disorder). Manic episodes that do not quite fit the criteria for hypomania or classic mania, may be part of other possibilities, such as Depression With Mixed Features or Cyclothymia. Manic and hypomanic episodes are not part of the Borderline Personality Disorder diagnosis. While some people with BPD may experience an “elevated mood”, it is not a true manic or hypomanic episode as it does not meet the criteria of symptoms, length, and severity.
True manic and hypomanic episodes are exclusive to Bipolar and Bipolar related disorders (such as Schizoaffective Disorder). Manic episodes that do not quite fit the criteria for hypomania or classic mania, may be part of other possibilities, such as Depression With Mixed Features or Cyclothymia. Manic and hypomanic episodes are not part of the Borderline Personality Disorder diagnosis. While some people with BPD may experience an “elevated mood”, it is not a true manic or hypomanic episode as it does not meet the criteria of symptoms, length, and severity.
Comments
Post a Comment