Bipolar Disorder

Borderline Personality Disorder and Schizoaffective Disorder Show Symptoms Similar to Bipolar Disorder

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a developmental syndrome that is superficially similar to bipolar disorder symptoms. Individuals with BPD are vulnerable to mood swings not because there are necessarily differences with their brain chemistry, but instead because they possess rather fragile, developmentally-delayed and under-developed emotional coping skills. Such people have a tendency to view relationship partners in a very high contrast, highly idealistic manner. Partners may be good or they may be bad, but they are generally not represented as possessing both qualities at once. As perceptions of a partner's actions and intentions shift in the borderline person's mind, so too do the bipolar moods of the person with BPD.

Young children tend to represent the word in this high contrast way, but to then grow out of this black and white thinking as they mature. Borderline personality disorder represents a situation where that normal social and emotional maturation process becomes interrupted, due to trauma or difficult life circumstances that interact with temperamental (instinctual) emotional sensitivity.

Mood swings in the context of borderline personality disorder are thought of as 'software' problems brought on by changes in the patient's perception and appraisal of their social situation. This is in contrast to bipolar disorder patients whose mood swings are thought of as occurring due to brain chemistry problems (e.g., a 'hardware' problem). It is not at all easy to differentiate borderline mood swings from those, which might be attributed to ultradian rapid cycling bipolar disorder. Because of this difficulty, some experts argue that BPD is best thought of as a form of ultradian cycling. This point is highly controversial and does not represent the mainstream view within the mental health professions, however. First line treatment for BPD remains psychotherapy (with medication offered as a secondary support). In contrast, bipolar patients are offered medication as their primary form of therapy.

Schizoaffective Disorder

Schizoaffective disorder is a diagnosis characterized by the simultaneous presence of both the mood disorder characteristic of bipolar disorder and the psychotic thought problems characteristic of Schizophrenia. Although psychosis can occur in a mood disorder, the presence of psychosis during a bipolar mood episode is not sufficient by itself to merit the diagnosis of Schizoaffective Disorder which is only made when the full criteria for diagnosis of both a mood episode (such as a manic, mixed or major depressive episode) and criterion "A" for the diagnosis of schizophrenia are present. Criterion A of the schizophrenia diagnosis states that a person must be suffering from two or more of the following symptoms of schizophrenia during a one month period: hallucinations and/or delusions, disorganized speech and behavior, or limited emotional expression, thought and speech, and lack of motivation. A severely depressed individual may hear voices that confirm their negative emotions and convince them to commit suicide.

A major difference between the psychosis characteristic of normal bipolar disorder and schizoaffective disorder is that bipolar symptoms will remit when the mood disorder episode is over. This is generally not the case with regard to schizoaffective disorder wherein mood symptoms are more or less constant (although they may change in character they will not entirely disappear), while psychotic symptoms may wax and wane.

In schizoaffective disorder, psychotic symptoms must be present in the context of an ongoing mood episode, as well as during periods of relative normal mood. For example, someone hearing voices during a manic phase continues to hear them even after the mania has subsided. Given the complexity of this disorder, doctors tend to differ on whether it is better to diagnose one schizoaffective disorder, or to diagnose bipolar illness and schizophrenia separately.

 




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