- Is It BPD Or Rapidly Cycling Bipolar?
QUESTION:
Dear Dr. Heller, What are the differences between mixed bipolar, ultra-rapid cycling bipolar and borderline? Can a person go back and forth between different types of bipolar? Do I have BP and BPD together? Do I meet the criteria for any type of bipolar? I was sexually abused by father, uncle and cousin between the ages of 10 and 13. I became promiscuous after this, and had 11 sex partners until meeting my husband at the age of 17…I had one affair after 7 years of marriage. Does the following sound like mixed states? I’m 34 years old now. 1980 At the age of 13, I overdosed on pills of some sort – it was my 3-year-old little brother’s medicine, with rat poison – then everything went black for a split second. I loss control of my muscles, collapsed and threw up. My vision returned immediately. No rages then. 1981 Removed from home at 14, group homes and foster care until age of 17. Ran away, had sex with older men, mostly in their 20’s. 1983 I overdosed at age of 16 on Valium, and made a halfhearted attempt to cut my wrists. No problems with rages then. 1984 I overdosed at 17 on an anti-anxiety drug (10 pills), beginning to have rages. Broke up with boyfriend of 8 months. 1984 At age of 17, I overdosed on an over-the-counter sleep aid (about 9 pills), and had rages and anger. I have a new boyfriend now (we have been married for 14 years). 1989 At age of 22, I overdosed on aspirin and pills that stop lactation. My daughter was about 2 years old then. I had anger and rages then. I tried to take something in 90. My husband was there and made me spit it out. I don’t remember meds. Rages and anger. I was diagnosed as borderline in 91. I read, “I hate You Don’t Leave Me” in the hospital, and it convinced me that there was no hope for me. I was committed for a month, because I was thoroughly depressed and I had intense anger and rages. I was suicidal at the time, too. I was sent home with Tegretol. I stopped taking it because of the side effects. I continued to have rages and some depression almost everyday. I had a baby in 94. I became suicidal and intensely angry again, and ask my husband to leave and take our children. I then went to a doctor for depression and took Prozac for three months, and I wouldn’t go back for more. The anger was improved greatly, but my depression remained, not as severe though. I was hopeless, but not suicidal. I haven’t felt suicidal since, just thoughts of suicide. I don’t rage as much. My family moved back in, in 98. Since then, I have been dealing with few and far between outbursts, and I have lots of irritability and frustrations, panicky ((lack of concentration, easily distracted with memory problems became worse over the last year or so)). I know these are symptoms of lots of things, but do you see a pattern? My irritability and anger have forced my family to move out about a week ago. 2001 I have visited many sites and I just get more confused. Some say, you have to cut to be borderline, I don’t. Some say it doesn’t matter Some say that borderline doesn’t exist, that borderline is bipolar. Some say that borderline isn’t a biological illness, that it’s a personality disorder. Some say that true borderline doesn’t involve depression at all. Then I come to your site and you say it is not a personality disorder etc., and that there is a certain combination of meds that work. Prozac then Tegretol, Haldol etc. I am taking Wellbutrin 2 pills a day 150mg each am & pm doses, Seroquel 2 pills at night 50 mg each, and trileptal 2 pills a day am & pm doses 300mg each. By the way, I feel great in just these 3 days. I have less distractions and not as much irritability. I know it’s early. I still feel good though. My daughter said yesterday, “Mom, aren’t you gonna get mad?” I said, “Honey, I don’t feel mad.” My other question is if I am a true borderline, will I get better on this combo? I know everyone is different, but most borderlines do well on your med combos right? So should I expect the worse? I have only been taking the meds for a few days now, 3 to be exact. I don’t want to go back to the suicide attempts, or rages. I hope you can clear some of this up for me.
ANSWER:
There’s no reason an individual can’t have both. The criteria for a mixed episode can be located at http://pks.947.myftpupload.com/MixEpisd.htm. Fortunately the BPD with bipolar can be treated identically as those with BPD and chronic dysphoria (anxiety, rage, depression and despair) or dissociative symptoms. It’s extremely rare for a borderline to not respond to medications. I believe the BPD is primarily an instability and epileptic phenomenon in the limbic system (in the trapped, cornered, wounded animal instinct part of the brain). It wreaks havoc on the personality, which is generally significantly impaired. The three parts to treat the BPD successfully are 1) control all the chronic symptoms, 2) having as needed medications for crashing, and 3) retraining the brain. While Seroquel is helpful for PTSD problems it does very little for BPD or bipolar. I’ve never been impressed with Wellbutrin as a BPD treatment.
