Thursday, April 8, 2021

Borderline Personality Disorder vs Bipolar Type 2: Navigating The Spectrum

Hello my lovelies,

Firstly I just want to say a huge thank you for 8k views and an even BIGGER thank you for 8.5k in under two days! My mind is literally blown that so many of you want to read my posts, so thank you!

I thought today I'd write a little mental health update as one part of my mental health journey comes to an end, and I wait for the next part to begin. 

As you can tell from the title I'm going to be talking about my diagnosis, or perhaps diagnoses, and the journey that got me to them. 

You may already be aware from my Lockdown 3.0 post, but in April of last year I struggled with a serious falter in my mental health. After moths of just about holding it together, things started to fall apart. One relapse, trip to a hospital, crisis evaluation, brief chat with an NHS psychologist and a rejection from standard therapy services for needing "more immediate care" later, I landed into the care of a private psychiatrist.

I just want to pause here to say how incredibly grateful I am that I was able to access a private psychiatrist. I am incredibly fortunate that my dad's job provides limited private healthcare. We knew funding-wise it would only be short term, as we certainly would not be able to afford it outside the plan provided, but regardless I'm aware it is such a privilege to be able to access private care even for just a short while. So many people struggle to access the proper care and treatment they need on the NHS and I remain grateful that this opportunity was available to me.

A brief timeline

From my initial appointment around late August/early September the possibility of borderline personality disorder, or emotionally unstable personality disorder was already on the cards, but a few symptoms weren't quite a match. Now I am not a psychiatrist nor particularly good at explaining things but here's my attempt at explaining why its sometimes hard to differentiate between borderline personality disorder and bipolar type 2.

Firstly, the difference between bipolar 1 and bipolar 2 is the level of mania someone experiences. Those with bipolar 1 experience very extreme mania, which can often involve psychosis or lead to hospitalisation. Bipolar 2 however involves something called hypomania, this is still a disruptive and distressing state to be in, but is not as extreme as bipolar 1 mania.

Now many psychiatrists put borderline personality disorder and bipolar type 2 on a spectrum due to their overlap in symptoms. Of course BPD is a personality disorder in which episodes are very rapid, while bipolar 2 a mood disorder in which episodes of major depression and mania are much longer (though rapid cycling does exist) lasting days to weeks to months. The difficulty I faced was occasionally experiencing rapid mood swings throughout the day, as well as more consistent periods of low or high mood. I've included a nifty venn diagram which shows some of the symptoms present in both disorders.

After discussing any noticeable periods in the last 6 months of possible hypomania, periods of stability and periods of extreme low mood, April being the worst recent period of low mood, I began a very small dose of quetiapine (an anti-psychotic) in September to see if it would help stabilize my mood. Bipolar type 2 as a diagnosis officially became a consideration, but it was far too early for a definite diagnosis.

After that it was a bit of a waiting game to see if it helped. Aside from sleeping a fuck ton I only noticed minor improvements in my mood. This prescription stayed the same for my first few months at university, and by October I started a round of person-centred therapy for some short term focus on coping mechanisms. Unfortunately, a few months later I struggled again with a hypomanic episode, followed by a dreadful period of depression in which I slept in till 4 or 5 everyday, had no motivation or desire to do anything, and entered relapse again after a brief period of being clean. 

This resulted in my anti-depressants being doubled and my quetiapine dosage gradually being raised until it was quadrupled from the original amount. Since then I have noticed much longer periods of stability between high or low moods, and my low moods being nowhere near as severe as before. This return to semi-stability felt like a great victory, and as my funding for private care ran out it was a question of what happens next. 

Though the issue of whether my bpd traits are actually caused by bpd remains partially unexplored, I have a working diagnosis of bipolar type 2, which will be periodically reviewed as my medication changes or if new symptoms arise/current symptoms worsen. 

How am I feeling?

Honestly, I feel pretty at peace with a diagnosis of bipolar disorder. It was nice to finally have a sense of clarity around the emotions I was feeling. Though I don't feel as though I'm in a particularly good place mentally right now, and have other issues to address such as my eating disorder, I'm looking forward to starting my psychotherapy on the NHS (DBT hopefully!), and to keep on trying to recover.

I know this post was a bit of just a ramble about myself but I hope somebody maybe found it interesting? Or if not it certainly serves as a page in my mental health journey to look back on :)

Take care and stay safe x

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