One of the main reasons that borderline personality disorder (BPD) is sometimes believed to be a misdiagnosis is that it has symptoms in commom with two other disorders. These are :
1) Asperger’s Syndrome (a milder form of autism).
2) Bipolar Disorder. This used to be called manic-depression – its key feature is that it produces dramatic mood swings ,eg from being suicidal to being ecstatic, in those who have the disorder (as you might well already know, if you live in the UK, that Steven Fry -pictured above- has been diagnosed with this condition).
Let’s briefly look at these 2 in turn :
1) Why is Asperger’s Syndrome sometimes misdiagnosed as BPD?
Research suggests that it is mainly females who are likely to be wrongly diagnosed with BPD when, in fact, the condition from which they suffer is BPD. Why should this be? It has been hypothesized that because studies on Asperger’s Syndrome, until recently, had concentrated upon boys, the diagnostic criteria, whilst relevant to males, was not so relevant to females (as symptoms of Asperger’s Syndrome manifest themselves differently in boys and girls). In other words, the criteria for diagnosing Asperger’s derived from a non-representative sample as far as females were concerned.
It has also been suggested that girls were adept at concealing their Asperger’s Syndrome, sometimes by modelling their own behaviour on somebody else (who did not have Asperger’s).
WHICH SYMPTOMS DO ASPERGER’S AND BPD HAVE IN COMMON?
These are as follows :
– serious difficulties in forming and maintaining relationships
– feeling like a social outcast or pariah; feel they do not belong anywhere
– eating disorders such as anorexia
– great difficulties understanding subtle, unspoken rules of social interaction
2) Why is bipolar disorder sometimes misdiagnosed as BPD?
Sometimes. too, those who actually have bipolar disorder are falsely diagnosed with BPD. Again, the confusion arises due to the fact that there is an overlap between the symptoms of bipolar disorder and the symptoms of BPD.
WHICH SYMPTOMS DO BIPOLAR DISORDER AND BPD HAVE IN COMMON?
These include :
– mood swings
– impulsivity/risk taking
However, there are also differences between the two conditions. For example, whilst mood swings for those who suffer from bipolar disorder tend to be extremely dramatic (see above) and are often independent of what is going on in the patient’s life, the shifts in mood for those suffering from BPD are less extreme (for example, a transition from feeling distressed to feeling just about alright).
Also, for those suffering from BPD the mood changes are much swifter than for those with bipolar disorder. For example, a person with BPD may go from feeling upset to OK, back to upset again and then revert to feeling OK again all on the same day. In contrast, a person with bipolar disorder may feel profoundly depressed for a month and then elated for, say, the next to weeks.
ARE ASSESSMENTS TO DIAGNOSE BPD THOROUGH ENOUGH?
It is not unusual for individuals to report that they feel they have been diagnosed without being properly assessed (eg they have not been asked very much about their behavioural and psychological history). Obviously, this, too, is likely to be another reason for a mis-diagnosis
GIVEN THE SIMILARITIES BETWEEN THE SYMPTOMS OF BIPOLAR DISORDER AND THOSE OF BPD, CAN IT BE CONCLUDED FOR SURE THAT THE CONDITIONS RELATED?
More research needs to be conducted in order to answer this question. However, one study showed that 1 in 5 individuals with BPD also suffer from bipolar disorder; however, only 1 in 10 of individuals with personality disorders other than BPD were found to also suffer from bipolar disorder. Whilst these findings certainly support the idea that the two conditions are related, they do not provide us with sufficient evidence to draw any firm conclusions.
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David Hosier BSc Hons; MSc; PGDE(FAHE).