Personality Disorders And Bipolar Disorder

In my blog from last week I touched upon the relationship between Personality Disorders and Bipolar Disorder. In clinical practice, we see a lot of people who can be diagnosed with both a Personality Disorder and Bipolar Disorder, and research studies have shown that approximately 4% to 10% of people who have a personality disorders also meet criteria for either Bipolar I or Bipolar II Disorder. The highest co-occurance rate has generally been found between Borderline Personality Disorder and Bipolar Disorder, pointing towards about 10% of people with Borderline Personality Disorder also having Bipolar Disorder.

Bipolar Disorder is characterized by alternating episodes of mania (or the milder form, hypomania) and depression. The main difference between Bipolar I and Bipolar II Disorder is basically in how severe the symptoms are and for how long the episodes last. Most people might know what some of the typical symptoms of depression are – feeling blue or down or hopeless, experiencing no pleasure in things, often combined with difficulties in concentration and lack of energy.  Similar to the diagnosis of depression, a manic episode can be diagnosed when a defined set of several different symptoms occurs at the same time, but the experience of a manic episode is extremely different from that of depression.

Some typical symptoms of mania include:

• a mood that is better than just good, for instance,  elated, euphoric or hyper; or a markedly irritable mood
• decreased need for sleep
• impulsive behaviors, such as reckless driving, gambling, overspending, use of drugs
• feeling more self-confident than usual, or belief that you have special powers
• being very talkative or feeling like other people can’t keep up with you
• feeling like your thoughts are racing in your head
• feeling more active or outgoing than usual

These symptoms might sound rather clear and straightforward in theory, but in practice, bipolar disorder can be difficult to diagnose. Sometimes, people can be in a mixed state of mania and depression, and things are not as clear-cut. Since being in a manic state tends to involve feeling excited, elated, or hyper, some people really enjoy that state. This also means that people may not think that there’s anything wrong, may not realize what’s going on, and may not seek help. I often hear people with bipolar disorder tell me:” I wish I could be in a manic state all the time. It feels really good.” However, frequently, it is a devastating drop out of the mania into a severely depressed state that really bothers them, and it is dealing with the consequences and aftermath of the manic episode, such as debt, relationship issues, trouble at work, and feelings of embarrassment over impulsive or aggressive behaviors.

The symptoms of mania can look quite similar to some of the characteristics and behaviors found in people with personality disorders. For instance, people with Antisocial Personality Disorder may engage in the impulsive behaviors mentioned above. The same is true for people who have Borderline Personality Disorder who, additionally, can experience anger outbursts and marked shifts in their mood. In fact, some experts believe that Borderline Personality Disorder is a form of bipolar disorder, whereas others maintain that these are two distinct disorders.

Regardless, the differential diagnosis can be difficult to assess, and sometimes can be determined only through careful observation and experience over time.   The diagnosis should be made by a trained professional, so that other conditions that could cause the symptoms can be ruled out, and the right kind of treatment can be recommended.