Bipolar and Borderline. Do I Still Need Meds?

By Kristina Randle, Ph.D., LCSW

I have been treated for bipolar I for 12 years/now added dx of BPD. I am 54 years old & was have been treated for bipolar I disorder for the past 12 years with medication & seen different therapists on & off who have not been very helpful. The medications (I took a combo of 6) helped very much until I had a period of 5 mos. of hypo mania & didn’t report it to my meds provider as I didn’t know it was dangerous & it felt so good. My husband made a negative comment to me about the weight gain I have had (50 lbs.) since being on these medications & I overdosed. I had been relatively stable for 5 years before the episode of hypo mania & was seeing my provider every 6 mos. for check-ups since I was doing well.

I have had a very hard time with my moods since I was 15 when I had my first suicide attempt. My mother was also bipolar & committed suicide when I was 15 after many attempts & hospitalizations. My childhood was very chaotic with her (she was psychotic often). My brother claims she sexually abused him. I don’t know as I cannot remember much of my childhood at all except sort of “snapshots” of her calling me a whore (when I was 11 years old & didn’t even know what the word meant) & examining my genitals for venereal disease & locking me in the closet when she had her boyfriends visit or my father driving drunk & I would be crying & begging him to stop & he would be angry at me. In fact, he was very angry at me after my suicide attempt, too, as the boarding school where he had dumped us kids after my mother’s death made him take me home for 2 weeks “to get help”–which basically meant he left me alone while he went off to do whatever he was doing. He was an alcoholic & absent much of the time so sometimes I had to call the police when my mother was beating up my brother.

So since my overdose 2 1/2 years ago I’ve been in a mixed–moderate state & not doing too well (according to my meds provider’s diagnosis on the insurance form). She’s been changing some of my meds & I started dialectical behavioral therapy as someone in my support group said how helpful it was & I have found it to be VERY HELPFUL & VERY HARD to practice all that I am learning, but it is giving me such hope that I don’t have to live at the mercy of my out-of-control & over-reactive emotions. I am finally starting to get over my suicidal thoughts & making some progress in repairing my relationship with my husband.

He had no idea I would react as I did. He is remorseful & says we all have our faults & that our marriage is 90% good & we need to focus on that. We have companionship, etc. I can no longer even think about having sex with him as my self-esteem was destroyed with his remark.

I’m having a hard time trying to give the right info. so you can address my question! I have all the symptoms of bipolar–excessive spending, deep depressions & hypo mania (never full blown mania), mixed episodes, paranoia (thought my husband wanted me to kill myself) & delusional thinking (thought my husband was planning to poison me), insomnia, anxiety, etc. Also binge eat & binge drink & have feelings of unreality where I don’t feel “real”–like I’m a vapor or I look around & the world is not real. I “lose time”, have a very hard time being appropriate in that I reveal too much to people (blurt out info. about my mental illness or suicide attempts) so I feel like I’m not “safe to be out in public” & isolate myself. These do sound like symptoms of borderline from what I’ve read.

I’m very dependent on my husband’s approval & am constantly trying to read his facial expression or body language to see if he is “thinking bad thoughts” about me–though the DBT is helping me get over that. We have been married for 34 years & it is still hard for me to believe that he really loves me.
I started individual therapy with the therapist who is doing the DBT group & I noticed on my insurance form she put down the diagnosis of bipolar & borderline personality disorder. Can I have both or is she just seeing that because that is her focus?

I have been able to decrease my dosages of Lamictal & got off Abilify (caused weight gain) & Klonopin (mindfulness helping with anxiety) & Trazodone (insomnia is much better). Added Topa max to help maybe lose weight.

Since the symptoms overlap so much can I have both?–yet one is biologically based & the other has more to do with trauma (can’t remember any specific trauma though my therapist does say a lack of parental nurturing is trauma & I definitely did not have any nurturing or a feeling of safety in childhood or really any time at all except from my husband & that feels very fragile). And then there is the issue of treatment. Bipolar seems to require meds & borderline not. So do I need to take meds?

A. You’ve asked a number of specific questions but first I wanted to make a general comment about your letter. I hope that you are proud of your progress. You endured neglect and abuse by your parents. You were left to essentially fend for yourself as a child. No child should have to go through what you did. Your parents’ treatment of you (and your sibling) left you in the unfortunate position of essentially having to raise yourself. You had no guidance, no mentor, no stable individual in your life to teach you how to behave, to manage life, to think, to feel, to manage emotions, to encourage your psychological growth, etc. Now as an adult you have to heal yourself from all the damage your parents have done. It’s unfair but you are making a major effort to change and you are seeing progress. I hope you continue to work with your DBT therapist and support group.

With regard to your questions, it is possible to have bipolar disorder and borderline. They are similar in some ways but different in many others. Bipolar disorder may also be related to the trauma you’ve experienced.

Keep in mind that some believe that bipolar is biological whereas others do not. Science has not definitively identified the cause of this disorder (or any others). The same is true for borderline personality disorder. Some believe it’s biological but others would disagree. Until science has a clear-cut answer there will continue to be differing opinions.

Medications are typically helpful for individuals with bipolar disorders. Medications have been shown to be less effective for borderline personality disorder. The best treatment for the latter disorder is the one that you are currently engaged in, DBT. If your doctor believes that medication is helpful for the bipolar disorder at this time then it best to stay on the medicine, especially because it seems that you’ve finally found a medication combination that works for you.

Between your DBT, individual and group therapy and the medication, you seem to be engaged in all of the correct treatments. I would add that you should inform your therapist or your psychiatrist about the symptoms you continue to experience. Overall, however, you seem to be on the right track. Keep up the hard and effective work. Thanks for writing.

Photo

 

 

Last reviewed: By John M. Grohol, Psy.D. on 18 May 2009

APA Reference
Randle, K. (2009). Bipolar and Borderline. Do I Still Need Meds?. Psych Central. Retrieved on July 13, 2014, from http://psychcentral.com/ask-the-therapist/2009/05/18/bipolar-and-borderline-do-i-still-need-meds/