Coping with BPD – Dual (quadruple?) Diagnosis 

Borderline personality disorder can be hard to diagnose. It can be even harder to diagnose when their are co-occurring disorders. This can lead to a lot of stress when you’re trying to get treatment and no one you see can seem to agree on what you have.

I’ve mentioned before that along with BPD I have OCD, and agoraphobia. What I haven’t said is that I may also be Bipolar. I was diagnosed bipolar before borderline, and none of the treatments seemed to help so I gave up, became a workaholic, and let my OCD overshadow all else. When I finally went back to treatment I was relieved to hear “borderline personality disorder”, not because I want it, not because I didn’t see the difficulties, but because it fit. My diagnosis fit and I could finally get treatment.

After sometime with my current therapist she mentioned (though never pushed) the possibility of co-occurring disorders. That I may have a dual diagnosis of Borderline and Bipolar. I shrugged it off and ignored her. We moved on to guided meditation. All was happy in the land. 

My med adjustment last month is helping more than expected with my BPD. What I’m finding is that instead of living in my constantly overwhelmed brain of mismatched emotional torment, I am reacting like a real human to real stressors. But then those stressors became a lot of stressors, and I went manic.

I am in a manic phase of hyper productivity, jitteriness, and easily agitated. I saw my therapist this morning and she saw it immediately in the way I spoke. She mentioned that maybe we should do some grounding meditative exercises to which I took a deep breath, said “I think you may be right about the dual diagnosis, I think I’m in a manic phase” and then went back to jittery agitated talking before she finally slowed me down enough to do some breathing exercises. 

My frustration with co-occurring disorders is that it can be difficult to know what is going on with you, and where to focus your energy. There are times I feel like I’m trying to make sense of my brain just as I did before any diagnosis. So here is how I’m learning to distinguish between my 4 diagnoses. 

  1. Am I looking for balance? If yes, it is definitely OCD. The rest of my brain is too scattery to care about balance (which is why it so desperately needs it)
  2. If I think of picking something up from the grocery store, can I still breath? No? Okay, agoraphobia is taking over.
  3. Are my emotions extreme? Duh! But for how long? 2+ weeks usually means it’s my Bipolar, less than 2 weeks means it’s borderline.
  4. Another distinguishing factor between those two: Bipolar has 2 set extremes. High and low. Borderline typically combines them for me. I can go through highs, lows, and every extreme in between in a matter of hours (sometimes minutes!), I feel numerous extremes at once, not just manic or just depressed.

To be clear, I don’t mean “oh it’s just depression, or just mania” as though it is less than my BPD feelings. That’s not the case. I simply mean it is a very distinct extreme. It gives me set feelings each time I face it, and what those are do not change each time it comes. Again, this applies to me and my journey with my screwed up brain. It could look different for you and that’s fine. 

I am trying to compile notes in my journal to see if I can find ways of treating the necessary disorder as it flares so I can better fine tune my self care. I’ll keep you posted.

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