Are you a green or a magic? The overlap between bipolar and borderline personality disorder

The first diagnosis I received from a psychiatrist, in my early twenties, was of bipolar mood disorder. As I have described elsewhere on this blog, I rejected the diagnosis and the treatment plan, and then avoided psychiatric intervention for around 8 or 9 years. The next time I saw a psychiatrist, I was asked different questions and came away with a diagnosis of clinical depression, clinical anxiety and borderline personality traits. I was surprised by this, but after reading around I had to admit that I displayed many characteristics or behaviours which could point to borderline personality disorder. I struggled to spend time alone; I had had a recent period of intense relationship instability; I had difficulties knowing who I really was; I had taken an overdose a couple of years before; I felt that I tended to repeat a lot of the same mistakes over and over again in my social interactions, especially at work. Overall, the diagnosis seemed a reasonable fit, and was useful for explaining some of the ways I behaved.

More recently, however, I began to question how appropriate that diagnosis was. Between 2004 and 2010, my life was very stable. I began and sustained a very good, secure, long-term relationship; I worked for the same organisation continuously and progressed steadily in my career without any disasters. I coped with my partner being away without any of the panic I would have experienced in my twenties. When I presented myself to a psychiatrist earlier this year, I gave him my full history, including both prior diagnoses, and came away with the diagnosis of bipolar restored.

Trying to make sense of the change of diagnosis, I came home and did some Googling. Among the many articles I read, one by Dr Jim Phelps on his informative site, Psycheducation, really stood out. Moving from “your diagnosis” to “your position on a spectrum” introduces what Phelps calls a “paint” approach to the question of why someone receives a diagnosis of borderline or bipolar. He points out that there is “an almost complete overlap of symptoms” between the markers for the two conditions. Both involve an unstable sense of self, an unstable pattern of mood (possibly with paranoid or other psychotic features), and changes in mood states and energy levels which can lead behaviours such as impulsive spending, poor sexual and relationship choices, substance misuse, self-harm, suicidal behaviours, etc.

Phelps suggests that if conditions were colours, with this much diagnostic overlap, both Borderline Personality Disorder and Bipolar Disorder would share a lot of the same pigments – they are on the same spectrum. In this model, both can be seen as having a “red” pigment that represents hot emotions (like anger and elation), a “blue” pigment for depressive symptoms, and what Phelps thinks of as a “sparkly” pigment (isn’t that nice?) which stands for impulsive traits.

Here’s where the difference comes: the bipolar person has a “magic” pigment which makes the other pigments vary in a cyclical way over time. Get a big dose of the magic, and you’ll end up unequivocally Bipolar I; get less, and you may be Bipolar II or cyclothymic. (A criticism I would insert here is that the theory assumes bipolar people “tend to be either one way, or another, all symptoms together” i.e. all red or all blue, which doesn’t account for mixed states). Borderline people don’t have this magic pigment, but they have what Phelps suggests is a “green ingredient” causing feelings of emptiness and loneliness, which can cause problems in their interpersonal relationships, and lead them to struggle to cope if they are alone.

Phelps summarises this “pigment” or “spectrum” idea like this. Diagnoses are not objective realities; “they are conveniences for researchers, and are also supposed to help you find the right treatment.  But because symptoms are spread over spectra, from a little to a lot, labels can often be misleading.  Finally, borderline patients have most of the features of bipolar, plus an emptiness streak; and may have less clear “cycling” of their symptoms.”

What does this mean in practice? Well, for a start, your diagnosis will depend on how good a sense of colour vision your doctor has, and maybe what glasses she or he is wearing that day. Some pigments may leap out at one doctor, but if you ask for a second opinion, another doctor may think a different pigment seems more obvious. Also, I think your level of pigmentation can change; I’m not the same person I was at 15, or 20, or 30, and people develop and grow.

Put this way, a diagnosis of bipolar when I was in my early twenties makes sense. The psychiatrist didn’t see so much of my undeniable greenness because we didn’t talk about those issues much, so for him the magic of my mercurial mood changes outweighed the green. In my late twenties, after disclosing an overdose, with relationship problems and job problems, and having failed to recognise some hypomanic phases, I got a diagnosis with more green, less magic. After developing some emotional coping skills, relationship and job stability and functioning well for years, but then having very distinct blues and reds, I was at my most “magic” and got re-diagnosed as bipolar.

The major difference between whether you are seen as “green” or “magic” is the type of treatment plan you are offered. Viewed as having borderline issues, I received no drug options other than anti-depressants, but I was offered NHS therapy; viewed as bipolar, I have had in-depth discussions of drug treatment options, but no offer of talking therapies. Phelps has some interesting things to say about potential risks of treating people who are actually borderline as if they are bipolar, but his over-riding message is that we should avoid getting “too hung up on a diagnostic label” – if the doctor and the treatment plan are helpful for you, that’s what counts, more than whether you are “really, truly” borderline or bipolar. Neither diagnosis is an unreasonable interpretation of the symptoms bipolar and borderline people tend to display. For people who have had different diagnoses at different times, the pigment model helps to understand how this can happen, and perhaps begin to let go of any anger about being “wrongly” diagnosed or treated.

The best thing about the pigment model, in my view, is that we’re all purple together.

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About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards 2013. Winner of the World in Mentalists Mood Disorder blog 2012. Regular guest blogger for the International Bipolar Foundation http://www.internationalbipolarfoundation.org/ Expert by Experience working with Mind training department. Working on The Incoming Tide, a bipolar memoir. Find me on Twitter @BipolarBlogger or at my Facebook page http://www.facebook.com/BipolarBlogger
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19 Responses to Are you a green or a magic? The overlap between bipolar and borderline personality disorder

  1. pink0banana says:

    That is so very true, I like being purple tho too! Having been very blue am now coming through purple to red! I had 6 years of relative stability and I think I only ever saw blue as a “problem” hence why I never really talked about anything else.
    Very interesting my purple friend xxx

    • Thanks, when we were talking about this issue I thought I must find this article for you! It’s true that overall I have been more blue than red, and found the blues to be more of a problem, and that this has led me to not realise recognise some red times (as I was saying to you on email). As in – I didn’t recognise that it was problematic for not sleep or rest for days after giving birth and just bounce about thinking how wonderful everything was, because I felt good! But I sure recognised the importance of crashing down on day 12 and having major depression for months. This led me to emphasise the blue when talking about it in my 20s, and neglect to mention the red.

      Don’t forget we are not just purple, but sparkly! Like purple glitter! 😀 xxx

  2. ani says:

    brilliantly written. thank you and Dr Phelps
    love the ‘magic’ idea. and the colours.’magic’ sounds far better than bipolar:
    i’m magic!

  3. maddie50 says:

    This is such good sense. I have been variously diagnosed as bipolar and borderline but reading this I do not think I have much magic but I do have a hefty helping if green. Thanks for posting.

    • I know, isn’t it a great metaphor? It was talking with you and the other friend I mentioned this week which reminded me of the article. It’s helped me see that I used to be really quite green, but some of this has faded as I’ve learned to cope with life better, so now I can see the magic! Thanks for reading, do share with anyone you know who may find it helpful or of interest.

  4. JuliesMum says:

    Oh goody: two posts from you to read today! I love your writing, and I am so glad that now I understand why you are purple. Didn’t know about the sparkly bits, but not surprised.

    It also confirms me in my own growing belief that diagnoses are not that much use a lot of the time. They can seem not much more sophisticated than a medieval doctor’s description of humours. Even if they could be relied upon, it’s hard to know what they could tell you. If you just listed all the ingredients in a bottle of wine, and you didn’t drink it, you wouldn’t be able to tell the difference between a bottle of Chateau Amazing Vintage from the cheap plonk next to it on the shelf.

    • Hi Julie, the truth is I have always loved purple and called myself purple this and purple that online….. it’s only very recently I found this metaphor and discovered I am sparkly and magic too! My psychatrist is quite pragmatic, and very open about the fact the European (ICD) and American (DSM) diagnostic criteria are not always the same, so are we even talking about the same things? His view is that it’s the treatment plan that matters.

  5. phylor says:

    I like the idea of a sparkly pigment — and that symptoms are on a range of colo(u)rs. I’ve never neatly fit into any diagnosis category (except, yes, I am in physical pain, and yes, I am chronically depressed). My experience with the pyscho-analitical crowd hasn’t been a pleasant one most of the time, hence the broad definition of clinical depression. I have parts of bipolar, and parts of borderline personality disorder — I guess maybe I’m a rainbow?

  6. Love this comparison, what a brilliant and realistic professional! Looking forward to reading the article later. Thanks for yet another great post. 🙂

  7. Ann says:

    thank you for this! my therapist (i’m lucky to be in the u.s. and have good health insurance so i see both a therapist and a psychiatrist) describes the various mental illnesses as just providing various different problems in living, which is what you have to figure out how to live with. i’m not bipolar (depression) but i did/do have a good chunk of borderline symptoms for quite a while but have currently resolved them and live a calm life with a long-term partner (31 years). i think the color theory is a really interesting one and i’m going to share it with the mental health agency where i work (kind of similar toe Mind). thanks again!

  8. Moon Tree says:

    Thanks for drawing my attention to this! I’m familiar with the Psycheducation website and Phelps’ other page on the similarities and differences between BPD and bipolar, but I don’t think I’d come across his paint metaphor before. It’s fabulous! I often feel frustrated that my diagnosis (recurrent depressive disorder) doesn’t seem to account for all the symptoms/issues I have, but from reading this it’s very clear that what I actually have is a sparkly turquoise magic diagnosis! 🙂

    • YW, Moon, really appreciate you leaving me a comment. My basic thought with the blog is that if I find something useful, I’m prettty sure someone else out there will too. I’m going to try and get a post up today about a forum I went to yesterday which gave me some food for thought about recurrent depression and why people don’t get “cured” even after therapy. More ideas sharing 🙂

  9. Pingback: Sparkly turquoise magic diagnosis | Seeking Myself

  10. Emma says:

    ..Makes a lot of sense and what a beautiful way of looking the ways in which we are similar and different, especially in the area of mental health.

  11. Pingback: I think I might have bipolar…. Tips for approaching healthcare professionals | purplepersuasion

  12. butterflywgs says:

    I have spent a lot of time reading Phelps’ site – it makes so much more sense than anything I had read before. I love the graph and had been trying to express something about how I was feeling and that it was kind of cyclical for a long time before I came across it. I assumed I could never have bipolar as I didn’t become psychotic or fly to Australia on whim, and was mostly get depressed.
    I don’t feel I’m green – I don’t really struggle with being alone or feel empty. I don’t feel at core I struggle with knowing who I am (although when mood changes start in adolescence, *anyone* would wonder sometimes!)
    It’s so refreshing to see the idea of a spectrum – people don’t always fit in neat diagnostic boxes.
    I think people have legitimate reason to be angry with a BPD diagnosis: not because it’s wrong – health professionals are only human, many symptoms are similar, people are complex and maybe don’t report mild hypomania, because who would complain about feeling great. But the way that people with a BPD diagnosis, correct or not, are treated (or often, not treated) is appalling. It is so stigmatised. *That* is worth being angry about rather than misdiagnosis per se. Not a criticism and I know you are aware of that 🙂
    Again, boxes that as you say affect what treatments are offered. Offering only therapy or only meds based on someone’s label, not what they actually want or need is appalling. Most people in reality do best with both. The NHS seems to base MH services entirely on the medical model.
    I am not doing so well with the thinking or the putting thoughts into words today, so: people are complex. And yay purple 🙂

  13. Bipolar and BPD Support says:

    Reblogged this on Bipolar and BPD Support and commented:
    Overlapping or on the same spectrum?

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