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Diagnostic confusion. - May 2nd 2012, 12:01 AM

Ok, so, on my crisis response plan - which was written a couple of weeks after I left hospital - my diagnosis is:
Bipolar II
Executive Functioning Difficulties (in the areas of planning, problem solving, and emotion regulation)
Borderline traits.

But when I went to my GP this morning, she had a letter written to her just before I left hospital which had my diagnosis as:
Borderline Personality Disorder.

I asked her about this and she said it's just what the letter says, she's not really sure what's going on. I don't see her very often so that's understandable. However I'm a bit messed up about this nonsense. I am going to ask my psychologist about it when I see her on Monday, to attempt to get an explanation and a clear diagnosis.
I understand that online tests are not diagnostic tools, I simply did a couple for Borderline out of curiousity, and they all were of the opinion that I'm not Borderline. (Which I agree with.)

I do not have issues with interpersonal relationships, black and white thinking, fear of abandonment, need for attention, isolation or any of those other "classic" borderline things. I have had problems with emotion regulation and mood swings, as well as reckless behaviour, but that improved dramatically whilst I was on a certain combination of medication. (I stopped taking it.) I have also had problems with self-harm, and multiple (unsuccessful) suicide attempts. I have had periods of severe depression which have lasted weeks and in some cases, months - this has contributed to the times I have tried to kill myself. I have also had two periods of elevation that were clinically observed and classified as hypomania at the time. (There have probably been others, but only two that have been clinically observed.)

So anyway, I was just wondering if others have had issues with the diagnostic procedure or if there's been confusion over your diagnosis, and if you have any opinion on what's happening to me. I know that nobody here is a medical professional which is why I am asking for opinions.

And yup.
   
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Re: Diagnostic confusion. - May 2nd 2012, 05:42 AM

Honestly, BPD and Bipolar Disorder are confused fairly often, especially Bipolar II.

I have Borderline Personality Disorder (8 of 9 major symptoms), and have had mood episodes that are Bipolar Disorder. I had to go through a lot of crap with a psychiatrist and a therapist, then my GP sent me to a Mood Disorder Clinic, where recently there has been more progress in my diagnosis (meaning they've addressed my mood episodes and want to start a medication regiment for Bipolar Disorder).

Point is, the diagnostic process can be a long, and diffiult road. For BPD, you technically only need to meet 5 of 9 symptoms for a diagnosis. Perhaps make sure to mention the clinical observations proving Hypomania, to make sure you still get proper treatment.


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Re: Diagnostic confusion. - May 2nd 2012, 07:23 AM

As with many disorders in the DSM, you do not need to have all of the listed criteria or symptoms in order to get a diagnosis of borderline personality disorder. If I recall correctly, there is over 100 combinations of symptoms and each satisfy the same diagnosis. There is similarity between bipolar and borderline personality disorder, but do the letters explain the reasoning behind the diagnoses? Were you given any tests, not including the online ones? A differential diagnosis is always made while the diagnosis is being developed, so it is possible one letter was the differential diagnosis while the other is the diagnosis.

Unfortunately, psychiatric diagnoses can be quite confusing, in part it's because the DSM is riddled with so many problems and different psychiatrists will include scientific theories to help reach their diagnosis, while others won't.


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Re: Diagnostic confusion. - May 2nd 2012, 10:02 AM

Oh, I know what the DSM criteria for BPD is. My issue is that I fit two, and at the most three, of the listed criteria, so whilst I agree with the diagnosis of borderline traits, I am of the opinion that I do not have the full-blown disorder.

As I said, I will be asking my psychologist about it, because we're in the progress of discussing my understanding of my diagnosis - that is, the diagnosis presented on my crisis response plan, which is what me and my mental health team are working with. I know they want me to do DBT, which is basically tailored to treat people with BPD, but I was told by my former psychologist that there were only two of the modules they thought were actually relevant to me, and interpersonal relationships, which makes up the brunt of it, was not one of them - they wanted me doing it for the mindfulness and emotion regulation stuff.

I guess this is one of the difficulties of changing teams. I've only met my new psychiatrist once, and that was just before I was released from hospital - at which point I had just settled back on to citalopram and lithium (it had been a fortnight so they were both working a little bit at this point.). He decided that because I've been inconsistent with medication in the past that he'd discontinue all my medication, but I didn't realise he had changed my diagnosis. Which means really that the crisis response plan should say something different.

But as I said, I'll ask. Thank you for your responses
   
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Re: Diagnostic confusion. - May 2nd 2012, 11:59 AM

Many psychs who aren't properly familiar in PD diagnoses can often confuse the two, it happens very often. The main difference is mania or lack thereof and the unaffective/affectiveness and nature of mood swings.

BPD can manifest in different ways, but the 9 criteria are as a group the most consistent traits that all BPDs experience, 5 needing to be met at the very least. So i wouldn't personally say it's extremely broad in itself, there are specifics for BPD criteria despite the 9 listed. However, a Bipolar diagnosis is certainly more stringent in its own diagnostic criteria.

I'm sorry you've had such a tough time trying to get the proper diagnosis, mood clinics are generally the best way forward in your situation, as well as liasing with a practised psychiatrist and psychologist. I'm also on Citalopram, in addition to Olanzapine and Clonazepam to keep me stable with my Borderline Depressive symptoms, apart from seeking therapy again from a PD service for my condition(s).

Good luck!

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Re: Diagnostic confusion. - May 2nd 2012, 12:26 PM

The combination I was on in the past - which my previous psychiatrist felt was the most succesful combination - was lithium, citalopram, and olanzapine. This is the same psych who threatened to put me under the mental health act and hospitalise me if I didn't take my meds - so . . . the new guy has a completely different system!

So far as I know we don't have mood clinics here, and even if we did, I doubt I'd be referred to one because of the fact that I'm already working with the team for . . . more, well, idk troublesome maybe? patients. What happened was I was meant to be referred to a local team, but they wouldn't accept my transfer of care, so I got transferred to the intensive team instead. And they are supposed to be experienced in all areas of mental health, supposedly, although I know a large percentage of the people being treated in my area are schizophrenic. All the ones I meet tend to be anyway.

With my previous psychologist, we did about six months of good work, which is the most I've ever actually done. She was sure that I have a mood disorder, and she thought that it fitted most neatly into the bipolar spectrum. She differentiated between the moods I have that last a long time (usually weeks, sometimes months), and my more impulsive, affective behaviour. One of the reasons that coming to a conclusion diagnostically for me is so hard is because I had a traumatic brain injury as a kid, and this interferes with some things - that's the executive functioning difficulties, which isn't a diagnosis in itself but it's solidly there and been tested rigorously.

This is not the first time there's been confusion over my diagnosis, for a long time the executive functioning difficulties was diagnosed (and treated) as ADHD, because I present as hyperactive - many of the symptoms of ADHD are the same as those of a person experiencing a hypomanic episode, and I think this is part of why my former psychologist felt that bipolar II fit so well. Also, as my psychiatrist was medicating me for it (with moderate success, at least when I took the medication) you'd think they'd accept the diagnosis.

But, I'll find out on Monday
   
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Re: Diagnostic confusion. - May 2nd 2012, 12:29 PM

Wishing you all the best, it sounds like you've been through a very frustrating and stressful time with all of this! I'm sure that once you receive a clear diagnosis, with Axis III physical compromise being taken into account, you'll be much more relieved and proper treatment for it can commence

Michy.


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