Diagnosed with Bipolar II and Cluster B personality disorder

[Tryptamine*Dreamer]

I'm just not sure if the diagnosis is correct. The Bipolar II diagnosis is likely correct. I went from feeling so hopeless, worthless, and unworthy of life that I decided I wanted to end it(and tried unsuccessfully to do so) to feeling better than I have felt in a very long time, perhaps better than ever in just 12 days. Looking back, I have probably had other hypomanic episodes.

What I really disagree with is the Cluster B personality disorder diagnosis. There are several disorders that fall in that category and there is only one that sort of describes me, borderline personality disorder.

The disorders and how they apply to me are as follows:
I was diagnosed with a Cluster B personality disorder. I really disagree with that. Cluster B personality disorders include antisocial, narcissistic, borderline, and histrionic personality disorders.

Antisocial is a pervasive disregard for the law and rights of others. The only laws I disregard are drug laws and I care much about the rights of others.

Narcissists have a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Not me at all. I usually feel that others are better than me. Admiration embarrasses me. I think I feel empathy for others just fine, though I might not express it.

Histrionics have pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions. I do not like to seek attention. I like to go unnoticed. I don't seduce people. I may sometimes be overly emotional though.

Borderlines have extreme "black and white" thinking, instability in relationships, self-image, identity and behavior often leading to self-harm and impulsivity.

Borderline personality disorder is the only one that might apply to me as I do have many of the problems described, though I don't think they are bad enough to meet the criteria for borderline personality disorder.

I see shades of gray on most issues, though in some cases I have black and white thinking. I don't have instability in relationships. I have a lot of problems with self image, often feeling inferior, feeling a hatred of myself, and feeling worthless and unworthy of life with other periods of feeling confident, optimistic, and equally valuable as my fellow human beings. There may be some problems with self identity, sometimes feeling like I have dramatically changed in ways that I usually can't define and sometimes feeling like I might not even be real. My behavior can be erratic at times. I am almost always nice and polite to everyone, but I often engage in harmful behavior such as burning myself or doing things that are harmful in a non physical way, and I tend to be impulsive with drug use and sometimes do stupid things like holding a long pole up in the air during a thunderstorm or doing other dangerous things just to get a thrill out of it. BPD can cause episodes of dissociation, which has happened to me a few times.

I have a few questions that I thought someone with a lot of knowledge of mental illnesses might be able to answer.

1. I know Bipolar II disorder can develop into the more serious Bipolar I disorder which causes full mania instead of hypomania. Is this a common occurrence?

2. Do I need to be on a mood stabilizer? I actually like the hypomanic state I am in and want it to continue, but am worried that it could evolve into full blown mania, which can even cause psychosis.

3. From what I wrote regarding Borderline Personality Disorder, do you think I'd meet the diagnostic criteria for the condition? What kinds of treatments might be helpful for that condition?

 

[panic in paradise]

these are some serious questions, and they could/should take a good a great deal of time for a doctor to answer, watching for long term patterns and any situational factors to maybe be resolved.

you should get 2 or 3 opinions no matter what, but especially with psychiatric diagnosis.
its good you are looking deep into yourself for answers, seeking and accepting others, but any answers that are attempted to be given here, could be dangerous at worst.


i see no problem discussing the questions you have generally, but specifically, that cant happen, even if we were MD's...
i dont want to close this, and leave you wondering and frustrated, i do know the feeling, so lets try and discuss the meaning of the diagnoses involved here.


please only share any relations or experiences youve have had posters.

 

[Lolie]

The whole personality disorders group is being extensively revised for DSM-5 as are the criteria for diagnosing them, so you're not likely to get a reliable diagnosis in that area in the short-term. Trying to diagnose yourself from the current DSM-IV criteria is both futile and dangerous because diagnosis is considerably more complex that whether or not you simply display certain symptoms.

Mood stabilisers are definitely the first line treatment for bipolar disorder, whether Bipolar I or Bipolar II because preventing the devastating depressions depends largely on preventing mania/hypomania.

Many people - including me - like early hypomania, but it's a mistake to believe that it's somehow more benign than full-blown mania. Frank psychosis is likely to be noticed by family and friends and action taken to get the person help. Hypomania can easily be mistaken for enthusiasm, passion, and drive until everything starts falling apart at the seams. People don't generally seek help because they're feeling great and nor do those around them usually suggest that they should.

Dialectical Behavioural Therapy is the treatment of choice for Borderline Personality Disorder at the moment, but people diagnosed with BPD rarely meet the diagnostic criteria ten years later so the new criteria will be looking at factors which should remain stable over time if true disorder exists.

 

[panic in paradise]

its true about the early stages of mania being something you feel is positive.

i took close to three years and several doctors, 10-12 in the room at once one time heheh, before i accepted that i did indeed fit the criteria for schizoeffecive-clinical depression... then 6 years after so many years on neuroleptics i stopped(that was a whooole other ball-game), then "relapsed" into psychosis for maybe 75-100 days, 6 years later.

during this period, the neuroleptics fucked me all up 3 times, i was given Lithium, my diagnosis changed from schizoefectve-c. depression to SE-bipolar I.
the only psych meds i take now are Klonopin(which i have been working on for 3 years, to get to a start stopping taper point), and Lithium, im totally dependent on the lithium, im astounded at the massive trickle down of relief i personally get from it. the thought i was never diagnosed with bi-polar honestly stuns me, its very clear that i can stay in chain~thoughts for days, 85% of my jealousy issues left in our relationship if that tells you anything, and i realized i was "addicted/very dependent" heh on mania to pretty great extents, and would go into mixed states up to days on end for most my life unwittingly...

i still after many years on the stuff, catch my-self thinking that i need a bit of mania,,, and then sometimes the Lithium will go and make me manic. this is very common, and understandable, you/we are in fact on a fkn run and its great :D absorbing, planning, arranging, doing, doing again :D feels good man. so much is learned and created, but, then inevitable negative sides come out, be it sleeplessness and exhaustion, or the crash and depression, watching what was done become neglected and not understanding how you can do it, generating more depressive thoughts into a physiological response.


IDK man, just sharing this shit that took a whole lot to learn,,, and a long long time.

are you familiar with Cognitive Behavioral Therapy? Suggestive/Hypno-Therapy? both of these are short, numerous sessions that you customize and can have with you, for me in pain i can trance, sleepless, high stress, inpatient, and after many years of practice CBT became adapted into my way of thinking.

working hard with a CBT therapist would be a good idea while you are in the process of diagnostics, it could change a lot... anyone with a psychological disturbance or not could benefit from more cognitive awareness, and accepting more responsibility of the schematic involved with the mental inner play we lead ourself into...


okay, hope some of what i said makes some sense,,, heh,,, keep us updated as much as possible. this is big stuff, seriously getting help with this could be something you look back on as a major major much needed chapter to end, and a new one to begin.
dont try and fight or struggle with this stuff, that will only open a door for it all, listen, learn, accept and know that you are only bettering yourself... not herding, hurting, accepting less of anything - just bettering, trying and learning in order to live better then you thought you previously could.

 

[Lolie]

Like pip, I believe CBT is so useful that everyone should be learn about it in Personal Development and Health in high school. I believe the same about meditation.

It took thirty years for my bipolar disorder to be diagnosed, and even then it was only a chance comment to my doctor which led to it happening. Looking back, it seems so obvious but it was only ever depression which took me to the doctor and nobody thought to ask me the questions which would have revealed that my depressive episodes weren't unipolar.

While I think that second opinions are often helpful in mental health as they are in physical health, it's important to remember that the DSM-IV is being overhauled so radically in part because it generates such poor inter-rater reliability (meaning that different doctors assessing the same patient will often reach a different diagnosis) and also because its current structure leads to clinical features of a disorder being diagnosed as a discrete disorder (meaning that it generates a high number of invalid co-morbidity diagnoses).

I think that it's really important in the early stages following diagnosis to look more at whether treatment is benefiting you than what label is attached to your disorder - because that label may change as a bigger clinical picture emerges and as treatment progresses.

Therapy is a really important part of managing bipolar disorder because there's often a pattern to major episodes and understanding that pattern plays a huge role in preventing future episodes. Learning to recognise the warning signs of an approaching episode is something a therapist can really help with.

At various times in the past bipolar disorder has been thought to be purely organic and largely environmental. The current consensus is that although its origin is organic, environmental factors play a big part in both the likelihood and severity of episodes - so better outcomes are expected from combining medication with managing environmental stresses than from medication alone.

One thing I think is worth exploring with your therapist is the ways in which certain symptoms might manifest themselves. Some are obvious but others are more subtle and not necessarily something you'd connect with a simple symptom list.

 

[Eyes On the Roll]

I'm bipolar I but have only had 1 full blown manic state, i usually have hypomania for a while, and depression for a while.
I've been depressed for quite a while and really hope i will be in a hypomanic state soon
Yes, your hypomania can evolve into a full blown manic episode. Thats what happened to me. I was in a normal hypomanic stage, and some stressors triggered a me to become full blown manic. I like my hypomanic stages a lot, but it does make me narcisstic and i find myself feeling extremely grandiose about myself and my goals. The only thing i don't like is the level of impullsiveness that comes with it.. I become very impulsive and will act on an idea with the flip of a switch, that usually involves drugs partying and a good time, and i usually walk out of the situation with a lot of money spent.

To stay away from a full blown manic episode you really just have to stay away from certain stimuli and stressors that trigger your depressed and hypomanic episodes. When I get my depressed stages like i am now, i tend to lock myself away from society and away from any form of stress possible, involving friends or girls.. shit i just don't want to deal with that can trigger me to do something bad

 

[Lolie]

^^^

Your post gives a good illustration of how people can end up with questionable co-morbidity diagnoses. Grandiosity, narcissism, impulsiveness, etc are common features of manic states and they can be explained by bipolar disorder alone without any valid reason to make a diagnosis of an additional disorder of which they are also features. It's one reason that a proper differential diagnosis is made which takes into account not just positive and negative symptoms but all of the other elements necessary for a diagnosis of a particular disorder.

Like you, I control my environment to an astonishing degree in order to limit my exposure to stressors which I know can trigger an episode. My home is both my sanctuary and my fortress and I'm quite ruthless about keeping it a protective cocoon for myself.

 

[paranoid android]

I was misdiagnosed by my first shrink as suffering from narcissistic personality disorder and i think anti-social personality disorder as well. I rarely saw the actual psychiatrist and i think i only met her 5 times as the other doctors at that clinic saw me more often and thought i had bipolar disorder from the start pretty much. But for some reason she suddenly switched my diagnoses to narcissistic personality disorder and then dropped me as her patient. This was inspite of the fact that i was very suicidal at the time due to her taking me off all my meds besides clonazepam and gabapentin the latter of which was prescribed to me for pain. So yeah it was pretty much just a way of her getting rid of me i think.

I finaly got to see another psychiatrist and i was diagnosed with bipolar NOS. Basically i don't fit into any neat catagory. I get hypomania alot and i used to get alot of mixed states before i got on the right meds but now i don't get them so much. I also get full blown mania that can last for over a week and i sometimes get psychotic symptoms as well. I also get long periods of major depression. I had mania so bad there early in the summer that i was on both risperidone and olanzapine (the zyprexa was for emergencies) and i was still manic on and off. So yeah real fun

Get a second opinion for sure. I know way too many people who have been diagnosed with personality disorders right out of the blue by doctors.

 

[Lolie]

^^^

"Mixed episode" is being dropped in DSM-5 and will now just be a descriptor used to indicate mixed features in a manic or depressive episode in the same way "psychotic features" is used now.

 

[paranoid android]

^^^

"Mixed episode" is being dropped in DSM-5 and will now just be a descriptor used to indicate mixed features in a manic or depressive episode in the same way "psychotic features" is used now.

Weird. Ya i have with psychotic features attached to the bipolar diagnoses though i rarely get psychosis these days since i take my anti-psychotics if i start feeling bad. The provincial government does not cover olanzapine here so im stuck with risperidone or seroquel and risperidone makes me feel kinda dumb and seroquel does not work that well for my mania or mixed states. So im stuck with risperidone although i have a few zyprexa zydis pills saved for emergencies.

Mixed episodes are nothing short of pure psychological torture and i wouldnt wish them on my worst enemy. I wonder if theyl chance my diagnoses because of that to maybe bipolar 2 or bipolar 1? Oh well. I get bad rapid cycling when unmedicated so i dunno where i fit in.

 

[Lolie]

A lot of people aren't aware that one of the main reasons the DSM was first developed was to create a standard set of diagnostic codes for insurers and it still serves that purpose. What treatment an insurer will pay for can often depend on the DSM diagnostic code provided. Income support eligibility can also depend on DSM diagnostic codes.

Seroquel was never previously subsidised here as a monotherapy for bipolar disorder for longer than six months - it could previously only be subsidised as a maintenance med if prescribed in combination with a mood stabiliser. That has only just changed and now it can be prescribed as a maintenance med for bipolar disorder on its own. Such restrictions often lead to doctors assigning DSM codes with those restrictions in mind.

Lamictal isn't subsidised here for anything other than treatment resistant epilepsy. Abilify is subsidised only for schizophrenia, Zyprexa for schizophrenia and maintenance treatment of bipolar I.

So even though the exact DSM label applied to someone can be largely irrelevant from a clinical standpoint, it can have a very real impact on their treatment options.

 

[Jabberwocky]

Most of the criteria for personality disorders aren't to be applied if they occurred only in manic or psychotic states, which some practitioners forget.

I had a psychiatric evaluation done years ago by a third year med student. On the basis of an hour with me it was concluded I had mixed personality disorders. Subsequent psychiatrists told me that a third year med student should never have conducted a psychiatric evaluation and that diagnosis of personality disorders requires a long term therapeutic relationship with a patient. A few sessions is never adequate.

A psychiatrist admitted to me that many new psychiatrists or some others feel a need to to not leave the axis 2 stuff blank, when axis 2 ought mostly be left blank especially in the presence of an axis 1 diagnosis. Individual institutions and practitioners are going to vary on these things a lot even though there are a lot of guidelines and best practices materials out there.

I also think certain personality disorders go through periods of extreme interest and over diagnosis by the mental health community. I think borderline has been in that position for about ten years now.

Another thing, some diagnoses are about getting people services. A Doctor might make sure to diagnose an axis two disorder in a system where only axis 2 folk get much psychotherapy time, mostly to ensure therapy is available rather than someone only getting 15 minute med checks every month.

 

[Lolie]

^^^

Fortunately the number of personality disorders will be reduced to 5 in DSM-5 and the general diagnostic criteria for a personality disorder will have to be met in addition to the criteria for the specific types. The dimensional model which is going to be used to assess whether a patient meets the general diagnostic criteria covers 6 domains of personality and also assesses severity of impaired function in the domains so a lot less people should find themselves with an unwarranted personality disorder diagnosis.

To be honest, I think that some of the over-diagnosis of personality disorders has been patient driven by people looking for "proof" that's what's wrong with their lives isn't their fault or within their control. Because the personality disorders are largely regarded as untreatable, they attract less external pressure to "fix yourself" than many Axis I disorders and psychiatrists aren't expected to "fix" it either.

 

[panic in paradise]

.....To be honest, I think that some of the over-diagnosis of personality disorders has been patient driven by people looking for "proof" that's what's wrong with their lives isn't their fault or within their control. Because the personality disorders are largely regarded as untreatable, they attract less external pressure to "fix yourself" than many Axis I disorders and psychiatrists aren't expected to "fix" it either.

that is an interesting observation... wow.

well as youve seen from all of our responses, none of us felt confident in our diagnoses. from our own, and others experiences we've become involved with, urging one to attend therapy for your own mental health, and to be observed allowing natural patterns to emerge or dissipate, and understand why.

taking the time and path of least resistance will get you there, and get you there more prepared.

what if any, psych meds have you tried?
how long?
how old?
and what was your experience?


trying a more unintrusive mood-stabilizer, like lithium if thats what being recommended, and seeing if any switches start swithing would be an easy way to get a factual diagnoses of Bi-Polar; reverse diagnostics, absolutely changed my life for the better-in this example.

i cant urge enough to avoid perceiving any degree of mania as positive, i mean if its occurring take advantage at a conscientious pace, practice CBT the entire time, and know that you as yourself are perfectly capable of accomplishing what you need and want according to the circumstances.
its easier to view it as a stimulant habit for myself, sure they will have you at first feeling creative, thoughtful, organized, passionate, involved, happy... but it wont last as it a temporary mental function occurrence causing this drive.
but maybe more importantly, applying this knowledge and discipline towards the depressive side can seem impossible, and worthless when you feel like everything always goes to shit, and that nothing in your life will ever change.

 

[Lolie]

Another feature which is now regarded as being definitively diagnostic of bipolar disorder is the onset of mania/hypomania following the prescribing of anti-depressants. It sounds like this may have occurred in the OP's case as she mentions the rapid time-frame for mood change.

I'd recommend working with your doctor to get the mood disorder stabilised before worrying too much about any provisional Axis II diagnosis. Sometimes you can luck in with the first lot of meds you try and sometimes it takes a while to hit the combination which keeps you stable with no dramatic mood swings in either direction. Different doctors also have their preferred combinations of meds, although a mood stabiliser and an atypical anti-psychotic seems to be the starting point for most people.

I would also stress the importance of finding both a psychiatrist and a therapist (I would recommend that you don't use anyone less qualified than a clinical psychologist for Axis I disorders like bipolar disorder) that you like and whose judgment you trust even if you must try several. Because our own judgment is impaired during depressive and manic episodes, it matters that we respect our health care providers enough to listen to them when they tell us we're not well.