This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Tuesday, May 5, 2009

Borderline Personality Disorder

Borderline Personality Disorder: Lack of one's own
identity, with rapid changes in mood, intense unstable interpersonal
relationships, marked impulsively, instability in affect and in self image.

We have always believed that while Kitty (and Bear) have shown traits of Borderline Personality Disorder, that they could not be diagnosed with it until they are 18. In talking to Kitty's psychiatrist today I learned that this may not be the case. Over a year ago Kitty was diagnosed with BPD traits, now I'm wondering if we should look into this further.

Personality disorders are not formally diagnosed in patients younger than
18 years because of the ongoing developmental changes. However, if the
disturbance is pervasive and if the criteria are fully and persistently met and
are not limited to a developmental stage, diagnosing borderline personality
disorder (BPD) in children and adolescents is appropriate.

I think the following description of BPD in children, really fits Kitty well especially the excessive use of fantasy. She spends hours outside in the backyard talking to herself (usually wildly gesticulating). Another typical symptom is self-mutilation, which I do not see with Kitty (although Bear did some cutting); however, Kitty is so unaware of how her body feels, almost complete dissociation, that she is constantly encouraging others to try to hurt her and runs into things all the time. I do not believe she would get the relief that some describe that comes from cutting.

Andrulonis evaluated a population of 45 children (aged 5-12 y) who met the
Diagnostic and Statistical Manuel, 3rd Edition, (DSM-III) and Gunderson criteria
for BPD.17 The primary behaviors that differentiated these children from the control group were aggression and rage, attention deficit hyperactivity disorder, excessive use of fantasy, impulsivity, and poor relationships.

While Bear's issues seem to have dramatically improved and I am not too worried about him having to deal with this as an adult, with Kitty I am not so sure. They both have all the precursors.

Although the borderline condition in childhood is not necessarily a
precursor to BPD in adulthood, evidence suggests that both have strikingly
similar risk factors, which might indicate a common etiology. These factors
include family environments characterized by trauma, neglect, and/or separation;
exposure to sexual and physical abuse; and serious parental psychopathology,
such as substance abuse and antisocial personality disorder.

I looked into the differences between bipolar disorder (which Kitty is diagnosed with) and BPD. Honestly I think she might have both, but it was impossible to find someone who compares bipolar disorder in children with BPD in children, and bipolar in children is much different then adults.

"Bipolar disorder is essentially a mood fluctuation disorder, characterized
most often by depression. Bipolar people can abuse substances, but
otherwise they do not typically show the range of different symptoms BPD people

BPD individuals can be depressed, but BPD is essentially a
hyperreactive/impulsiveness disorder with mood features, but also other symptoms
affecting thinking and perception, self-concept, relationships, etc.

BPD involves instability not only of mood, but of perception of self,
perception of others, relationships, behavioral consistency, self-control, etc.
The mood disturbances in Bipolar Disorder typically are along a
depression--mania dimension; (mania, hypomania) with BPD, however, mood
disturbances typically involve the dimensions of anger and anxiety.

Most BPD patients do not have mania (sustained hyperactivity and elation),
though they can often act impulsively." (Daniel C. Claiborn Atlanta)

"In bi-polar the self-destructive behaviors are because the individual feels all powerful and invincible, whereas in the BPD the self-destructive behaviors are an attempt to stop pain. It's a huge

(I feel Kitty leans more to the BPD side on this one.)

In bipolar disorder mania or hypomania must be present for the diagnoses to be made. Many individuals with the BPD have been erroneously diagnosed with
bipolar because of the mood swings, even though they've never had mania or
(With Kitty's diagnosis of ADHD I have no idea how you would
tell the difference).

Can we confuse bipolar and BPD? Well, in theory, not !

  • Cycles in bipolar disorder are theoretically of rather long duration, sometimes a few months what is not the case in the borderline disorder.

  • The Bipolar has long periods of remission during which he is well, we cannot say the same with bpd peoples

  • The bipolar will suffer its cycles, basically no matter what it does, and independently of external factors, whereas in the borderline disorder cycles are the fruit of its emotions and its impulses, in short of lived moment what explains the speed of mood swing and the misleading feeling that he has several personalities

  • Borderline people are unstable almost in all domains like self-image, relationships, black and white thinking, emotions , ... what is not the case with bipolar

Unlike most adults who have bipolar disorder, however, children who have pediatric bipolar disorder are characterized by abrupt mood swings,
periods of hyperactivity followed by lethargy, intense temper tantrums, frustration and defiant behavior. This rapid and severe cycling between moods may produce a type of chronic irritability with few clear periods of peace between episodes

Can the BPD / Bipolar diagnosis be made with working medication? It seems
to be not possible to say "this medication is working, it is then the evidence
that my diagnosis is...". As the studies are saying, bipolar medications like
lithium and anticonvulsivants are also well responding with BPD so we can't use
such result for diagnosis.
One more depressing point:

    • "Bipolar is Axis I, BPD is Axis II. Insurance companies usually DO NOT
      cover Axis II diagnosis... An official diagnosis of bipolar disorder 'with'
      borderline personality traits is better then a single diagnosis of bpd, because
      bpd is NOT covered by most insurance companies" (Kathi's Mental Heath Review)

    • BPD is frequently called bipolar in a hospital because BPD is not covered by insurance companies since it is viewed as a "personality disorder" and not amenable to change" (bpd sanctuary)

    • "The statistic of 2% cannot be accurate for the following reasons: clinicians are actively discouraged from putting BPD on a patient's chart because of the stigma and insurance denials and because most clinicians do not have the training to make a diagnosis" (bpdcentral)

If we refer to long-term studies, we can see that bipolar disorder (BP I and BPII) are life long disorders. There are treatments to better live with BP disorders but it seems that we can't talk about "cure." For bpd, the problem is different, there are treatments but we also have the possibility to speak about "cure." Several studies show that most Bpd people can no longer be diagnosed with a bpd disorder after some years of treatment. The "funny" thing is that a lot of therapists don't hesitate to diagnose a person as "bipolar" but are afraid to diagnose a people as "bpd"... it seems that it is because they have in mind that there is no hope for bpd people. It is totally false!
So there it is. Does Kitty have BPD? Maybe. She definitely has a lot of the traits. Does she have ADHD? Well the stimulants work, and without them she is obnoxiously hyper, so almost definitely. Is she bipolar? She has the genetics for it, and a lot of the symptoms, so probably.
I wish the kids only had one diagnosis, and that all the diagnoses didn't overlap. Add in the RAD, PTSD, ODD and I don't know what is causing symptoms or how to deal with it or treat it.
We know a lot about our kids and have learned a lot about their diagnoses, but it makes me so nervous when the psychiatrist asks me what I want to do. Not that I don't want her to ask my opinion, but I'm not a psychiatrist either. I've always wanted a magic ball. Guess I'll just have to keep praying that I'm making the right decisions.

1 comment:

Kristina P. said...

What a difficult situation! BPD women are very difficult to work with, I have to admit. The therapeutic relationship can be difficult because of their issues with relationships in general.

I hope you get the answers you are seeking!