What is a borderpolar? Has psychiatric research abandoned us?

So, borderpolar. After all, this is what this blog is, or better was, all about. In simple words, borderpolar is the comorbidity of bipolar disorder and borderline personality disorder. The article would basically stop here, or this blog would not even exist if the definition was all that mattered. Both disorders have been researched to quite a significant extent, after all. This article focuses on the impact of this dual diagnosis on a patient's life and the lack of optimal borderpolar treatment.

That's not to say that each disorder individually is easy to handle. Bipolar disorder is considered to be the fifth leading cause of disability among young adults. Add to that the fact that patients with bipolar disorder have a reduced life expectancy of 9 to 20 years. Patients with borderline personality disorder demonstrate a similar reduction in life expectancy. These numbers are present even though both disorders are considered major public health issues and have been researched significantly. I don't know the exact amount of patients that receive treatment for these disorders. But there must be quite a lot.

The first lingering question is whether these treatments actually work and to what extent. From my experience, many people with bipolar or borderline personality disorder can only expect things to be somewhat manageable. I don't consider myself part of this category. However, I think I was lucky in terms of genetics and the environment I grew up in. Things could have been much worse.

Comorbidity: borderpolar

The second and more important lingering question in the context of this article is the following: Is the body the equal of its parts? Asking my therapists, they responded that this is not necessarily true for mental illness. Meaning that having a set of mental health challenges does not necessarily mean that you treat that set as a union of each challenge individually.

The only online source about borderpolars, Dr. Mark Zimmerman's article in the Psychiatric Times, refers to an estimated 20% rate of comorbidity in diagnosing the two disorders.

That is, approximately 20% of patients with bipolar disorder have comorbid BPD and approximately 20% of patients with BPD have bipolar disorder.

Mark Zimmerman, Psychiatric Times.

Psychiatric research has focused on distinguishing the two disorders. Naturally, this guides psychiatrists to diagnose either one or the other disorder in patients. If the scientific community is biased towards an either/or diagnosis, how can the overlap percentage be reported — even in approximation — at 20%? It seems more like an “unknown” but a potentially high percentage. The direct consequence of this is that you cannot expect optimal borderpolar treatment when it is ignored.

Bipolar with/without BPD vs. BPD with/without Bipolar

Dr. Zimmerman explains that evaluating the impact of one disorder on the other has been dominated by studies comparing patients with bipolar disorder with patients with bipolar disorder and BPD. So the other side of the spectrum, the comparison between BPD patients with and without bipolar disorder, is not well researched.

Among bipolars, those with comorbid BPD reported more mood episodes, an earlier age of onset of bipolar disorder, greater suicidality, greater hostility, and a higher prevalence of substance abuse. For the record, I am 4/5 here, as my suicidal tendencies have been under control for most of my life. Unless my idea of “under control” is twisted.

As it turns out, there has been very little research conducted on the treatment of borderpolars too. Thus, we don't know how well they respond to each treatment and the closest-to-optimal treatment for borderpolars.

Of note, they found little research that examined treatment response, psychosocial functioning, time unemployed, disability payments, or prospectively observed longitudinal course.

Mark Zimmerman, Psychiatric Times

Dual diagnosis is a challenge

Moreover, it is hard enough to distinguish between unipolar depression and bipolar disorder. It's even harder to distinguish between bipolar disorder and borderline personality disorder. My psychiatrist told me that more and more researchers associate borderline personality disorder with the bipolar spectrum. Is bipolar disorder “just” a mood disorder? When two disorders are associated with the same part of the brain, can you clearly distinguish the two? Finally, when both bipolar disorder and borderline personality disorder are present, can this, in fact, be the presence of a more severe and versatile version of bipolar disorder that heavily affects personality? Or is it the other way around, for instance?

Do we really know what we are dealing with here, or are we just shooting in the dark in a best-effort manner? It is important to let at least the patients know that nothing is definite yet. You can look at the complexity of identifying the borderpolar comorbidity in our article about borderpolar symptoms.

Don't play psychiatrist

So, a few weeks ago, I ended up browsing r/suicidewatch on Reddit because I had found the post of a borderpolar who had overdosed on Zoloft (SSRIs) the night before. Another borderpolar told him that SSRIs don't work with BPD. How can you tell something like that to someone driven by an impulse on a suicide watch? Consequently, I decided to engage lightly and asked him who told him that. His psychiatrist did!

But I take Zoloft too, and it works like a charm on me, along with mood stabilizers. That doesn't mean I will go around playing the psychiatrist to people. The point is that it's both the patient's responsibility not to spread indefinite information and the therapist's job to explain that what they are saying isn't the gospel. Each case can be unique despite common patterns. I'm afraid that as a community, we shoot ourselves on the feet sometimes.

Same pattern, different treatment?

There is a fascinating aspect of the science of human behavior. Although people with mental health problems live different, unique lives, they seem to experience those lives in similar ways. I would go as far as saying that our brain is like a machine that takes any environmental input and twists it to a predetermined set of patterns of experiences and reactions. Two machines that produce similar patterns probably suffer from the same disorder. Expectedly, the twist's severity may be different, but there are always some clear-cut identical symptoms.

So why do two machines with the same problem react differently to the same treatment? Answering this question requires an amount of detail on mental illness research that is still missing. Let me be clear, and this is not an attack on psychiatric science or researchers. As a researcher myself, I know how hard things can be, even in computer science, where you at least have something concrete to work on. Obviously, identifying and classifying elements of behavior and understanding malfunctions in the human brain is on another level of difficulty. As a result, it is not a surprise that the same treatment may not work for two different individuals. The human brain is not a car. And it is affected by far too many environmental parameters to be treated like one.

Imagine suffering from multiple disorders at the same time and receiving hit or miss medication for this comorbidity. Borderpolar treatment seems to follow these lines.

Borderpolar: something old or something new?

So, going back to borderpolars, is it possible that the chain reaction between two disorders can deepen the impact they have on the brain? Firstly, it is important to identify cause and effect. For instance, when bipolar disorder is onset at a young age, it manifests mostly as depression. Secondly, is it that surprising for a depressed teenager to start developing borderline or narcissistic personality traits in their effort to overcome loneliness and depression? Moreover, can a mood disorder be the reason for such significant changes in personality? Furthermore, can bipolar disorder result from the brain trying to battle depression so that it becomes unsustainable?

It goes without saying that there are many questions related to borderpolars that have not been answered as there are a ton of questions about borderline personality disorder and bipolar disorder that have not been answered.

However, Dr.Zimmerman's article's significance does not result just from its unique presence on the internet because Dr.Zimmerman points out the importance of handling the comorbidity of two disorders with similar causes and overlapping symptoms with caution and skepticism.

 It is our hope that by giving this group of severely ill patients a unique name-borderpolar-the recognition of this comorbidity will increase. And, as such, there will be increased efforts to identify the most effective treatment approaches.

Mark Zimmerman, Psychiatric Times

What the future holds for borderpolars

I've been talking to borderpolars on an almost day-to-day basis. And this experience has led me to believe that I am one of the luckiest borderpolars out there. I have it “easy,” as I have responded to medication much better than others. I have no idea why but answering questions like this matters.

But a positive outcome will not necessarily affect this generation. Unfortunately, even if psychiatric research makes significant progress in the case of borderpolars, it will probably be too late for a lot of people of this generation. However, our children will inherit this condition. As a result, it goes without saying that progress in the diagnosis and treatment of borderpolars needs to be made.

We have to admit that society tends to neglect people with disabilities. Also, it is tough for people with disabilities to advocate for themselves due to their condition. It is the responsibility of those of us who are doing better to be advocates of their needs. I don't know if “borderpolar” is interesting for the scientific community.

However, what I know is that “borderpolar” is probably the sum of two things. Yet what that sum accumulates to is still quite unknown.

Finally, I know that I have found far too many people affected by this, just sitting and waiting for people to understand its importance. The necessity for better borderpolar treatment is emphasized because we are a high-risk group of patients. That is why knowing matters. I don't expect anyone to start drawing attention to this condition in my place. I will try my best to draw attention to this condition myself. Nothing comes for free.

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