Often, I’m asked about what the difference is between a Mood Disorder and Borderline Personality Disorder.
Part of the difficulty is our present diagnostic system: So many symptoms and observable behaviors are shared by different disorders that at times it’s extremely difficult to distinguish between them.
To make things even more complicated, there is a concept presently called co-morbidity or co-occurring disorders. This means an individual may have a Personality Disorder such as BPD as well as a mood disorder. Many symptoms can be caused by any one or a combination of these disorders.
This is why you need a skilled clinician and a multi-modal approach to determine the most effective treatment.
My 30-plus years of clinical experience has taught me that, rather than obsessing about the diagnosis, focus on what helps you the most, taking into account your presenting symptoms, history, genetic, biologic and social history.
This helps get to the core of the issue.
To the degree that a clinician feels compelled to fit a patient into a particular category, it is sometimes to that degree that the patient may not be availed of a treatment approach that, while theoretically inconsistent, could prove to be helpful. Having some awareness of the contribution of a mood disorder and the possible contribution of a personality component can help construct a rational approach that helps you.
Understanding somebody’s thinking style and the ways they mange anxiety is, many times, more important than a diagnostic label. When working with someone with a Black-or-White, idealized or perfectionistic thinking style, a form of talking therapy is necessary. Medications may be of benefit to help decrease anxiety.
Pharmacological approaches to treating mood disorders may not only be beneficial but in serious mood disorders, such as bipolar, they are essential to help the individual move forward.
Whether medications are helpful for personality disorders is not as definitive: There do not seem to be any clear pharmacologic, short-term resolutions. The assumption is that it took a long time for a personality disorder to evolve and it may take a long time for that person to change and develop more skillful coping habits.
There have been major changes of a positive nature in treating individuals with Borderline Personality Disorder with the advent of treatment strategies such as cognitive behavioral, mentalization and Dialectical Behavioral Therapy.
These have proven to be extremely effective in stabilizing and beginning growth. When combined with mindfulness techniques and Transformative Renewal Therapy℠ (TRT), growth and movement toward independence can occur.
All of us are a composite of our personality structure, our thinking and feeling mind and its expression in terms of anxiety, depression, and disorders of thinking. We may try to separate these based on biologic or genetic physiologic balance, but they are inseparable.
If you have any follow-up questions to this post, feel free to leave them in the comments below and I’ll be happy to respond.
Dr. Robert Fischer, MD