Tuesday, June 19, 2012

BPD and Mood Disorders

Did you know ?

If you have BPD (borderline personality disorder) chances are very high you will also have a mood disorder (a.k.a affective disorder)

One study found that about 96% of patients with BPD met criteria for a mood disorder. 

  •  about 83% of patients with BPD also met criteria for major depressive disorder(aka clinical depression)
  • about 39% of patients with BPD also met criteria for dysthymic disorder.
According to NAMI :
Co-morbidity with other disorders:
Major Depressive Disorder                                                --  60 percent
Dysthymia  (chronic, moderate to mild depression)          --  70 percent
Eating Disorders                                                               --  25 percent
Substance Abuse                                                               -- 35 percent
Bipolar Disorder                                                                -- 15 percent
Smiley green alien drunk sad.svg

What is Major Depressive Disorder?  (MDD)

Clinical depression (also called major-depressive disorder, or unipolar depression when compared to bipolar disorder) is a common mood disorder it is a serious disabling illness that involves the body, mood, and thoughts that cannot simply be willed or wished away. A person's enjoyment of life and ability to function socially and in day to day matters (work, school, sleeping and eating habits...) are disrupted by intense sadness, melancholia, numbness, or despair. Recurrence of clinical depression is common, and suicide or suicidal thoughts are a major risk.

What is Dysthmic Disorder ?

Dysthmic disorder(or dysthmia) is a chronic long-lasting form of depression sharing many  characteristic symptoms of major depressive disorder (MDD).The symptoms tend to be less severe but do fluctuate in intensity.

Is it depression or Borderline?

Clinical depression is associated with excessive guilt and sadness.

Borderline depression is associated with strong feelings of emptiness, anger, deep shame (such as feeling evil),intense boredom,restlessness,sadness,desperate loneliness , fears of abandonment,acute suicidal thoughts and self-injurious behavior .These feelings are frequently triggered by some life events  (for example, an argument with a parent, boyfriend, spouse, or boss).The symptoms will often improve if the situation causing them improves.Sleep appetite and energy disturbances (if present) are usually related to an identifiable life stress and stop when the stress is managed successfully.

Full details of a major depressive episode can be found here http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=427# 
But here is a less complicated summary from bpddemystified.com :

Symptoms of a Major Depressive Episode:

persistently depressed or irritable mood
diminished interest or pleasure in activities
significant decrease or increase in appetite, or weight loss or weight gain
increased or decreased sleep
decreased mental and physical activity, or increase in such activity as demonstrated by excessive worrying and agitated behavior
fatigue, or loss of energy
feelings of worthlessness or excessive or inappropriate guilt
diminished ability to think or concentrate, or indecisiveness
recurrent thoughts of death and dying, recurrent suicidal thoughts with a specific plan, or a suicide attempt

In major depressive disorder, the symptoms of a major depressive episode listed above are often characterized by:
decreased appetite or weight loss
decreased sleep with early morning awakening
increased mental and physical activity as demonstrated by excessive worrying and agitated behavior

Bipolar II Disorder-Depressed*
In bipolar disorder-depressed, the symptoms of a major depressive episode listed above are often characterized by:

increased appetite or weight gain
increased sleep and napping
marked decrease in mental and physical activity
marked fatigue and loss of energy

* Bipolar I and II, and major depressive disorders occur more commonly in patients with borderline disorder than they do in the general population. Bipolar II disorder is the most common type of bipolar disorder that occurs with borderline disorder. People with bipolar II disorder do not experience manic episodes as do those with bipolar I disorder, but do experience brief hypomanic periods and recurring episodes of depression. Depressions associated with bipolar disorder appear to be related to depressions referred to as atypical depression and seasonal affective disorder (SAD).

Atypical Features

The essential characteristics of atypical features are the capacity to be cheered up when experiencing positive events and two of the following: increased appetite and weight gain, nighttime sleep and napping of at least ten hours duration, or two hours more than usual, feeling heavy, leaden, or weighted down, usually in the arms and legs, and moderate to severe sensitivity to rejection.

So What Should I be Treating 1st?

Patients with both a personality disorder and depression have poorer responses to treatment (medication and psychotherapy) than those without a personality disorder.BPD tends to worsen the depression.
Research has shown that if a patient with both BPD and depression is treated for BPD and sees improvement in those symptoms, the symptoms of depression also seem to lift. But, this effect seems to only work in one direction (i.e., treatment solely focused on depression does not seem to alleviate BPD symptoms in patients who have both conditions).

What to do if I have both depression & BPD?
Look into the different treatment options available in your area, try to treat the BPD first.Some options are listed here 


This is a very good free 2012 article on the treatments & new facts of BPD with co-morbid depression (easy to read with a nice summary) don't forget to send a thank you email to the researchers if you found it helpful ;-)

and my post on new treatments

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