Diagnoses Articles

Article / Updated 10-20-2023

Maybe you’re wondering whether you’re codependent. It may be hard to tell at first, because, unless you’re already in recovery, denial is a symptom of codependency. Whether or not you identify as codependent, you can still benefit from alleviating any symptoms you recognize. You will function better in your life. Recovery helps you to be authentic, feel good about yourself, and have more honest, open, and intimate relationships. Like most things, codependency varies on a scale from minimal to severe. When you’re under stress, symptoms flare. Some individuals show only slight symptoms, while others have all of the typical characteristics Some traits and examples may sound foreign, while you can relate to others. The severity of codependency varies depending on a number of things, such as the following: Your genetics Your culture, including your religious beliefs Your family’s dynamics Your experience of trauma Your role models Your addictions or use of drugs Intimate relationships you may have or had with addicts If you’re codependent, generally symptoms show up to some extent in all your relationships and in intimate ones to a greater degree. Or codependency may affect your interaction with only one person — a spouse or romantic partner, a parent, sibling, or child, or someone at work. Codependency may not affect you as much at work if you’ve had effective role models or learned interpersonal skills that help you manage. Maybe you weren’t having a problem until a particular relationship, boss, or work environment triggered you. One explanation may be that the parent has a difficult personality or the child has special needs, and the couple has adjusted to their roles and to one another, but avoids intimacy. The spectrum of codependency is illustrated in the figure below. The horizontal vector shows how opposite codependent personality traits can manifest in a relationship. Individuals may reverse roles. For example, you may be the pursuer in one relationship and a distancer in another, or flip back and forth in the same relationship. In an alcoholic marriage, the sober spouse may scold and blame the irresponsible, needy alcoholic, who behaves like a victim. Then their roles switch, and the alcoholic dominates and controls his or her partner. Sometimes the spouse who acts needy or “crazy” gets well, and the self-sufficient, invulnerable partner breaks down. Both the disease and recovery exist on a scale represented by the vertical vector here. Codependent behavior and symptoms improve with recovery, described at the top, but if you don’t take steps to change, they become worse in the late stage, indicated at the bottom. As you get better acquainted with the symptoms and characteristics of codependents, you may see yourself. If you feel overwhelmed by the thought of having codependency, instead focus on the patterns and behaviors you want to change. If you’re committed to change, it really doesn’t matter whether or not you consider yourself a codependent. However, it’s important to realize that codependency won’t get better or go away by itself. Support is essential, because you won’t be able to make permanent changes on your own.

Article / Updated 10-20-2023

Guilt can, in some instances, actually lead to self-improvement and build self-esteem. The problem for codependents is that their guilt is usually irrational and stems from shame and poor boundaries. Studies show that healthy guilt encourages people to have more empathy for others, to take corrective action, and to improve themselves. Shame, on the other hand, makes you feel inferior, inadequate, or bad about who you are versus what you did. Unhealthy guilt impedes self-acceptance. Self-forgiveness is self-essential to self-esteem. Yet for many codependents, self-acceptance remains elusive because of unhealthy guilt — sometimes for decades or a lifetime. It may be an unrelenting source of pain. You might hold a belief that you should feel guilty and condemn yourself — not once, but over and over — or guilt may simmer in your subconscious. Either way, this kind of guilt is insidious and self-destructive and can sabotage your ability to find happiness and achieve your goals. Here are things you should examine when you feel guilty: Guilt shouldn’t drag on and preoccupy you. When guilt is irrational and not absolved, it can lead to shame. Instead of enhancing empathy and self-improvement, it has the opposite effect. It causes greater self-preoccupation and undermines both the self and relationships. It also promotes aggression and depression. You may be punishing yourself unnecessarily. Are you harder on yourself than others? Would you keep punishing someone over and over for a mistake, or would you forgive them? Guilt causes anger and resentment, not only at yourself, but toward other people in order to justify your actions. Anger, resentment, and guilt sap your energy. They keep you stuck in the past and prevent you from moving forward. A better approach is to think of your mistakes as learning opportunities. To be sure, you’ll have another chance to do things differently next time. Guilt about your thoughts and feelings impairs rather than promotes self-acceptance. You may feel guilty not only for your actions, but also for your thoughts (for instance, wishing someone pain, misfortune, or even death); your feelings (like anger, lust, or greed); or your lack of feelings (such as not reciprocating love or friendship or not feeling grief over the loss of someone close). You may be feeling guilty for things others have done. Because of a lack of boundaries and low self-esteem, it’s common for codependents to take the blame for others’ behavior. Although irrational, you may feel guilty for the thoughts, attributes, feelings, and actions of someone else. You may be adopting others’ projections. You might judge yourself based upon the blame or false accusations emanating from others, which you accept to be true. For example, an abuser or addict may blame you to avoid responsibility, but you take on that blame. If your partner is a narcissist, they might accuse you of being selfish, even though your partner is the one who is selfish. Rationalizing or ignoring your guilt helps only temporarily, but it isn’t the same as self-forgiveness. Alternatively, beating yourself up prolongs guilt and shame and damages your self-esteem. The best approach is to face what you did, accept responsibility, do some self-examination, and take remedial action.

Article / Updated 10-20-2023

Good parenting requires having appropriate and flexible boundaries that respect individuality and separateness. In healthy families, parents respect emotional, mental, sexual, and physical boundaries. In dysfunctional families, boundaries are rigid, blurred, or a mixture. Individual boundaries When boundaries are too rigid, family members are likely disengaged emotionally and physically. There may be no feeling of closeness, nor affection showed. As adults, siblings may be emotionally distant, and families may not often celebrate together. On the other hand, when boundaries are nonexistent or enmeshed, family members may feel as though they have no right to set boundaries. They may gossip and overreact to each other, give unwanted advice, and invade each other's personal space. In the same vein, some controlling parents may disrespect their children's decisions and control their hobbies, school courses, friends, and personal dress styles. Parents may also invade boundaries by prying, reading their children's mail, questioning their friends, and ransacking or taking their belongings without permission. One likely explanation for this behavior is that some parents resist their children's urge to separate because they want to be needed. They see natural independence as disloyalty and abandonment. Children, on the other hand, may either rebel or feel guilty when they try to set boundaries with their controlling parents and with others as an adult. Your experiences with individual boundaries As an exercise, describe the boundaries in your family growing up in the following areas: Money Your personal belongings Physical touching and showing affection Sex and nudity Emotional — respect for your feelings Mental — respect for your thoughts and opinions Generational boundaries There are also generational boundaries between parents and children, which can be violated if children are put in an adult role. This often happens when a parent becomes overly close with their child and uses them as a companion, as a confidante to discuss their parental relationship or personal problems, or as an ally against the other parent. In this case, the child functions as an emotional surrogate for the lack of intimacy between the parents and/or as an ally or pawn in their power struggles. After a divorce, generational boundaries are often disrespected when one parent uses a child to convey messages to the other parent. Generational boundaries are also crossed when a child takes over parental responsibilities for an irresponsible or emotionally or physically absent parent. This can happen in single-parent families or if one parent is ill, in the military, or an addict. Some children as young as 5 are left to make their own meals. One child may assume the role of “little mother” or “little man” and take care of younger siblings or a needy parent. This is how many codependents learn to become over-functioning adults and caretakers. Some receive praise for doing so, and their role becomes part of their personality as adults. Your experiences with generational boundaries? Crossing generational boundaries is psychologically damaging. If this happened to you, you likely had to repress your needs and feelings in order to adopt an unnatural, age-inappropriate persona (be “a little adult”) to accommodate the needs of your parent. This may have separated you from your authentic child-self. Think about boundaries between generations: Did you have to perform adult tasks or assume adult responsibilities? Did a parent inappropriately confide with you? Did a parent ask you to talk to your other parent for him or her? Did you believe you had a special relationship with a parent who excluded your other parent? How did you feel in each of these situations?

Article / Updated 10-20-2023

The best advice in healing from codependency would be “love yourself.” Does that sound kind of cheesy? Probably. It might even feel wrong because you’re so used to loving other people. Or you may not even know how to love you. But think about those you love. You want to know them, support them, encourage them, give to them, and make them happy. Your love for them involves actions as well as feelings. Do you do that for yourself? Here are a few ways you can start. 1. Have a spiritual practice Love yourself by spending time alone. Whether or not you believe in God, a spiritual practice is an excellent means of creating a deeper relationship with your self. What better way is there to honor yourself than by setting aside some quiet "me-time" each day? A spiritual practice doesn’t require religious beliefs. Your intention may simply be to find a centered, calm place to access inner guidance, to develop reverence for life, or to experience harmony with yourself and others. Listening and finding truth gives you greater confidence, clarity, and peace. It helps you let go of control and be less reactionary, despite what’s happening around you. 2. Receive support Asking for and receiving help is another way to love yourself. Human beings are social animals, and we need each other. When you’re lonely, confused, anxious, overwhelmed, or in the dumps, reaching out is a way of giving to yourself. Sometimes, turning to God brings comfort and guidance. Other times, your emotions take over, and you’re unable to think or calm yourself. That’s when you need others. There are times when everyone needs support. When problems persist and don’t go away on their own, that's a sign you may require more than friends can offer. Unfortunately, some people believe that asking for and receiving help are signs of weakness. If you’re used to helping others, you probably don’t feel worthy of or comfortable receiving help. Changing that pattern is growth. Whether it’s going to a meeting or seeking professional counseling, getting support isn’t an indulgence or a character flaw. In fact, it takes self‐honesty to know your limits, and humility and courage to ask for help. Doing so allows others to give and feel close to you. Appreciating their love and support is both human and healthy. 3. Meet your needs It's key to attend to your own needs. If you’ve been tending the needs of others but neglecting your own, it’s time to turn that around and put yourself first. The reverse can also happen — you expect others to fill needs that are your responsibility. Be sure to address your basic, physical needs, such as healthy food, rest, exercise, and medical and dental checkups. Give special attention to needs you may be overlooking. When you’re lonely, sad, angry, afraid, overwhelmed, confused, tired, or feeling like a victim, ask yourself what you need. If you’re depressed, you may have been avoiding and neglecting yourself for a long time. Some needs are met by others, such as needs for intimacy and friendship. It’s your responsibility to speak up and ask for what you need and want. Don't expect others to develop ESP and read your mind — that only leads to resentment and conflict. 4. Have fun Show love to yourself by planning pleasure, recreation, and hobbies. Though they might seem trivial, these are needs, too. Focusing on a problem often makes it worse. Without balance, pain can turn into self‐pity and become a way of life. There are also people who take themselves too seriously. They develop tunnel vision when it comes to work and problems. For them, living is a struggle, a competition, or a test of endurance and achievement. You may have forgotten how to laugh and enjoy yourself, which is important in maintaining balance in both your body’s chemistry and your life. Life isn’t meant to be a burden, but to be enjoyed. Celebrate it by making time to relax, play, and be creative — activities that are rejuvenating and bring you into the present. Sometimes, when you take a break and have fun — even for a short time — your worries magically dissolve, and you gain a new perspective on a problem. Pleasure restores your energy and sense of well‐being, which not only nourishes your soul, but also enhances the productivity and quality of your work. 5. Protect yourself Keeping yourself safe from physical, mental, and emotional abuse is an essential part of showing yourself love. Loving someone doesn’t mean you have to accept insulting or ­demeaning words or behavior. If you think you’re being abused, don’t waste your energy or risk your safety trying to change the abuser, explaining your position, or proving your innocence. It won't change them, and it make things more difficult for you. You didn’t cause, nor are you responsible for, other people's words or behavior, but you do have a responsibility to protect yourself and your children. You have a choice to speak up, set limits, disengage from the conversation, leave the room, get professional help, call the police when there’s violence, or end the relationship. 6. Accept yourself Love yourself as the unique individual you are, including your appearance, feelings, thoughts, and addictions. You don’t have to earn respect or prove anything. You’re deserving of love and respect as a human being with flaws and failures. Notice if you’re trying to change for someone else’s validation. Instead, remind yourself that being yourself is more important. When you practice self‐acceptance, you stop worrying about what others think and can be more authentic and spontaneous. Becoming and accepting yourself takes time. Forcing change with constant self‐evaluation and self‐judgment keeps you stuck, but self‐acceptance allows change to happen with little effort. When you slip or make mistakes, remember that self‐criticism compounds them. It’s much more productive to forgive yourself and focus on your behavior in the present. 7. Be gentle to yourself As the old song goes, "try a little tenderness." Love yourself with gentleness and compassion. Modulate your inner voice so that it’s calm and kind. When you’re afraid or in pain, blaming yourself or thinking there’s something wrong with you makes matters worse. When you’re tempted to ignore your feelings and distract yourself with more activity, obsessions, or addictive behavior, practice just being with yourself. Just as you would for a friend, be the one who is there for you with gentleness and compassion in your anxiety, sorrow, hopelessness, anger, and terror. The child within you needs you. Comfort yourself with all the tenderness you would a crying child or wounded animal. Listen, forgive, and embrace your full humanness. Develop the trust that you can count on yourself. 8. Encourage yourself Give yourself encouragement and enthusiasm. Transform your inner critic into a positive coach. Get in the habit of finding things you do well and acknowledging them. Don’t wait for others to appreciate and compliment you. Appreciate and compliment yourself. In fact, repeat praise over and over. Instead of taking your good qualities for granted, notice them, and give yourself credit. Look for small things you do right and well. Stop doubting yourself, and pay attention to every small sign of progress toward your goals. Tell yourself you can make it — you can do whatever you desire. When you love yourself with encouragement, you'll soon see your self-confidence grow. 9. Express yourself Madonna was on to something with this lyric. Your self has been hidden too long. Healing shame requires that you risk being seen. Commit to stop hiding and honor yourself by communicating your feelings, opinions, thoughts, and needs. You have a right to think and feel what you do without explanation or justification. Your self‐respect and the respect you receive from others will grow. Self‐expression also includes your creativity. There are all sorts of different mediums where you can explore expressing yourself: music, writing, design, art, cooking, crafts, dance, or wherever else your creativity leads you. Tell your inner critic you’re creating for fun. There's no room for them here. 10. Pursue your passions Finally, tune in to your true passions. Only you hold the keys to your happiness. Talking yourself out of pursuing your desires leads to discontent and regret. Even if your desires are impractical or unprofitable, don’t allow those obstacles to discourage you. Every day, take one small step toward realizing your goals or doing something that excites you. If you’re uncertain about your passions, pay attention to what stimulates you, or try some new things. Listen to what calls to you, follow your inspiration, and take risks to experience the fullness of who you are. If you’re depressed or overwhelmed, it can be hard to think about positive goals. For now, make your recovery your number‐one objective. In time, you will have more energy and motivation about the future and your desires. Be patient. Goals or a specific direction eventually emerge.

Article / Updated 10-18-2023

Although mental health clinicians recognize codependency when they see it, the definition of codependency and who has it has been debated for decades. Experts agree that codependent patterns are passed on from one generation to another and that they can be unlearned — with help. An overview Therapists and counselors see people with an array of symptoms, such as depression, anxiety, addiction, or intimacy and relationships issues. Clients are hurting and often believe the cause is something outside of themselves, like their partner, a troubled child, or a job. On closer examination, however, they start to see that, despite whatever else may be going on, their behavior and thinking patterns are adding to their problems — that is to say, their patterns are dysfunctional. These patterns have an addictive, compulsive quality, meaning that they take on a life of their own, despite their destructive consequences. The root problem is usually codependency. Why relationships hurt Along with comfort and pleasure, intimate relationships especially evoke all your hopes, fears, and yearnings. You want to feel secure and be loved, appreciated, and taken care of. Dependence upon those closest to you further magnifies your emotional needs and vulnerability to being rejected, judged, and seen at your worst. Codependency is a particular kind of dependence. It’s insidious and ­powerful. It robs you of joy, peace of mind, and the ability to have sustained, loving relationships. It affects your relationship with yourself and limits your flexibility and the natural flow of relationships with others, including giving and receiving love and support and the ability to communicate, compromise, and problem-solve. All the symptoms work together to not only deprive codependents of the benefits possible in relationships, but they also create problems that wouldn’t have otherwise existed. For example, shame and low self-esteem make you insecure, anxious, and dependent upon others’ acceptance and validation. You may feel uncomfortable being yourself and be hypersensitive to perceived criticism or abandonment (even where neither exists). You may attempt to control or manipulate people to maintain a relationship and to be liked. Some codependents require repeated reassurances or are afraid to be direct and honest, which is necessary for effective communication and real intimacy. Childhood shame and trauma conceal their real, core self, which they can’t access. Instead, codependents develop a persona in the world that reacts to others, to their own self-criticism, and to their imagined ideal of who they should be. To be acceptable to others and to themselves, you hide who you are and become who you aren’t. You may not even be aware of how self-critical you are but suffer the “tyranny of the should’s” — a phrase coined by psychoanalyst Karen Horney (pronounced “Horn-eye”). Even though you may not relate to this, it still operates beneath your conscious awareness. You may only be aware of your persona illustrated here and nothing on the inner circles. Credit: By Darlene Lancer All relationships require boundaries. Love is not safe without them. Yet many codependents tolerate being treated without respect, because they lack self-worth. They don’t feel entitled to compliments, to be truly loved, or to set limits. They might do more than their share at work or in a relationship to earn acceptance, but they end up feeling unappreciated, used, or resentful. Shame can also cause codependents to deny or discount their feelings and needs, both to themselves and in their relationships. To cope, they sometimes disregard what’s actually happening, ruminate with worry or resentment, or finally explode. Their denial and confusion about their boundaries and responsibilities to themselves and to others create problems with intimacy and communication. Instead of bringing couples closer, frequently communication is avoided, is used to manipulate, or is highly reactive, leading to escalating conflict and/or withdrawal. Nothing gets resolved. They end up feeling trapped and unhappy because their symptoms paralyze them with fear of rejection and loneliness. The symptoms of codependency are all interwoven. They lead to painful emotions and self-sabotaging behaviors that produce negative feedback loops.

Article / Updated 10-18-2023

If you think you may be codependent, you need help to change your behavior. Here are some sources of help for those suffering from codependency: Read all you can about codependency (but reading alone is insufficient to change). Go to a Twelve Step meeting for codependents, such as Codependents Anonymous, called CoDA, or Al-Anon for family members of alcoholics. There are other Twelve Step groups for relatives of other addicts, such as for relatives of gamblers, narcotic addicts, and sex addicts. You can look on the Internet or in your phone book to find out where there’s a meeting near you. Get counseling from someone familiar with codependency. It’s preferable that they are licensed in your state. They may be marriage and family counselors, social workers, addiction specialists, psychologists, or psychiatrists. You will probably find it hard to focus on and discipline yourself to make changes without the support of a group or therapist. If you’re practicing an addiction, stopping that should be your first priority before tackling codependency. Here’s a list of things you can do on your own to get started: When you’re tempted to think or worry about someone else, turn your attention back to you. Pay attention to how you talk to and treat yourself. Much of low self-esteem is self-inflicted. Train yourself to speak gently and encouraging rather than telling yourself what you should or shouldn’t be doing or what’s wrong with you. Have some fun and pursue hobbies and interests of your own. Start a spiritual practice where you spend time alone with yourself. Meditation is an ideal way to help you become more calm and self-aware. Start looking for the positive in your life and what you do. Make a grateful list each day and read it to someone. Stand-up for yourself if someone criticizes, undermines, or tries to control you. Don’t worry! That’s not easy, but most worries never come to pass. You lose precious moments in the present. Mediation and talking things out with someone who knows about recovering from codependency can help you. Let go of control and the need to manage other people. Remember the saying, “Live and let live.” Accept yourself, so you don’t have to be perfect. Get in touch with your feelings. Don’t judge them. Feelings just are. They’re not logical or right or wrong. Express yourself honestly with everyone. Say what you think and what you feel. Ask for what you need. Reach out for help when you feel bad. Don’t fall into the trap of thinking you’re self-sufficient and can manage alone. That’s a symptom of codependency, too.

Cheat Sheet / Updated 10-18-2023

If you wonder whether you may be codependent, you’re not alone. Different types of people may behave in a codependent manner, and codependence manifests in varying degrees of severity. Not all codependents are unhappy, but others live in pain or quiet desperation. Codependency is not something you heal from and are forever done with, but you can enjoy yourself, your life, and your relationships. Should you choose to embark on recovery, you’re beginning an exciting and empowering journey.

Article / Updated 10-18-2023

Codependents’ shame and low self-esteem result in problems with boundaries and dysfunctional communication. Self-esteem, clear boundaries, and the ability to be assertive are essential to healthy communication. They are the foundation for avoiding fights and handling conflict. Unresolved or escalating conflicts are the norm among codependent couples, who probably didn’t have good role models for expressing anger and handling conflict. Often in codependent relationships, one or both partners are usually passive or aggressive, rather than assertive. When it comes to disagreements, low self-esteem leads to Inability to express your needs and wants Being very reactive People-pleasing Not taking responsibility for your behavior, feelings, and needs Inability to be honest Taking things personally Defensiveness Hidden expectations of others Blaming Attacking or withdrawing Arguments in themselves aren’t necessarily a bad sign. Having different needs and opinions is inevitable. Conflict means differences are surfacing, and this allows for negotiation and respect for one another’s needs. But in some relationships, differences aren’t acknowledged, either because one partner dominates a subservient one or because boundaries are enmeshed and both individuals are merged. They don’t really know themselves, or one or both are sacrificing who they are to please the other. The solutions to differences usually backfire, because they build resentment and passive-aggressive behavior. As a result, intimacy suffers. For such couples who don’t usually argue, conflict is a sign of growth and maturity. In healthy conflict, you’re able to express your needs and wants and mutually work out compromises. You’re able to problem-solve together. Your intentions and how you approach differences are critical. The objective should be to resolve a disagreement to the satisfaction of both of you. It’s not about winning and losing. You can “win” an argument, but the relationship may suffer if your partner feels discounted, deflated, or resentful. Planning when, where, and how you approach a disagreement is important for achieving satisfactory results. Draw up rules of engagement in advance. Here are eight suggestions for handling conflict: Make it okay to “agree to disagree.” You don’t have to agree on everything. Try to accept irresolvable differences that don’t violate your values. Have time-limited discussions and stick to the pre-set time. A half-hour is plenty. You can always reconvene. Work through things as they come up. Don’t stockpile resentments; otherwise, each postponement becomes a block to the next communication. Remember to maintain goodwill by separating the person you care about from the behavior. Assume that your partner is doing his or her best and isn’t hurting you intentionally. Take responsibility for your behavior, needs, and feelings. Use “I” statements to share your feelings and thoughts about yourself. Listen with curiosity and a desire to understand your partner and to see the world through his or her eyes. When you don’t understand, ask for clarification. Use a “we” approach. “We have a problem,” not “My problem with you is . . .” Adapted from Darlene Lancer’s “22 Do’s and Don’ts of Positive Conflict.”

Article / Updated 07-10-2023

Bipolar disorder and borderline personality disorder often share many of the same symptoms — mood shifts, emotion dysregulation, impulsivity. Prior to settling on a diagnosis of bipolar disorder, your doctor should consider borderline personality disorder, among other conditions with symptoms that overlap with those of bipolar disorder. Treatment for bipolar disorder and borderline personality disorder differ significantly, so determining which condition a person has plays a major role in selecting the most effective treatments. The following sections present guidelines for distinguishing between bipolar disorder and borderline personality disorder. Considering whether symptoms represent a deviation from a person's baseline A core diagnostic feature that's helpful in distinguishing between bipolar disorder and borderline personality disorder is whether the symptoms represent a deviation from a person's usual moods and behavior: Borderline personality disorder describes patterns of ineffective interpersonal skills and poorly modulated emotional and behavioral responses to the ups and downs of day-to-day life. These patterns have developed since adolescence or even earlier, and the symptoms have always been present — they are part of the person's typical or baseline self. Bipolar disorder is a condition in which emotional and behavioral patterns emerge that differ from the person's typical or baseline self. For example, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) requires that a hypomanic (elevated mood and energy) episode be an "unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic." Distinguishing between situational and episodic symptoms Mood dysregulation in borderline personal disorder and bipolar disorder also differs according to whether the moods changes are situational and short-lived or episodic (lasting for an extended period of time): Borderline personality disorder is characterized by affective dysregulation — big, painful, emotional reactions to stimuli that wouldn't typically cause so much internal and external upheaval. People living with borderline personality disorder struggle chronically with feelings of anger, sadness, and anxiety that often trigger painful and damaging behaviors, such as explosive rages, impulsive actions, or self-harm. These frequent mood changes and behavioral responses are the baseline for a person with this disorder — they occur often and may occur minute-to-minute or hour-to-hour. Something, often frustration, perceived frustration, or fear of abandonment typically triggers the mood disruption in borderline personality disorder. Bipolar disorder is characterized by episodes of mania, hypomania, or depression that last for longer periods of time (days or weeks), are a change from a person's baseline, may occur without any clear trigger, and typically diminish significantly when the mood episode ends. Comparing the types of mood symptoms Although borderline personality disorder and bipolar disorder share some symptoms (for example, irritability that may result from and lead to interpersonal conflict), their symptoms differ: Borderline personality disorder mood symptoms tend toward chronic feelings of irritability/anger, sadness/emptiness, and anxiety. Euphoric feelings aren't part of the diagnostic criteria for borderline personality disorder. Bipolar disorder requires at least one episode of mania or hypomania (elevated mood or euphoria). Mood symptoms in bipolar disorder — specifically mania or hypomania — almost always include some periods of euphoria and grandiose thinking — not just anger. (It can be just irritability/anger, but this isn't typical.) Comparing the nature of the impulsivity Borderline personality disorder and bipolar disorder share the symptom of impulsivity, but the nature of the impulsivity differs: In borderline personality disorder, the impulsivity is a chronic symptom; difficulty controlling or regulating behavior is a challenge that is part of everyday life. In bipolar disorder, impulsivity and disinhibited behaviors occur in the context of a manic or hypomanic period; they aren't chronic or baseline. And if someone is impulsive at baseline, the impulsivity must look significantly worse during a sustained period of time to qualify as a symptom of mania or hypomania. Differentiating bipolar depression from borderline personality disorder The depressive phase of bipolar disorder is also often confused with borderline personality disorder, because both conditions are characterized by periods of sadness that may be accompanied by irritability or anger. However, the two differ in the following ways: Borderline personality disorder is characterized by chronic sadness and anger, which again are part of the person's baseline self. Bipolar depression is episodic, not momentary, and is not limited to mood symptoms such as sadness, anger, or irritability. Bipolar depression is characterized by broader changes in function, which can include low energy and fatigue, diminished interest in activities normally considered pleasurable, changes in appetite or weight, sleeping too much or too little, moving slowly or having physical agitation, feelings of worthlessness or excessive guilt, diminished ability to think clearly or concentrate on a given task or make decisions, and recurrent thoughts of death or suicide. Determining whether they can occur together People with borderline personality disorder are at high risk of developing major depressive episodes and anxiety disorders. They can also develop bipolar disorder, but for both diagnoses to be present the bipolar symptoms have to be different from the person's typical way of behaving (the baseline self). The sadness or impulsivity or anger must differ significantly from the person's usual patterns and must be sustained for longer than just a few moments. Also, sustained euphoric/grandiose periods are almost always going to be present in bipolar disorder, and these must differ from the person's baseline thoughts, feelings, and behaviors. The differentiation between borderline personality disorder and bipolar disorder is often challenging, but important. If you're getting different diagnoses from different doctors, try to have a conversation with your doctor about why the doctor has made a particular diagnosis. Expressing your confusion and asking about your doctor's thought process is okay. If your current doctor is unwilling to have this conversation, consider exploring it with another doctor or therapist. You have a right to understand your diagnosis and have your questions answered.

Article / Updated 07-05-2023

To be a savvy consumer in the world of doctors and therapists, you have to assess your caregiver's credentials and qualifications, make informed treatment choices for your bipolar disorder, determine how you can tell if treatment is working, and know what to do if you begin feeling worse. This article provides a list of questions to ask a psychiatrist or therapist to obtain the information you need. (If you have other questions, write them down so you remember to ask them.) Research shows that medical outcomes improve dramatically when patients are empowered to ask questions and actively participate in their care. Don't assume that the doctor has all the answers and will tell you everything you need to know. Be proactive! You have the right to ask for clarification, simplification, or more information at any point in your care. How much experience do you have in treating bipolar disorder? Some psychiatrists and therapists are like general practitioners, whereas others specialize in particular areas, such as bipolar disorder, depression, anxiety disorders, or schizophrenia. Still others specialize in treating children and adolescents. Professionals who have more experience in treating bipolar disorder may be more attuned to the many ways people experience bipolar disorder and better equipped to sort through your history and ask pertinent questions to effectively identify patterns of your condition. They may also have a deeper range of experiences with different treatments and know how to apply their understanding of how people have responded to them over the years. Is it tough to get an appointment? If you can't get in to see your doctor or therapist when your moods begin to cycle, they can't help you much. So before you choose a psychiatrist or therapist, make sure that you won't have to wait three months before your next appointment. (Getting in for an initial appointment with the doctor may take more time because those appointments are longer.) Ask the office how far in advance you usually need to call to make a follow-up appointment so you can get an idea of how hard it is to get in to see this particular doctor or therapist. Can I contact you during a crisis? Nights, weekends, and holidays — the three times you most need your doctor or therapist, they're at home, spending time with their friends and family. The nerve of these medical people! Everybody, even doctors and therapists, needs some time off, but as a person with bipolar disorder, you need some numbers to call in a crisis. Doctors and therapists have a variety of systems for after-hours emergencies. Ask for your doctor's policy and procedures, which should include the following information: Office number: When you call the office after hours, a recorded message should provide instructions for emergency calls. After-hours number: Does the doctor use an answering service that can reach them? Do you call their cellphone or home phone for emergencies? Make sure you're clear about this. Name and number of the person who covers for the doctor or therapist when they're out: Doctors often take turns being on call. Emergency number of the hospital or mental health center where you should go in a crisis: If you're in the middle of a mental health crisis and you can't get in touch with your doctor, where should you go? Ask how long it typically takes your doctor or therapist to return calls if you need to leave a message. What's the diagnosis and how did you arrive at it? Sometimes a doctor prescribes medication without providing a final diagnosis, especially when some uncertainty exists. For example, if a patient is experiencing mania, the doctor may prescribe an antimanic medication without diagnosing bipolar disorder until they have the opportunity to rule out other possibilities. However, your doctor will have some ideas (working diagnoses, as they're often called) that drive their treatment choices. If your doctor doesn't mention a diagnosis, ask them to explain their thinking and the possible diagnoses they're considering. You have a right to understand what they think may be going on and why they're choosing particular treatment plans. How your doctor arrived at your diagnosis may be just as important as the diagnosis itself. Make sure your doctor has considered your family history, any prior mood episodes, the possibility of medication- or substance-induced symptoms, other medical conditions that may be causing symptoms, and aspects of your life that may be causing stress or sleeplessness or is otherwise contributing to symptoms. What's the treatment plan? Your doctor may hand you one or more prescriptions for antidepressants, antimanics, antipsychotics, or sedatives, but your medication doesn't make up your complete treatment plan. In most cases, you should have a doctor and a therapist; ideally, they work together to develop a treatment plan specifically for you. The doctor typically handles the medications, and the therapist deals with everything else, although some doctors are more actively involved in the bigger treatment picture. Your treatment plan should include the following: Medications Individual therapy, self-help, and lifestyle changes Family education and, possibly, family therapy Instructions on what to do if your moods begin to cycle Whenever your doctor recommends a change in medication, be sure to ask what the goal of the change is and how you and your doctor will evaluate whether the change met its objective. In the real world, having ready access to a psychiatrist and therapist isn't always possible. In such cases, you may find yourself relying on your primary-care physician, self-help, lifestyle changes, family and friends, and community resources. When can I expect to feel better? Your doctor and therapist are likely to tell you to remain patient, but you should know upfront what patient means. A week? A month? Two months? In most cases, you can expect to see some improvement in one to two weeks, but some medications may take four to six weeks or even longer to become fully effective. Ask your doctor and therapist to be sure. Typically, your doctor will follow up with you two to four weeks after your initial appointment or after you start a new medication to assess the effectiveness of the treatment and monitor for side effects. If you're feeling very unstable, they may want to see you even sooner. If the doctor tells you to come back in more than one month after you start a new medicine, find out why they don't want to follow your situation more closely. How will I know I'm getting better? With bipolar disorder, feeling better may convince you that you are better even when you're not, particularly if you're cycling into mania. Ask your doctor for more objective signs that your mental health is improving. When an episode of depression is lifting, you may experience these signs: Sleeping more regularly and getting better-quality sleep Doing more with less effort — in other words, better energy Socializing more Crying less Diminished thoughts of death or suicide When recovering from an episode of mania, these signs may appear: More sleep in general and less restless sleep overall Sustained stability in thought patterns — not racing or flying from topic to topic Reduction in pressured speech (rapid, nonstop talking) More typical energy and activity levels Fewer and less intense confrontations with others Improved ability to control impulses Less irritability What should I do if I feel worse? Getting just the right combination of medications requires communication between you and your doctor. Being able to get in touch with your doctor between visits is especially important when you're first starting medicine. Some medications may not work for you or may have an adverse effect on you. If your condition fails to improve or worsens or if you have a bad reaction to the medication (such as a rash or shortness of breath), contact your doctor, who may suggest one or more of the following steps: Stop taking the medication. Keep taking the medication to see whether the side effect settles down or the desired effects kick in and then call or come in to the office in a few days. Take a lower dose of the medication. Take a higher dose of the medication. Add something else to the medication. Be sure to follow up all these actions with additional phone calls or office visits to further optimize your treatment plan. How did you pick this medicine and what can happen when I take it? Most doctors hand you a prescription for the medications they think are going to be most effective and have the least chance of causing serious side effects. The doctor should always review with you how they chose this medicine over other ones (alternatives) and carefully review the potential effects and side effects of the medicine they have chosen to prescribe. Make sure that your doctor has answered the following questions for you before they reach for the prescription pad: How effective is the medication at treating the symptoms I have? Are there more effective medications? What are the potential risks and side effects of this medication, and what are the chances that I'll experience them? Are there any medications that may have fewer, less serious side effects? How will this medicine interact with other prescribed medications and over-the-counter products and with other substances including alcohol and caffeine? Make sure you always know the possible side effects and interactions of a medication before you begin taking it so you know what to watch for. Armed with a list of the most common and most serious potential side effects, ask what you should do if you notice any signs that you may be experiencing one of them. Will you work with my other providers? Coordinated treatment, especially between your doctor and therapist, is an essential component of success. Ask your doctor and therapist if they're willing to exchange notes. Make sure they have each other's contact information and signed consent forms that enable them to share information. If you want family members, friends, and other nonprofessionals to enter the treatment discussion, ask the doctors if they're willing to talk with the people in your support network. Your doctor and therapist can't legally discuss your condition or treatment with anyone unless you've signed consent forms for them.