Is it Bipolar, BPD or ADHD?
All three of these diagnoses are distinct and very real entities. An individual can have one, both or all three diagnoses. Since they are all treated differently, the diagnoses must be made carefully and accurately. Bipolar is the least frequent, but the one that can be triggered by treating the other two.
Although MRI studies of the right prefrontal cortex may soon be available to diagnose AD(H)D, at this time there are no imaging or other studies that will confirm or rule out a diagnosis. The DSM is the diagnostic tool that establishes the official diagnoses, and in my opinion they are excellent and extraordinarily useful.
The official diagnoses can be found on this Website:
Borderline Personality Disorder (BPD)
Attention deficit (hyperactive) disorder (AD(H)D)
Bipolar disorder (BP) - please note that in order to have the bipolar diagnosis, mania or hypomania must be present.
Bipolar in Children (not yet an official diagnosis)
The primary symptom of bipolar is mania (or hypomania). Most individuals with depression do not have mania or hypomania. Cycling is not necessary for the diagnosis of bipolar, but it is common. Cycling is not exclusive to bipolar disorder. Most individuals with the BPD have mood swings, but they do not get mania or hypomania - their mood swings mostly vary within the realm of feeling bad.
The presence of mania or hypomania establishes the diagnosis of bipolar, which can begin as an infant. The BPD begins at puberty. AD(H)D appears to be a genetic phenomenon, not a disease, and does begin in early childhood - in fact, those with exclusively the inattention part of AD(H)D may be very "easy" babies.
The similarities are the irritability, the mood instability, and overreacting to stress. There are subtle differences however. Bipolars - especially children - respond badly to being told "no" whereas those with ADHD don’t like excessive stimulation, and borderlines cycle downward to dysphoria (anxiety, rage, depression and despair) under stress - particularly when experiencing fear or anger.
I suspect both the BPD and bipolar are a form of epilepsy (brain cells firing inappropriately and out of control). That’s why anti-epilepsy medications work so well. Bipolar may be epilepsy on top of a normal seasonal up and down pattern that our ancestors needed to survive the severe ice ages tens of thousands of years ago where hibernation in the winter and increased energy in the spring/summer were beneficial. The BPD is epilepsy in the "trapped, cornered, wounded animal" instinct. In the BPD, there are abnormalities in the brain’s "adrenergic and cholinergic systems" which respond to lithium and carbamazepine, abnormalities in the central dopaminergic systems causing psychotic symptoms that respond to low-dose neuroleptics, and abnormalities in the central nervous system serotonergic system underlying impulsive aggressive behaviors that respond to serotonergic agents such as Prozac.
Bipolar needs to be aggressively treated with antiepilepsy medications and antipsychotics prior to treating the other diagnoses, although in adults who also have the BPD I’ll usually treat with an SSRI first for a week prior to adding the antiepilepsy medication Tegretol because of the profound benefits waiting a week prior to initiating Tegretol can bring. Antipsychotics like Risperdal and Seroquel may be necessary early on.
Drs. Papolos' book "The Bipolar Child" is a fantastic book, and a must read for any parent dealing with a bipolar child. My few areas of disagreement include:
1) that the other diagnoses shouldn’t be treated also - I’m sure they must be and I have successfully treated both together,
2) that childhood depression should always be considered bipolar - because they’re not. I use the bipolar child symptoms [http://www.biologicalunhappiness.com/BiPlrKid.htm] to see if bipolar disorder is present prior to treating depression,
3) that all mood swing disorders are bipolar - they’re not,
4) I have found that adolescents and adults who experience dysphoria (anxiety, rage, depression and despair) have the generalized anxiety disorder and this serotonin imbalance needs to be treated with BuSpar so that Prozac and other SSRI’s can be taken without triggering dysphoria,
5) I suspect both dawn simulators and bright light during the day are necessary, and
6) that the problem is necessarily due to neurotransmitters - 90% of the cells in the brain are support cells called "glial cells", and I strongly believe research needs to be directed to determine whether glial cell malfunctions could be causing or contributing to bipolar disorder.