It can be very tough for even the most experienced clinician to differentiate the distinctions in between Bipolar Disorder, Type II, Borderline Personality Disorder and Adult ADHD. Signs frequently overlap and these disorders frequently co-occur; nonetheless, there can be ideas from the history and presentation that commonly assist determine the medical diagnosis and the suitable sorts of therapies. Below, is a case of a patient with a difficult medical diagnosis followed by pointers on distinguishing Bipolar Disorder, Type II, Borderline Personality Disorder, and Adult ADHD.
Anna is a 46 year-old, married nurse with 3 youngsters. She provided with consistent low-grade depression, anxiety, and irritation. She was on probation at work for poor performance. She also had a long-standing history of trouble with friendships.
She complained of life-long depression with periodic episodes of more severe symptoms. During the more severe episodes, she overslept, felt more irritable and nervous. She reported chronic racing ideas and problem concentrating.
She had a chaotic childhood. Her dad was an effective, workaholic lawyer who was also an alcoholic. There were regular, explosive fights in between her parents. Anna was the oldest of 3 children and at the age of 10, her moms and dads divorced. She ended up being ensnarled in their long, drawn-out separation process. In pre-school and elementary school, she had actually been rather bright, according to school reports. She listened well, followed guidelines, and had lots of close friends.
However, as the combating heightened in your home around third and fourth grades her grades dropped and she started to display behavioral issues at school.
The above case represents a challenging diagnosis. Below are suggestions to assist identify the diagnosis and whether there is the possibility of more than one diagnosis.
Mood swings in Bipolar Disorder, Type II last for one to 4 days and consist of the person feeling "hyper", "on top of the world", irritable, invincible, elated, or even depressed in spite of being in a hypomanic episode.
People with Borderline Personality Disorder likewise have mood swings but they have feelings of despair, temper, rage, or depression that is more chronically present and caused by criticism, disappointment or tension. Also, individuals with Borderline Personality Disorder rarely feel elation.
People with Adult ADHD likewise describe state of mind swings and trouble with handling state of minds; nonetheless, the duration is usually short and due to reduced frustration tolerance. Likewise, in Adult ADHD there are sensations of shame, irritation, disappointment, and unhappiness secondary to problem with school, work and relationships.
Likewise, the signs of impulsivity exist in all the conditions however with different histories. Impulsivity might manifest as sexual indiscrimination, extreme shopping binges, inadequate decision-making, vehicle mishaps or speeding tickets, and careless mistakes. With Bipolar Disorder, Type II, the impulsivity is present just during the durations of hypomania compared with Borderline Personality Disorder and Adult ADHD, when the impulsivity takes place chronically or due to a psychological trigger.
All 3 disorders present with problem focusing or focusing. This creates difficulties with finishing jobs, jumping from job to task, and beginning tasks without finishing them. These symptoms take place in Bipolar Disorder, Type II just throughout the hypomanic stage but can be persistent with the various other two conditions.
In Borderline Personality Disorder, there is even more often a history of sensation empty and lonesome, chaotic relationships, self-injury, and an extreme worry of desertion. There is commonly a history of considerable physical or sexual harassment during childhood or extreme psychological neglect.
In Bipolar Disorder, Type II, there is frequently a family tree of depression or Bipolar Disorder, and the symptoms of depression start at an earlier age. Likewise, depression is the more frequent problem than hypomania.
In Adult ADHD, the person has relentless challenges with continual attention, focus, executive performance, distractibility, time management, procrastination, and substantial difficulty with organization.
These signs might appear in the other two disorders; nevertheless, in Adult ADHD, the symptoms have to have existed since youth. In addition, ADHD has the greatest genetic part of all three conditions and is approximated to have a concordance rate ranging from 60-80 %. Hence, eliciting a history of various other relative with ADHD increases the likelihood that the individual may be dealing with Adult ADHD.
All three conditions can manifest "racing thoughts". In Adult ADHD, these ideas are intermittently present and are intensified when there is higher stress or challenge in the environment.
With Bipolar Disorder, Type II, the symptom of racing thoughts takes place only during the hypomanic stage. The racing ideas are commonly called "congested ideas" and considering brand-new and creative tasks.
In Borderline Personality Disorder, the racing ideas are normally precipitated by a mentally loaded experience such as a battle with or criticism from a close friend or coworker.
Upon more discussion with Anna, she rejected having hypomanic episodes. Nonetheless, she explained feeling empty, lonesome and having reduced self-esteem. Under extreme stress, she would become acutely agitated, suicidal, have sensations of unimportance, and be missing from work.
Over her life, she has actually gone to the psychiatric emergency room 6 times for suicidal ideas, but has never ever made an effort. She has also had a partial hospitalization. In addition, she has a long history of self-injuring habits including anorexia, cutting, and unprotected sex with laid-back contacts.
Anna has Borderline Personality Disorder as well as dysthymia. My referral was to begin schema treatment two times a week as well as beginning on an MAOI and to begin treatment in an extensive Dialectical Behavioral Treatment Program (CBT). Although a MAOI is not FDA approved for Borderline Personality Disorder or dysthymia, there study reveals its efficacy.
2 years later, Anna's state of mind has actually supported and she feels much less anxious. In addition, she has actually had the ability to delight in more enjoyment in her personal life and career. She has actually currently been in a relationship for 14 months, and although the direction of the relationship is uncertain, she feels more comfy putting up with the unknown.
This case provides the diagnostic difficulties differentiating Bipolar Disorder, Type II, Borderline Personality Disorder, and Adult ADHD. Making use of the above distinguishing features and taking a comprehensive evaluation enhances the precision of the diagnosis and assists in the determination of a reliable therapy plan.