Is It Bipolar Or Borderline?

3 Distinguishing Differences
Most Often Overlooked

Discover Brain Reactivation Therapy

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Section 1 Title

I oftentimes get the question as to the difference between borderline personality disorder and bipolar disorder and people will come in that have been diagnosed with one or the other or even both and they don’t have an understanding of what these diagnoses mean what causes them what the treatments are and why the treatments might actually be different and what they only know is they are struggling where their mood seems to either sometimes they’re doing really well and other times it seems like they get it down in the dump so badly that they can’t function and so what we see in both of these diagnoses is up and down and up and down I struggle with depression and other times where I’m doing really well and I can’t make sense of what it is why that’s happening and because I can’t make sense I can’t attack the cause and so today we’re actually going to help you guys to understand what the difference between borderline personality dis disorder is and what the difference is between bipolar disorder and when sometimes they can be what we call co-occurring meaning they’re both happening at once versus the times where it’s one or the other and at the end of this you’re going to be able to help diagnose this uh yourself and so that you’ll know which treatment is right for you so welcome to the mental health and The Good Life podcast and let’s get going there are a lot of mental health experts out there that’ll give you their list of tips that they think will help the problem is they’re based on their perception of what is right and wrong at University Elite we do something different we treat our patients using sound psychological neurological and physiological science we know what works and what doesn’t we don’t get confused with what’s right versus wrong While others continue to struggle with these tips that they have received we help people gain the long-term happiness and well-being with our approach welcome to the university Elite podcast where you learn the why behind human behavior and how to live a truly happy life now your host is a combat proven veteran physician Master psychotherapist diet expert trauma Authority and someone who has everyday Common Sense Dr Hans Watson welcome back to the mental health and The Good Life podcast very excited today to to clear up up a point that is often times very confusing for many people and that is what’s the what is borderline personality disorder what is bipolar disorder and how do they differ now in this case many people will explain to me that they get confused by the two the names are quite similar borderline versus bipolar there’s not a lot of difference in the two names there and so first off they have to they have to figure out what the difference is then I help them understand the treatment then it seems like they can get better with whichever one they have now to make it even more confusing what happens when somebody could have both then what do we do for treatment how do they understand what’s going on all of that is going to be necessary today for you to understand it so let’s Jump Right In First we’re going to start with bipolar disorder now what I need to do is explain to you how these are formed so that you’ll understand that then you’ll understand when we talk about the different treatments why they make sense otherwise uh you could be getting treatment for one versus the other because the sad thing is not everybody is trained to be able to distinguish between the two you need somebody with a little more advanced training to be able to do that and that’s the purpose today is to give you the tools so that when you go in you can have somebody help you understand that so starting with bipolar disorder bipolar disorder is a disorder that is characterized by a part of the brain that is not functioning right and if you want to get right technical to it it’s actually the you have in your brain the frontal lobe right there the front of the brain is the part that causes us think of it like the parent in the room it puts the breakes on when we shouldn’t do something it helps us to tolerate different difficult things in life without without having to freak out or or uh having that wishy-washy up and down all the time in our mood that type of thing always feeling anxiety even when it’s the smallest amount of of uh an uh stress in our life and so you can see bipolar disorder is the problem where the mood going up and down is actually due to a part of the brain that has been damaged and not functioning correctly here’s the hard part about the bipolar disorder we don’t know what causes it science hasn’t discovered it we’ve found out many changes that happen we found out some of the things that if you already have that brain damage and that brain dysfunction some things that can trigger it to go off but we don’t know what causes the brain damage in the first place that’s that’s still unknown in science and so um so that’s the first thing that we have there now with bipolar disorder what it is is that frontal lobe should be controlling and making sure all the workers do their job and the workers would be the rest of the brain but that doesn’t work so sometimes what we see is in bipolar disorder the neurons or the nerves that make up your brain they dis they they foul up they they don’t function correctly and so you have three different parts of a neuron first you’ve seen that little bulb or that ball at the end we call that the nucleus and then it has this long tree trunk part so you got the bulb the long tree trunk that’s called an axon and in the axon that’s where the electricity runs down there it it shoots an electrical uh spark down there and it gets out to the end where we see what looks about like a bunch of tree branches out there those are called the dendrites and the dendrites that’s where that neuron keeps all of those hormones that it’s going to use to as a communication now what it’s going to happen is in bipolar disorder people’s neurons aren’t functioning correctly the nucleus there it it does it does its job we think but sometimes in that long tree trunk in that axon will get way too much electricity shooting down there it’s just way overloading the circuit and what do we call that those are the times where we call it Mania it does that way too much and so those those dendrites release way too many uh hormones out there to communicate and this is where we’re going to see what we’ll talk about which is called Mania but then the problem is it will get to the point that it’s burnt itself out and so now it doesn’t have enough electricity to send down that axon and to the dendrites and and release the hormones that it needs to to keep everything else healthy and so what you see is times in in bipolar disorder times where there’s way too much electricity and then it burns itself out followed by times where there’s just not enough and so what you’d see is when there’s way too much electricity we have Mania where people are abnormally above where they should be they’re just it feels great in the time but but they’re doing things that are absolutely going to cause painful consequences later and we’ll get into that in just a second whereas then when it burns out they dip down into the deepest depressions you’ll ever see and so what we’ve discovered in that one that there are medications that can help to take that membrane right along that tree trunk that that axon and it helps stabilize it so that we don’t get way too much electricity and we don’t get way too little electricity and so in this case we see that this is brain damage and that is the reason that that uh the medicines are required to stabilize those neurons and the sad thing is every time it does this and you get way too high or way too low we actually see brain damage millions of those neurons are damaged and often die and so that’s the first one which was bipolar disorder now when we’re looking at bipolar disorder there’s some very important things the first thing that you have to recognize is in bipolar disorder it’s going to have because those neurons aren’t functioning well it’s going to have times where we have way too much uh energy and we feel great about ourselves and we can be impulsive and irrational and and paranoid you can actually this is a psychotic disorder where often times you can become paranoid Hear Voices have illusions of things the government’s after me all that type of stuff but then there’s other times of extreme depression here’s a secret many of those same symptoms are shared by borderline but their cause is totally different but in this case it’s important to recognize those things in bipolar disorder are caused by that brain dysfunction now when the brain dysfunction happens here’s the secret it is not predict able when it happens you cannot look at a pattern of saying every time this thing happens in life this person ends up becoming psychotic and having a manic episode followed by a depressive episode no those manic episodes generally come in and they surprise the people that are struggling with bipolar disorder you cannot predict the pattern so that’s the first thing that you have to do now let’s talk about what that is um when it comes time to it I’ve written down here the the diagnostic and statistical manual it’s the DSM we’re on the fifth edition so they call it DSM 5 now remember anytime somebody’s having a manic episode this is not just they’re feeling high on life they’re feeling great no no this is another another level they are so have so much electricity surging through that axon that they are now out of their mind and and the key is then when they experience this manic episode and then that that excess electrical activity is happening this is a clear deviation or a clear difference from who they are normally you can’t say this person’s always this way and call it a manic episode it is a distinct difference and in fact what they say is if you’re Rapid Cycling bipolar disorder which is the the most frequent that you’re going to see a manic episode that starts at 4 four manic episodes a year not every single day if you have it every single day that is not you would be brain damaged within a year and no longer be doing it that is not when you’re when you’re having trouble controlling yourself it’s not due to bipolar disorder at that point it’s due to the other things that we often see such as borderline personality disorder now there’s a few other diagnoses that could also do that that are cousins to the the Border line personality disorder but remember we’re talking about bipolar now and so whenever we see a manic episode what we’re saying is this person is normally so level and so good and they operate normally in this manner but then suddenly I see a clear distinction a clear deviation off of how they would normally act and now they are psychotic and they go to where they will go seven or 10 days days not needing sleep sometimes it even goes as many as 21 days not needing sleep and and while they’re not needing sleep they are out of their mind they’re psychotic they are not in touch with reality is what I’m trying to say the example I give is they’re walking down the street in the middle of winter with snow outside naked and carrying an Axe and have no idea that there’s anything wrong with what they’re doing that there’s anything abnormal about their situation that’s what a manic episode looks like and so what what the DSM teaches us is it represents a noticeable change from usual Behavior that’s key because many people will say no I have I have uh a manic episode every single day when I have trouble controlling controlling how I react to things nope that is not the same thing as this this one is I’m normally great at doing it but as soon as I quit sleeping and I’ll go a week where I don’t need sleep and it’s not just that I stayed up playing video games it’s that I literally don’t need sleep as if I just won the championship and never come down for an entire week month it can go really Tong and and I’m out of my mind I don’t remember many times what I’m doing there and I don’t remember that and people tell me that I’m I’m talking abnormally so so they’ll say I have I have uh such a large self-esteem that it’s unrealistic I think that I’m going to start a business that is more successful than than one of these giants like uh like Elon musk’s business or Jeff bezos’s business or Steve Jobs or just fill in that you know I can put Microsoft out of business even though they don’t have the training or the understanding they are now not in touch with reality so that first inflated self-esteem that decreased need for Sleep they’re more talkative than usual this means that somebody that would normally be calm and Collective they they’re just talking so fast nobody else can get a word in you know they just go off like that um they cannot focus reliably on a single topic we call it flight of ideas or um the racing thoughts meaning it’s one to the other to the other and anybody is talking to them can’t keep up they’re like what are you talking about we were just talking about a and now unrelated thing B came in and C you’re already gone to the next one um and so they’re not going to have that attention and then um they’re going to have unreel unrealistic goal oriented tasks this means I think I’m going to start a business so I’m going to go out there had one patient one time who grew up in the city had no idea about farming and decided they were going to become a giant farmer and went out that day without the money and purchased a tractor and and and farm implements even though they didn’t have a farm they didn’t have land they hadn’t thought through it they were clearly psychotic and out of their mind and then and then um they’re going to experience and they’re going to engage in activities that have high potential for painful consequences this means things like um buying spree where they normally would not engage in buying spree notice the big difference this just doesn’t mean I go out and shop when I don’t have money that’s a different thing this is somebody who would never spend more money than they have and now suddenly they go out and spend tons of money they don’t have and and they’re they’re psychotic they don’t know what they’re doing they these are people who are normally very sexually uh conservative and they’re going out and having sex with anybody who will Who will uh who will uh agree to it and this is clearly deviation from them they’re they’re uh you know starting those businesses all those kind of things and that’s what happens in a manic episode and so that’s half of the bipolar where boom I do that but then as soon as my neurons burn out I sink down into the deepest depression you might have ever seen or heard of and I’m constantly in between and the depressions tend to last much much longer and these patients they require the medications called mood stabilizers that come in and they stabilize the membrane along that axon that tree trunk and essentially they stabilize the electrical system in there and when the electrical system is stabilized these individuals then can can uh start to heal and and we can treat other things that might have which are sometimes I need to add a medicine for depression that kind of thing so bipolar is the first one that everybody wants a person to have because there’s a medicine it’s much easier to give somebody a medicine to treat it and so we all wish everything was bolar and there’s a whole group of professionals out there that are going to call everything bipolar because at least then we can give it a pill instead of the much harder thing and and there are some different variations of of bipolar disorder there’s a b bipolar 2 but once again bipolar 2 requires a manic episode where they’re still just as as uh off it’s just that they don’t go the full week with no sleep they go the full week only needing one or two hours of sleep and they’re still good to go they have tons of energy and so um but there’s still clear deviation or change from who they would be normally and they’re making decisions and and things that are clearly out of bounds and they have no understanding they’re taking on activities with possible painful consequences even though they feel really good all the same stuff except just an hour or two that’s the difference between bipolar 1 and bipolar 2 pretty much and so now what is so if we look at it what is the difference between bipolar and borderline then well borderline personality disorder is not a problem where there’s brain damage instead even bipolar disorder still uses the term dis disorder it’s sneaky cuz they’re different borderline personality disorder is a problem where people have not yet developed the skills or ability to be able to handle strong emotions and I’ll explain that many times it’s not their fault and so we can’t just blame them but the bottom line the base psychology of borderline personality disorder is I have not not develop the skills or the resiliency to be able to tolerate strong emotions and so all of the coping I’ve learned in my life is to avoid those strong emotions and let’s use an example um very very uh and what you’re going to see is uh before we get to the example what you’re going to see is in borderline personality disorder we’re going to see almost the similar things uh you know 80% % is of the symptoms of somebody struggling with borderline personality disorder it’s not because they have brain damage but instead it’s just because they haven’t yet developed that skill and that ability but the symptoms how they react will look almost the same in about 80% of the shared symptoms of bipolar disorder they both can be impulsive one’s due to brain damage the other is because they are running away from strong emotions they both can show hypersexuality or hyper engagement in in activities with uh with a high risk for danger and one of them is due to brain damage and that frontal lobe not being able to say stop this is there the other one is I can’t stand the idea of strong emotions I’m going to use this activity to try to distract me from that thing in my life that might be causing the strong emotions you know the other one they may not sleep and that’s due to the the neuron not having the right electrical current going down it these guys they’re not sleeping because they don’t know how to control their anxiety and if they were to slow down enough to sleep they might actually have to face those strong emotions that they’ve been running away from the uh you know the the people when they burn out with bipolar the neurons burn out they’re going to struggle with depression people who can’t stand strong emotions they’re going to eventually experience social isolation and very shallow relationships are all that they can they can find or maintain so they’re also going to struggle with long long times of depression can you see how there’s a ton of overlap completely different causes how is borderline personality disorder formed well let’s use a simple scenario we have the the first example we’ll use a couple of different patients the first example would be a young man who comes in and you could say young woman it’s it’s it’s a interchangeable young man who comes in who has a a mother and father who cannot tolerate strong emotions themselves so anytime this young man comes in with something that’s very hard and they try to Toler they try to share a a situation in life that is going to cause strong emotions in Mom and Dad they’ll they’ll isolate they’ll run away and so that could be the mother that says I can’t handle this right now and runs into her bedroom and and so now what is the child left with if I bring something unconsciously they learn if I bring something that’s hard in life and Mom and it could be Dad too Mom and Dad run away from it I’m going to not have parents who are interacting with me and every child wants a parent who loves them and interacts with them so what are they going to learn to do I have to avoid anything that creates strong emotions because that will cause my parents to abandon me and leave me even if it’s a temporary time that can be devastating to a child and so they won’t ever learn to do that whereas the child who has a parent who can handle that what are they doing they’re helping them work through it even though that is difficult for a parent to see their child’s suffering they allow an appropriate level of suffering and they work through that and so the the child who learns this in this case they don’t know how to deal with strong emotions and so that’s the first case and we’re going to do one more case and then we’ll show you what about the second one who it’s it’s not just and we would call that a form of neglect what about the second one this time it’s a young young lady who a young girl who is in a home where the parents are uh let’s say uh addicted to drugs and alcohol and so every time in this home that uh you know it could be uh trauma it could be other things but every time they in this home when when the parents experience anything that creates strong emotions or adversity in the life they respond by drinking drugs or excuse me that drinking alcohol or taking drugs and so I guess in the end alcohol is a drug so you could drink drugs but take drugs or or use alcohol and what happens there the children then see an impaired adult that is that is sometimes abusing them both emotionally or sometimes even physically or sexually um and whereas they wouldn’t had they not been impaired due to their du to their addiction and so what do we see them there they realize if I bring anything that creates strong strong emotions in my parents this is dangerous I have to avoid that at all costs and so what do they do there they learn to avoid strong emotions at all cost because it results in if we can use some slang the metaphorical getting your butt kicked and it can be emotionally or literally physically getting your butt kicked and so what do we see a lot of people who have a history of various traumas or various abuses they struggle with borderline personality disorder and it’s not their fault they’re not the ones who chose to be raised or or brought up in a home where they were not given the advantage of being able to learn how to work through situations and the strong emotions that come with them instead they were innocent and unfortunately didn’t learn that lesson and so the advantage is it’s much harder when we’re an adult the advantage is this can be cured the disadvantage is it’s much harder when you’re an adult to learn those skills that other people were so fortunate to be able to learn over their lifetime and so when somebody comes in and they cannot tolerate strong emotions they may meet criteria for borderline personality disorder and so what are those criteria listen you’re about to hear the ones that are very similar to the ones in bipolar except unlike bipolar this is not something where you’re great and you’re level and you’re functioning just fine up until you have that manic episode now there’s a clear difference in who you are during a manic episode than you were the rest of the time these ones are the individuals who you can identify patterns you can see it and what will they do they’ll they’ll do they they’ll they’ll react to anything that could cause a strong emotion in a way that is that is no longer appropriate when they were kids it was the only way they could survive that crappy situation so they’re not at fault they had to do this to survive but then when they become older and now it requires interpersonal and the ability to resolve conflict in a healthy manner they’ve never been taught this not their fault but now we see this is where they’re going to have those coping mechanisms a a lack of those coping mechanisms necessary and so what do we see we’re going to see first every single relationship that you engage in in this life is going to require you to learn how to tolerate strong emotions because no matter how good of a person you see or or you work with guess what they’re going to make a knuckleheaded move in life nobody’s perfect unless you’re Jesus Buddha or Muhammad those are the three that I’m aware of that are believed to have been perfect and most people are not claiming to be Jesus moham Buddha now the people who are in a manic episode and psychotic yes I’ve had many of them claim to be one of those people but not the people who are uh in touch with reality still and so unless you’re one of them every single relationship is going to have times where there is conflict and if you don’t have the basic healthy conflict resolution skills you’re going to be stuck and it will every single time you’re in a real relationship that goes more than just a superficial level you will create strong emotions and sometimes they’re difficult strong emotions where you’re angry and so in those cases what do we see they can’t maintain anything more than a superficial relationship so these are people who often times their appearance is the shell that they will show people because they don’t want to let him any deeper because if you you got any deeper you would see and create strong emotions in me and I don’t know how to tolerate those my UNC ious tells me those are always dangerous and I should run from them and that’s literally all I know how to do so far and so what will they do they’ll have a a pattern you see this in all the time not just when they’re manic all the time instability of interpersonal relationships instability of their own self-image and and perception instability of their affect meaning I’m up Suddenly when something’s going great and even in the same day I’m down to depressed and then I’m up and I’m down and that can happen multiple times a day or multiple times a week remember in bipolar we’re talking multiple times per year not daily and then that marked impulsivity of course they’re going to be impulsive anything to get away from these strong emotions that I don’t know how to deal with okay and so that’s where the criteria that you read in there in in the in the diagnostic and statistical manual the DSM will tell you about borderline personality disorder it’s not that your brain’s damaged and you can’t change it’s just that you haven’t learned how to deal with strong emotions yet so how is that going to look this is what it’s going to look like well first they’re going to do anything to avoid the strong emotions that come with people that abandon them think of that I was abandoned as a child my parents did not care for me in the manner that I needed to teach me those lessons of how to deal with strong emotions and work through things so what are they going to do they’re going to fear that abandonment being alone so they will do things that are just absolutely absurd to the rest of us and and to avoid abandonment things like I’ll threaten suicide if you leave me or I will I will agree to things I would never agree to sexual favors or other things that I should do that I would never agree to in my right mind but you will’ll see this pattern anytime they think somebody’s about to leave them they’ll do this um they’ll they’ll get in those Rel they’ll have those unstable relationships and they’ll see the world in black and white all or none this means this person is all good which we know Jesus Muhammad and Buddha would be the only three that are believed to be all good or all bad and so what is the reality every single person out there is some good to them and some bad to them the example would be even look at Hitler Hitler is a overall terrible person I am going to go ahead and declare my opinion I think Hitler is as bad a guy as you can get but Hitler did some good things too I can see the gray area which is Hitler had some good and some bad if you appreciate our Highway systems you can thank Hitler for giving that to um to our our politicians when when World War II ended they saw the Autobon that’s our freeway system so that we can travel around the country wonderful jet travel Hitler made the most advances in jet travel we took a lot of his technology the the uh the Rockets which allow us to to have the space races and your GPS and all this thanks to Hitler for doing that so Hitler not everything you know but Hitler did way more negative to he’s a terrible person but there is some positive about him that causes some strong emotions in me to have such a terrible person and to be able to say but there was some good but I have the ability and the conflict resolution skills inside myself to be able to resolve that internal conflict so that I then can say okay I think Hitler’s terrible but there was some positive well they don’t have that the people who have borderline personality disorder don’t have that yet and so instead they view the world in all good or all bad well that’s a problem that’s a mindfield you’re walking into because every single person is eventually even if they’re good people they’re going to make a knuckleheaded move to where now you’re going I should have known it and if you put them on this pedestal and idealize them as perfect even if you didn’t consciously do it it can be unconscious suddenly when they make an error or they disappoint you you’re then going to go you’ve been a a a counterfeit this whole time you’ve just been pretending to be a good person and you’re really just a wolf in sheep’s clothing who has been a bad person trying to take advantage of me whereas the reality is no they’re probably a good person who’s not perfect who made a knuckleheaded move or even disappointed you that doesn’t make them a bad person but you’re so afraid consciously or unconsciously of those strong emotions that would come with this that then suddenly that goes from all good to this person’s all bad and what are you going to do now you’re fearful they might abandon you so you’re going to reject them before they can reject you um what is that going to do to your own image I can’t even maintain a healthy romantic relationship or a healthy friendship or healthy family family bonds you’re going to start to see yourself as just unacceptable it reminds me of the the old the old uh uh play where the the person comes out and says look away I’m hideous and if you looked at this the individuals with borderline personality disorder when they look in the mirror when they’re really honest with themselves and I’ve worked with them and every single one this has been true they say people would be disgusted if they see what in me what I see when I’m truly looking at myself and they can’t do that so once again that when they’re feeling this way that’s where we’ll see those impulsive acts um and then then they they do those impulsive acts of what if I’m feeling alone and fearing abandonment I might engage in unsafe sexual activity or other risky behaviors to distract me from what I don’t want to face which is man I am struggling to deal with the strong emotions that come with and then fill in the situation and then then they’re going to so what is that going to result in when you can’t run away you nothing works eventually you’re going to start thinking of okay maybe I need to kill myself to get away from this so suicide becomes a problem and if you’re not really wanting to do suicide what about a suicidal gesture so that people don’t abandon me so I don’t have to feel the emotions of screwing something up and facing myself and learning where I’m weak and and then learning to strengthen that weakness that’s a hard thing and creates many strong emotions can’t deal with it so instead a short-term fix could be I’ll threaten suicide I may even do a gesture or or something where I think I’m doing it but unconsciously I’m not quite doing it enough to where it would be lethal that’s a problem because many times they accidentally take more than they thought or do something that is way more dangerous than they thought and they accidentally kill themselves and that’s one of them uh we’re going to see them up and down with that mood depression anxiety I’m on top of the world I’m down in the dumps just as quick they’re going to feel empty on the inside and then they’re also going to have inappropriate anger meaning it shouldn’t be the big a deal but I keep flipping out way bigger than is necessary and then you know what when they finally get so desperate and they can’t avoid real life anymore they can actually get so overwhelmed with Stress and Anxiety that they can uh they can become paranoid even though they’re not they’re not psychotic like with brain damage like we see in schizophrenia or bipolar but they can become paranoid because they’re overwhelmed with stress or dissociating and dissociating isn’t that just another way to avoid dealing with those strong emotions that come there so instead I’m going to go into my imaginary world and Associate and so those are there do you notice the difference while both of these have shared symptoms the causes are completely different and that’s a problem for many people because these are very serious diagnoses that both require an expert in order to diagnose and help them do it but what if what if you’re seeing somebody that isn’t trained in how to treat both that’s where you need something like this to understand it and they’ll say oh you’re struggling and and to be honest I do psycho theapy with people with borderline personality disorder and since I’m a psychiatrist I also treat bipolar disorder now let’s be honest many people that have bipolar disorder also have Bor Borderline Personality Disorder so while they have legit legitimate manic episodes and depressive episodes due to that they also have never pushed themselves or been in a situation where they were taught how to deal with strong emotions without running away and so can you see how that gets even more confusing now we have the two of them mixed and so what if you’re not trained in both you’re going to a lot of times when people get overwhelmed and can’t explain it to their patients and what they really need is therapy that helps them to be able to learn to tolerate strong emotions which here’s a secret sometimes that will take years to develop that but slow and steady they will develop it what if you’re not an expert enough in therapy you’re then going to go oh that must be bipolar because then we can give you a pill in a way we’re looking for that cop out many of our many of the Mental Health Community will tell you it must be bipolar because my therapy I did with you didn’t work and that comes to no you have to be an ex expert an elite therapist to be able to work with somebody with borderline personality disorder thank goodness there are so many great people that are expert out there that can do that um but then secondly what if you’re the opposite end of the spectrum what if you’re a medication provider for mental health like a psychiatrist or a nurse practitioner a physician’s assistant and you don’t know how to how to treat somebody that runs away from it well what do you you don’t want to have to say hey turns out you’re just running from your emotions and I don’t know how to treat that you’re going to have to find somebody else I’m completely unable to help you well we don’t want to feel inadequate as as medication providers and so what are we going to do we’re going to call it borderline or excuse me we’re going to call it bipolar and give you medications now the advantage to that is many times those mood stabilizer or medications that help to stabilize that membrane they actually can help with some of the symptoms if it’s borderline personality disorder they can think of it kind of like a ctis for a broken leg they can keep them stable long enough that the therapy then can help them to develop that ability to tolerate strong emotions without having to run away every time and so it’s not a bad thing that they’re starting them on a lot of these medications but it is a bad thing if they’re not starting on the medications and then concurrently ensuring that they’re in therapy to start learning to tolerate and work through strong emotions that because otherwise it’s like putting a cast on a leg and never healing the bone you’re never going to see it as soon as you take that cast off or stop those medicines of course they’re going to get worse again and it’s not because they have untreated bipolar it’s because you never help them get to the root of the cause of the borderline personality where they can’t tolerate those strong emotions and so you see not everybody’s able to treat both of these and that’s why you need a a person who is trained in both and that’s why we’re giving you this and so that’s where you’re going to see those extremes as you see somebody so so let’s use a simple example here as a demonstration as we as we finish up here you have a patient come in and they have and we’re going to use an extreme here the patient comes in and they tell you that they are really depressed because they have now severed their relationships and what happened was they felt like the their friend that was a boy that they might have had some romantic interest in so they might have had a a romantic interest and they severed the relationship because the the the the boy that was a friend didn’t call them back and so they assume that they’re being blown off again and they don’t want to do that and so is it border line or is it bipolar well it all depends is this a pattern that we see consistently that we can predict because if we can predict it it’s borderline personality disorder and that indicates they don’t know how to work through those strong emotions because any of us the possibility of being blown off by somebody or or ghosted or whatever term you want to say that’s going to create strong emotions of being rejected and if that is how I always act then it’s not a problem of the brain being dysfunctioned but if normally that wouldn’t bother me but now I wasn’t sleeping and that’s clearly a difference from how i’ normally act now it’s bipolar disorder can you see and and some people if you had both of them you would say okay here’s the difference when somebody is in a manic episode that has both bipolar and borderline personality disorder then we would say is this normally how you act and if they say yes we would say that needs to be treated in therapy but we also know it gets worse when people are in a manic episode so they may have both but their borderline struggles of not being able to tolerate strong emotions get even worse when they’re in a manic episode and so in those cases we would want to make sure their moods is controlled on the medication front and they’re doing it in therapy so so here we’re going to recap that real quick if it’s something that is a clear deviation from how they normally would act it is bipolar disorder and medication is the first treatment and therapy is there to support it if it’s their Baseline functioning and they’re always struggling with these same things it is borderline personality disorder where they do not know how to deal with strong emotions and therapy is the main treatment and medications at best can help stabilize a little bit while they’re doing their therapy and so that is the big difference between borderline personality disorder and bipolar disorder and and that hopefully helps you so that when you’re going to seek out treatment you can find those people and then also you can understand it and you can start seeing this pattern remember patterns that you can predict that’s bipolar disorder if it’s unpredictable that’s borderline excuse me I said that backwards patterns that you can predict are borderline personality disorder driven when it’s unpredictable and it happens just once in a while and clearly not their Baseline the normal how they normally are that is when it’s bipolar disorder and so if you’re out there spending all your money and always in debt but we can see the pattern it’s every time right after you reject people because you don’t like them pointing out flaws about you and so you go shopping in order to in order to uh try to find some happiness in life yep that’s borderline personality disorder because what you’re doing is I don’t want the strong emotions of scene that I don’t have the interpersonal skills I need yet and so I’m going to go shopping to try to distract from it but I’m going to reject you and run away because you’re all bad and then I’m going to go shopping as a way to try to make myself feel better that’s borderline but those people who normally are excellent at budgeting never overspending and then suddenly when they’re not sleeping and they become manic they spend like uh like there’s no tomorrow and then they come they when they come out of their manic episode they’re suddenly in debt and can’t do it nope that is when it’s bipolar disorder in the meds and so so one of them medication and it’s it’s basically not their fault the other one still not their fault but therapy is the main stay of treatment all right guys really appreciate it and uh we’ll catch you on the next one

Section 2 Title

I oftentimes get the question as to the difference between borderline personality disorder and bipolar disorder and people will come in that have been diagnosed with one or the other or even both and they don’t have an understanding of what these diagnoses mean what causes them what the treatments are and why the treatments might actually be different and what they only know is they are struggling where their mood seems to either sometimes they’re doing really well and other times it seems like they get it down in the dump so badly that they can’t function and so what we see in both of these diagnoses is up and down and up and down I struggle with depression and other times where I’m doing really well and I can’t make sense of what it is why that’s happening and because I can’t make sense I can’t attack the cause and so today we’re actually going to help you guys to understand what the difference between borderline personality dis disorder is and what the difference is between bipolar disorder and when sometimes they can be what we call co-occurring meaning they’re both happening at once versus the times where it’s one or the other and at the end of this you’re going to be able to help diagnose this uh yourself and so that you’ll know which treatment is right for you so welcome to the mental health and The Good Life podcast and let’s get going there are a lot of mental health experts out there that’ll give you their list of tips that they think will help the problem is they’re based on their perception of what is right and wrong at University Elite we do something different we treat our patients using sound psychological neurological and physiological science we know what works and what doesn’t we don’t get confused with what’s right versus wrong While others continue to struggle with these tips that they have received we help people gain the long-term happiness and well-being with our approach welcome to the university Elite podcast where you learn the why behind human behavior and how to live a truly happy life now your host is a combat proven veteran physician Master psychotherapist diet expert trauma Authority and someone who has everyday Common Sense Dr Hans Watson welcome back to the mental health and The Good Life podcast very excited today to to clear up up a point that is often times very confusing for many people and that is what’s the what is borderline personality disorder what is bipolar disorder and how do they differ now in this case many people will explain to me that they get confused by the two the names are quite similar borderline versus bipolar there’s not a lot of difference in the two names there and so first off they have to they have to figure out what the difference is then I help them understand the treatment then it seems like they can get better with whichever one they have now to make it even more confusing what happens when somebody could have both then what do we do for treatment how do they understand what’s going on all of that is going to be necessary today for you to understand it so let’s Jump Right In First we’re going to start with bipolar disorder now what I need to do is explain to you how these are formed so that you’ll understand that then you’ll understand when we talk about the different treatments why they make sense otherwise uh you could be getting treatment for one versus the other because the sad thing is not everybody is trained to be able to distinguish between the two you need somebody with a little more advanced training to be able to do that and that’s the purpose today is to give you the tools so that when you go in you can have somebody help you understand that so starting with bipolar disorder bipolar disorder is a disorder that is characterized by a part of the brain that is not functioning right and if you want to get right technical to it it’s actually the you have in your brain the frontal lobe right there the front of the brain is the part that causes us think of it like the parent in the room it puts the breakes on when we shouldn’t do something it helps us to tolerate different difficult things in life without without having to freak out or or uh having that wishy-washy up and down all the time in our mood that type of thing always feeling anxiety even when it’s the smallest amount of of uh an uh stress in our life and so you can see bipolar disorder is the problem where the mood going up and down is actually due to a part of the brain that has been damaged and not functioning correctly here’s the hard part about the bipolar disorder we don’t know what causes it science hasn’t discovered it we’ve found out many changes that happen we found out some of the things that if you already have that brain damage and that brain dysfunction some things that can trigger it to go off but we don’t know what causes the brain damage in the first place that’s that’s still unknown in science and so um so that’s the first thing that we have there now with bipolar disorder what it is is that frontal lobe should be controlling and making sure all the workers do their job and the workers would be the rest of the brain but that doesn’t work so sometimes what we see is in bipolar disorder the neurons or the nerves that make up your brain they dis they they foul up they they don’t function correctly and so you have three different parts of a neuron first you’ve seen that little bulb or that ball at the end we call that the nucleus and then it has this long tree trunk part so you got the bulb the long tree trunk that’s called an axon and in the axon that’s where the electricity runs down there it it shoots an electrical uh spark down there and it gets out to the end where we see what looks about like a bunch of tree branches out there those are called the dendrites and the dendrites that’s where that neuron keeps all of those hormones that it’s going to use to as a communication now what it’s going to happen is in bipolar disorder people’s neurons aren’t functioning correctly the nucleus there it it does it does its job we think but sometimes in that long tree trunk in that axon will get way too much electricity shooting down there it’s just way overloading the circuit and what do we call that those are the times where we call it Mania it does that way too much and so those those dendrites release way too many uh hormones out there to communicate and this is where we’re going to see what we’ll talk about which is called Mania but then the problem is it will get to the point that it’s burnt itself out and so now it doesn’t have enough electricity to send down that axon and to the dendrites and and release the hormones that it needs to to keep everything else healthy and so what you see is times in in bipolar disorder times where there’s way too much electricity and then it burns itself out followed by times where there’s just not enough and so what you’d see is when there’s way too much electricity we have Mania where people are abnormally above where they should be they’re just it feels great in the time but but they’re doing things that are absolutely going to cause painful consequences later and we’ll get into that in just a second whereas then when it burns out they dip down into the deepest depressions you’ll ever see and so what we’ve discovered in that one that there are medications that can help to take that membrane right along that tree trunk that that axon and it helps stabilize it so that we don’t get way too much electricity and we don’t get way too little electricity and so in this case we see that this is brain damage and that is the reason that that uh the medicines are required to stabilize those neurons and the sad thing is every time it does this and you get way too high or way too low we actually see brain damage millions of those neurons are damaged and often die and so that’s the first one which was bipolar disorder now when we’re looking at bipolar disorder there’s some very important things the first thing that you have to recognize is in bipolar disorder it’s going to have because those neurons aren’t functioning well it’s going to have times where we have way too much uh energy and we feel great about ourselves and we can be impulsive and irrational and and paranoid you can actually this is a psychotic disorder where often times you can become paranoid Hear Voices have illusions of things the government’s after me all that type of stuff but then there’s other times of extreme depression here’s a secret many of those same symptoms are shared by borderline but their cause is totally different but in this case it’s important to recognize those things in bipolar disorder are caused by that brain dysfunction now when the brain dysfunction happens here’s the secret it is not predict able when it happens you cannot look at a pattern of saying every time this thing happens in life this person ends up becoming psychotic and having a manic episode followed by a depressive episode no those manic episodes generally come in and they surprise the people that are struggling with bipolar disorder you cannot predict the pattern so that’s the first thing that you have to do now let’s talk about what that is um when it comes time to it I’ve written down here the the diagnostic and statistical manual it’s the DSM we’re on the fifth edition so they call it DSM 5 now remember anytime somebody’s having a manic episode this is not just they’re feeling high on life they’re feeling great no no this is another another level they are so have so much electricity surging through that axon that they are now out of their mind and and the key is then when they experience this manic episode and then that that excess electrical activity is happening this is a clear deviation or a clear difference from who they are normally you can’t say this person’s always this way and call it a manic episode it is a distinct difference and in fact what they say is if you’re Rapid Cycling bipolar disorder which is the the most frequent that you’re going to see a manic episode that starts at 4 four manic episodes a year not every single day if you have it every single day that is not you would be brain damaged within a year and no longer be doing it that is not when you’re when you’re having trouble controlling yourself it’s not due to bipolar disorder at that point it’s due to the other things that we often see such as borderline personality disorder now there’s a few other diagnoses that could also do that that are cousins to the the Border line personality disorder but remember we’re talking about bipolar now and so whenever we see a manic episode what we’re saying is this person is normally so level and so good and they operate normally in this manner but then suddenly I see a clear distinction a clear deviation off of how they would normally act and now they are psychotic and they go to where they will go seven or 10 days days not needing sleep sometimes it even goes as many as 21 days not needing sleep and and while they’re not needing sleep they are out of their mind they’re psychotic they are not in touch with reality is what I’m trying to say the example I give is they’re walking down the street in the middle of winter with snow outside naked and carrying an Axe and have no idea that there’s anything wrong with what they’re doing that there’s anything abnormal about their situation that’s what a manic episode looks like and so what what the DSM teaches us is it represents a noticeable change from usual Behavior that’s key because many people will say no I have I have uh a manic episode every single day when I have trouble controlling controlling how I react to things nope that is not the same thing as this this one is I’m normally great at doing it but as soon as I quit sleeping and I’ll go a week where I don’t need sleep and it’s not just that I stayed up playing video games it’s that I literally don’t need sleep as if I just won the championship and never come down for an entire week month it can go really Tong and and I’m out of my mind I don’t remember many times what I’m doing there and I don’t remember that and people tell me that I’m I’m talking abnormally so so they’ll say I have I have uh such a large self-esteem that it’s unrealistic I think that I’m going to start a business that is more successful than than one of these giants like uh like Elon musk’s business or Jeff bezos’s business or Steve Jobs or just fill in that you know I can put Microsoft out of business even though they don’t have the training or the understanding they are now not in touch with reality so that first inflated self-esteem that decreased need for Sleep they’re more talkative than usual this means that somebody that would normally be calm and Collective they they’re just talking so fast nobody else can get a word in you know they just go off like that um they cannot focus reliably on a single topic we call it flight of ideas or um the racing thoughts meaning it’s one to the other to the other and anybody is talking to them can’t keep up they’re like what are you talking about we were just talking about a and now unrelated thing B came in and C you’re already gone to the next one um and so they’re not going to have that attention and then um they’re going to have unreel unrealistic goal oriented tasks this means I think I’m going to start a business so I’m going to go out there had one patient one time who grew up in the city had no idea about farming and decided they were going to become a giant farmer and went out that day without the money and purchased a tractor and and and farm implements even though they didn’t have a farm they didn’t have land they hadn’t thought through it they were clearly psychotic and out of their mind and then and then um they’re going to experience and they’re going to engage in activities that have high potential for painful consequences this means things like um buying spree where they normally would not engage in buying spree notice the big difference this just doesn’t mean I go out and shop when I don’t have money that’s a different thing this is somebody who would never spend more money than they have and now suddenly they go out and spend tons of money they don’t have and and they’re they’re psychotic they don’t know what they’re doing they these are people who are normally very sexually uh conservative and they’re going out and having sex with anybody who will Who will uh who will uh agree to it and this is clearly deviation from them they’re they’re uh you know starting those businesses all those kind of things and that’s what happens in a manic episode and so that’s half of the bipolar where boom I do that but then as soon as my neurons burn out I sink down into the deepest depression you might have ever seen or heard of and I’m constantly in between and the depressions tend to last much much longer and these patients they require the medications called mood stabilizers that come in and they stabilize the membrane along that axon that tree trunk and essentially they stabilize the electrical system in there and when the electrical system is stabilized these individuals then can can uh start to heal and and we can treat other things that might have which are sometimes I need to add a medicine for depression that kind of thing so bipolar is the first one that everybody wants a person to have because there’s a medicine it’s much easier to give somebody a medicine to treat it and so we all wish everything was bolar and there’s a whole group of professionals out there that are going to call everything bipolar because at least then we can give it a pill instead of the much harder thing and and there are some different variations of of bipolar disorder there’s a b bipolar 2 but once again bipolar 2 requires a manic episode where they’re still just as as uh off it’s just that they don’t go the full week with no sleep they go the full week only needing one or two hours of sleep and they’re still good to go they have tons of energy and so um but there’s still clear deviation or change from who they would be normally and they’re making decisions and and things that are clearly out of bounds and they have no understanding they’re taking on activities with possible painful consequences even though they feel really good all the same stuff except just an hour or two that’s the difference between bipolar 1 and bipolar 2 pretty much and so now what is so if we look at it what is the difference between bipolar and borderline then well borderline personality disorder is not a problem where there’s brain damage instead even bipolar disorder still uses the term dis disorder it’s sneaky cuz they’re different borderline personality disorder is a problem where people have not yet developed the skills or ability to be able to handle strong emotions and I’ll explain that many times it’s not their fault and so we can’t just blame them but the bottom line the base psychology of borderline personality disorder is I have not not develop the skills or the resiliency to be able to tolerate strong emotions and so all of the coping I’ve learned in my life is to avoid those strong emotions and let’s use an example um very very uh and what you’re going to see is uh before we get to the example what you’re going to see is in borderline personality disorder we’re going to see almost the similar things uh you know 80% % is of the symptoms of somebody struggling with borderline personality disorder it’s not because they have brain damage but instead it’s just because they haven’t yet developed that skill and that ability but the symptoms how they react will look almost the same in about 80% of the shared symptoms of bipolar disorder they both can be impulsive one’s due to brain damage the other is because they are running away from strong emotions they both can show hypersexuality or hyper engagement in in activities with uh with a high risk for danger and one of them is due to brain damage and that frontal lobe not being able to say stop this is there the other one is I can’t stand the idea of strong emotions I’m going to use this activity to try to distract me from that thing in my life that might be causing the strong emotions you know the other one they may not sleep and that’s due to the the neuron not having the right electrical current going down it these guys they’re not sleeping because they don’t know how to control their anxiety and if they were to slow down enough to sleep they might actually have to face those strong emotions that they’ve been running away from the uh you know the the people when they burn out with bipolar the neurons burn out they’re going to struggle with depression people who can’t stand strong emotions they’re going to eventually experience social isolation and very shallow relationships are all that they can they can find or maintain so they’re also going to struggle with long long times of depression can you see how there’s a ton of overlap completely different causes how is borderline personality disorder formed well let’s use a simple scenario we have the the first example we’ll use a couple of different patients the first example would be a young man who comes in and you could say young woman it’s it’s it’s a interchangeable young man who comes in who has a a mother and father who cannot tolerate strong emotions themselves so anytime this young man comes in with something that’s very hard and they try to Toler they try to share a a situation in life that is going to cause strong emotions in Mom and Dad they’ll they’ll isolate they’ll run away and so that could be the mother that says I can’t handle this right now and runs into her bedroom and and so now what is the child left with if I bring something unconsciously they learn if I bring something that’s hard in life and Mom and it could be Dad too Mom and Dad run away from it I’m going to not have parents who are interacting with me and every child wants a parent who loves them and interacts with them so what are they going to learn to do I have to avoid anything that creates strong emotions because that will cause my parents to abandon me and leave me even if it’s a temporary time that can be devastating to a child and so they won’t ever learn to do that whereas the child who has a parent who can handle that what are they doing they’re helping them work through it even though that is difficult for a parent to see their child’s suffering they allow an appropriate level of suffering and they work through that and so the the child who learns this in this case they don’t know how to deal with strong emotions and so that’s the first case and we’re going to do one more case and then we’ll show you what about the second one who it’s it’s not just and we would call that a form of neglect what about the second one this time it’s a young young lady who a young girl who is in a home where the parents are uh let’s say uh addicted to drugs and alcohol and so every time in this home that uh you know it could be uh trauma it could be other things but every time they in this home when when the parents experience anything that creates strong emotions or adversity in the life they respond by drinking drugs or excuse me that drinking alcohol or taking drugs and so I guess in the end alcohol is a drug so you could drink drugs but take drugs or or use alcohol and what happens there the children then see an impaired adult that is that is sometimes abusing them both emotionally or sometimes even physically or sexually um and whereas they wouldn’t had they not been impaired due to their du to their addiction and so what do we see them there they realize if I bring anything that creates strong strong emotions in my parents this is dangerous I have to avoid that at all costs and so what do they do there they learn to avoid strong emotions at all cost because it results in if we can use some slang the metaphorical getting your butt kicked and it can be emotionally or literally physically getting your butt kicked and so what do we see a lot of people who have a history of various traumas or various abuses they struggle with borderline personality disorder and it’s not their fault they’re not the ones who chose to be raised or or brought up in a home where they were not given the advantage of being able to learn how to work through situations and the strong emotions that come with them instead they were innocent and unfortunately didn’t learn that lesson and so the advantage is it’s much harder when we’re an adult the advantage is this can be cured the disadvantage is it’s much harder when you’re an adult to learn those skills that other people were so fortunate to be able to learn over their lifetime and so when somebody comes in and they cannot tolerate strong emotions they may meet criteria for borderline personality disorder and so what are those criteria listen you’re about to hear the ones that are very similar to the ones in bipolar except unlike bipolar this is not something where you’re great and you’re level and you’re functioning just fine up until you have that manic episode now there’s a clear difference in who you are during a manic episode than you were the rest of the time these ones are the individuals who you can identify patterns you can see it and what will they do they’ll they’ll do they they’ll they’ll react to anything that could cause a strong emotion in a way that is that is no longer appropriate when they were kids it was the only way they could survive that crappy situation so they’re not at fault they had to do this to survive but then when they become older and now it requires interpersonal and the ability to resolve conflict in a healthy manner they’ve never been taught this not their fault but now we see this is where they’re going to have those coping mechanisms a a lack of those coping mechanisms necessary and so what do we see we’re going to see first every single relationship that you engage in in this life is going to require you to learn how to tolerate strong emotions because no matter how good of a person you see or or you work with guess what they’re going to make a knuckleheaded move in life nobody’s perfect unless you’re Jesus Buddha or Muhammad those are the three that I’m aware of that are believed to have been perfect and most people are not claiming to be Jesus moham Buddha now the people who are in a manic episode and psychotic yes I’ve had many of them claim to be one of those people but not the people who are uh in touch with reality still and so unless you’re one of them every single relationship is going to have times where there is conflict and if you don’t have the basic healthy conflict resolution skills you’re going to be stuck and it will every single time you’re in a real relationship that goes more than just a superficial level you will create strong emotions and sometimes they’re difficult strong emotions where you’re angry and so in those cases what do we see they can’t maintain anything more than a superficial relationship so these are people who often times their appearance is the shell that they will show people because they don’t want to let him any deeper because if you you got any deeper you would see and create strong emotions in me and I don’t know how to tolerate those my UNC ious tells me those are always dangerous and I should run from them and that’s literally all I know how to do so far and so what will they do they’ll have a a pattern you see this in all the time not just when they’re manic all the time instability of interpersonal relationships instability of their own self-image and and perception instability of their affect meaning I’m up Suddenly when something’s going great and even in the same day I’m down to depressed and then I’m up and I’m down and that can happen multiple times a day or multiple times a week remember in bipolar we’re talking multiple times per year not daily and then that marked impulsivity of course they’re going to be impulsive anything to get away from these strong emotions that I don’t know how to deal with okay and so that’s where the criteria that you read in there in in the in the diagnostic and statistical manual the DSM will tell you about borderline personality disorder it’s not that your brain’s damaged and you can’t change it’s just that you haven’t learned how to deal with strong emotions yet so how is that going to look this is what it’s going to look like well first they’re going to do anything to avoid the strong emotions that come with people that abandon them think of that I was abandoned as a child my parents did not care for me in the manner that I needed to teach me those lessons of how to deal with strong emotions and work through things so what are they going to do they’re going to fear that abandonment being alone so they will do things that are just absolutely absurd to the rest of us and and to avoid abandonment things like I’ll threaten suicide if you leave me or I will I will agree to things I would never agree to sexual favors or other things that I should do that I would never agree to in my right mind but you will’ll see this pattern anytime they think somebody’s about to leave them they’ll do this um they’ll they’ll get in those Rel they’ll have those unstable relationships and they’ll see the world in black and white all or none this means this person is all good which we know Jesus Muhammad and Buddha would be the only three that are believed to be all good or all bad and so what is the reality every single person out there is some good to them and some bad to them the example would be even look at Hitler Hitler is a overall terrible person I am going to go ahead and declare my opinion I think Hitler is as bad a guy as you can get but Hitler did some good things too I can see the gray area which is Hitler had some good and some bad if you appreciate our Highway systems you can thank Hitler for giving that to um to our our politicians when when World War II ended they saw the Autobon that’s our freeway system so that we can travel around the country wonderful jet travel Hitler made the most advances in jet travel we took a lot of his technology the the uh the Rockets which allow us to to have the space races and your GPS and all this thanks to Hitler for doing that so Hitler not everything you know but Hitler did way more negative to he’s a terrible person but there is some positive about him that causes some strong emotions in me to have such a terrible person and to be able to say but there was some good but I have the ability and the conflict resolution skills inside myself to be able to resolve that internal conflict so that I then can say okay I think Hitler’s terrible but there was some positive well they don’t have that the people who have borderline personality disorder don’t have that yet and so instead they view the world in all good or all bad well that’s a problem that’s a mindfield you’re walking into because every single person is eventually even if they’re good people they’re going to make a knuckleheaded move to where now you’re going I should have known it and if you put them on this pedestal and idealize them as perfect even if you didn’t consciously do it it can be unconscious suddenly when they make an error or they disappoint you you’re then going to go you’ve been a a a counterfeit this whole time you’ve just been pretending to be a good person and you’re really just a wolf in sheep’s clothing who has been a bad person trying to take advantage of me whereas the reality is no they’re probably a good person who’s not perfect who made a knuckleheaded move or even disappointed you that doesn’t make them a bad person but you’re so afraid consciously or unconsciously of those strong emotions that would come with this that then suddenly that goes from all good to this person’s all bad and what are you going to do now you’re fearful they might abandon you so you’re going to reject them before they can reject you um what is that going to do to your own image I can’t even maintain a healthy romantic relationship or a healthy friendship or healthy family family bonds you’re going to start to see yourself as just unacceptable it reminds me of the the old the old uh uh play where the the person comes out and says look away I’m hideous and if you looked at this the individuals with borderline personality disorder when they look in the mirror when they’re really honest with themselves and I’ve worked with them and every single one this has been true they say people would be disgusted if they see what in me what I see when I’m truly looking at myself and they can’t do that so once again that when they’re feeling this way that’s where we’ll see those impulsive acts um and then then they they do those impulsive acts of what if I’m feeling alone and fearing abandonment I might engage in unsafe sexual activity or other risky behaviors to distract me from what I don’t want to face which is man I am struggling to deal with the strong emotions that come with and then fill in the situation and then then they’re going to so what is that going to result in when you can’t run away you nothing works eventually you’re going to start thinking of okay maybe I need to kill myself to get away from this so suicide becomes a problem and if you’re not really wanting to do suicide what about a suicidal gesture so that people don’t abandon me so I don’t have to feel the emotions of screwing something up and facing myself and learning where I’m weak and and then learning to strengthen that weakness that’s a hard thing and creates many strong emotions can’t deal with it so instead a short-term fix could be I’ll threaten suicide I may even do a gesture or or something where I think I’m doing it but unconsciously I’m not quite doing it enough to where it would be lethal that’s a problem because many times they accidentally take more than they thought or do something that is way more dangerous than they thought and they accidentally kill themselves and that’s one of them uh we’re going to see them up and down with that mood depression anxiety I’m on top of the world I’m down in the dumps just as quick they’re going to feel empty on the inside and then they’re also going to have inappropriate anger meaning it shouldn’t be the big a deal but I keep flipping out way bigger than is necessary and then you know what when they finally get so desperate and they can’t avoid real life anymore they can actually get so overwhelmed with Stress and Anxiety that they can uh they can become paranoid even though they’re not they’re not psychotic like with brain damage like we see in schizophrenia or bipolar but they can become paranoid because they’re overwhelmed with stress or dissociating and dissociating isn’t that just another way to avoid dealing with those strong emotions that come there so instead I’m going to go into my imaginary world and Associate and so those are there do you notice the difference while both of these have shared symptoms the causes are completely different and that’s a problem for many people because these are very serious diagnoses that both require an expert in order to diagnose and help them do it but what if what if you’re seeing somebody that isn’t trained in how to treat both that’s where you need something like this to understand it and they’ll say oh you’re struggling and and to be honest I do psycho theapy with people with borderline personality disorder and since I’m a psychiatrist I also treat bipolar disorder now let’s be honest many people that have bipolar disorder also have Bor Borderline Personality Disorder so while they have legit legitimate manic episodes and depressive episodes due to that they also have never pushed themselves or been in a situation where they were taught how to deal with strong emotions without running away and so can you see how that gets even more confusing now we have the two of them mixed and so what if you’re not trained in both you’re going to a lot of times when people get overwhelmed and can’t explain it to their patients and what they really need is therapy that helps them to be able to learn to tolerate strong emotions which here’s a secret sometimes that will take years to develop that but slow and steady they will develop it what if you’re not an expert enough in therapy you’re then going to go oh that must be bipolar because then we can give you a pill in a way we’re looking for that cop out many of our many of the Mental Health Community will tell you it must be bipolar because my therapy I did with you didn’t work and that comes to no you have to be an ex expert an elite therapist to be able to work with somebody with borderline personality disorder thank goodness there are so many great people that are expert out there that can do that um but then secondly what if you’re the opposite end of the spectrum what if you’re a medication provider for mental health like a psychiatrist or a nurse practitioner a physician’s assistant and you don’t know how to how to treat somebody that runs away from it well what do you you don’t want to have to say hey turns out you’re just running from your emotions and I don’t know how to treat that you’re going to have to find somebody else I’m completely unable to help you well we don’t want to feel inadequate as as medication providers and so what are we going to do we’re going to call it borderline or excuse me we’re going to call it bipolar and give you medications now the advantage to that is many times those mood stabilizer or medications that help to stabilize that membrane they actually can help with some of the symptoms if it’s borderline personality disorder they can think of it kind of like a ctis for a broken leg they can keep them stable long enough that the therapy then can help them to develop that ability to tolerate strong emotions without having to run away every time and so it’s not a bad thing that they’re starting them on a lot of these medications but it is a bad thing if they’re not starting on the medications and then concurrently ensuring that they’re in therapy to start learning to tolerate and work through strong emotions that because otherwise it’s like putting a cast on a leg and never healing the bone you’re never going to see it as soon as you take that cast off or stop those medicines of course they’re going to get worse again and it’s not because they have untreated bipolar it’s because you never help them get to the root of the cause of the borderline personality where they can’t tolerate those strong emotions and so you see not everybody’s able to treat both of these and that’s why you need a a person who is trained in both and that’s why we’re giving you this and so that’s where you’re going to see those extremes as you see somebody so so let’s use a simple example here as a demonstration as we as we finish up here you have a patient come in and they have and we’re going to use an extreme here the patient comes in and they tell you that they are really depressed because they have now severed their relationships and what happened was they felt like the their friend that was a boy that they might have had some romantic interest in so they might have had a a romantic interest and they severed the relationship because the the the the boy that was a friend didn’t call them back and so they assume that they’re being blown off again and they don’t want to do that and so is it border line or is it bipolar well it all depends is this a pattern that we see consistently that we can predict because if we can predict it it’s borderline personality disorder and that indicates they don’t know how to work through those strong emotions because any of us the possibility of being blown off by somebody or or ghosted or whatever term you want to say that’s going to create strong emotions of being rejected and if that is how I always act then it’s not a problem of the brain being dysfunctioned but if normally that wouldn’t bother me but now I wasn’t sleeping and that’s clearly a difference from how i’ normally act now it’s bipolar disorder can you see and and some people if you had both of them you would say okay here’s the difference when somebody is in a manic episode that has both bipolar and borderline personality disorder then we would say is this normally how you act and if they say yes we would say that needs to be treated in therapy but we also know it gets worse when people are in a manic episode so they may have both but their borderline struggles of not being able to tolerate strong emotions get even worse when they’re in a manic episode and so in those cases we would want to make sure their moods is controlled on the medication front and they’re doing it in therapy so so here we’re going to recap that real quick if it’s something that is a clear deviation from how they normally would act it is bipolar disorder and medication is the first treatment and therapy is there to support it if it’s their Baseline functioning and they’re always struggling with these same things it is borderline personality disorder where they do not know how to deal with strong emotions and therapy is the main treatment and medications at best can help stabilize a little bit while they’re doing their therapy and so that is the big difference between borderline personality disorder and bipolar disorder and and that hopefully helps you so that when you’re going to seek out treatment you can find those people and then also you can understand it and you can start seeing this pattern remember patterns that you can predict that’s bipolar disorder if it’s unpredictable that’s borderline excuse me I said that backwards patterns that you can predict are borderline personality disorder driven when it’s unpredictable and it happens just once in a while and clearly not their Baseline the normal how they normally are that is when it’s bipolar disorder and so if you’re out there spending all your money and always in debt but we can see the pattern it’s every time right after you reject people because you don’t like them pointing out flaws about you and so you go shopping in order to in order to uh try to find some happiness in life yep that’s borderline personality disorder because what you’re doing is I don’t want the strong emotions of scene that I don’t have the interpersonal skills I need yet and so I’m going to go shopping to try to distract from it but I’m going to reject you and run away because you’re all bad and then I’m going to go shopping as a way to try to make myself feel better that’s borderline but those people who normally are excellent at budgeting never overspending and then suddenly when they’re not sleeping and they become manic they spend like uh like there’s no tomorrow and then they come they when they come out of their manic episode they’re suddenly in debt and can’t do it nope that is when it’s bipolar disorder in the meds and so so one of them medication and it’s it’s basically not their fault the other one still not their fault but therapy is the main stay of treatment all right guys really appreciate it and uh we’ll catch you on the next one