If I'm Not Bipolar, What Am I?

While this may seem a strange question at first blush, it makes a whole lot of sense once you sort it out. In this section, I hope to introduce you to a group of related disorders that are often found in conjunction with manic-depressive illness. It's a good idea at least to be on nodding terms with each of these because they often mimic bipolar symptomology and/or complicate both the diagnosis and treatment of same. I can only touch on them briefly here, for each is deserving of a website of its own and, in fact, most do have websites. I've provided some links to major sites if you care to seek out additional information.

Obsessive-Compulsive Disorder (OCD)

This disorder manifests itself in ways both unnoticeable to others and in those which are more bizarre.

ICD - Criteria for Diagnosis

F60.5 Anankastic (Obsessive-Compulsive) Personality Disorder
Personality disorder characterized by at least 3 of the following:

1. feelings of excessive doubt and caution;
2. preoccupation with details, rules, lists, order, organization or schedule;
3. perfectionism that interferes with task completion;
4. excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships;
5. excessive pedantry and adherence to social conventions;
6. rigidity and stubbornness;
7. unreasonable insistence by the patient that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things;
8. intrusion of insistent and unwelcome thoughts or impulses.
   
   

Includes:

1. compulsive and obsessional personality (disorder)
2. obsessive-compulsive personality disorder
   
   

Excludes:

1. obsessive-compulsive disorder

American Description and Diagnostic Criteria (DSM IV)

Either obsessions or compulsions:

Obsessions as defined by (1), (2), (3), and (4):

1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
   
   
2. the thoughts, impulses, or images are not simply excessive worries about real-life problems.
   
   
3. the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
   
   
4. the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
   
   

Compulsions as defined by (1) and (2):

1. repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
   
   
2. the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
   
   

  At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.

  The obsessions or ompulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.

  If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder).

  The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify if:

With Poor Insight: if, for most of the time during the current episode the person does not recognize that the obsessions and compulsions are excessive or unreasonable.

Associated Features

1. Depressed Mood
2. Somatic/Sexual Dysfunction
3. Guilt/Obsession
4. Addiction
5. Anxious/Fearful/Dependent Personality

For research articles and additional information on OCD, go here.

Borderline Personality Disorder (BPD)

American Description: Diagnostic Criteria

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
   
   
2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
   
   
3. identity disturbance: markedly and persistently unstable self-image or sense of self
   
   
4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
   
   
5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
   
   
6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
   
   
7. chronic feelings of emptiness
   
   
8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
   
   
9. transient, stress-related paranoid ideation or severe dissociative symptoms
   

Associated Features

Depressed Mood

Addiction

Dramatic/Erratic/Antisocial Personality



Differential Diagnosis

Mood Disorders; Histrionic Personality Disorder; Schizotypal Personality Disorder; Paranoid Personality Disorder; Narcissistic Personality Disorder; Antisocial Personality Disorder; Dependent Personality Disorder; Personality Change Due to a General Medical Condition; symptoms that may develop in association with chronic substance use; Identity Problem.

Go here for additional information and research articles on BPD.

      
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