How a mixed episode got me misdiagnosed – bipolar vs borderline personality disorder

In this post I share my experience being “misdiagnosed” with borderline personality disorder over bipolar disorder.

Background – my experiences leading up to seeking help. 

As I believe I have already stated around April of 2016 I started becoming consumed by my increasingly poor mental health. I would be at work and burst into fits of crying, wanting to kill myself, fits of rage where I would verbally attack any poor soul that happened to be around me, I was unable to control my emotions and was flying around at 1000mph on a destructive war path. I could not act professionally and was constantly being sent home early due to my behaviour, I even stepped down in my role to try and ease up the pressure but nothing, absolutely nothing could shift the burning anger I felt towards the world.

Then all of a sudden I crashed into a severe depression, the crying spells intensified, I hated myself and felt completely hopeless and alone. I was so afraid to admit that I was hurting, I felt weak and insecure. I struggled to get out of bed, stopped going to the gym or seeing friends, stopped cleaning my house, stopped bothering to cook meals. I had no energy or desire to try.

After some time the depression suddenly lifted, I felt incredible, euphoric. I felt connected to the world in a way others could not achieve, almost as if I was a god. I started talking incredibly fast, jumping between thoughts rapidly. I took on so many projects and took time off from work to “fix my life” or so I thought. I distinctly remember thinking wow, I must have been so depressed to feel this happy in comparison, I need to stop this ever happening again. I started researching my experiences and came across a condition I was already hyper aware of – bipolar disorder. The reason I say I was so aware of this is I was assessed for this back in 2012 and was identified to be at risk.

Seeking a referral 

Suddenly my whole life made sense once again, how did I forget about this, about my assessment. I couldn’t believe I hadn’t figured this out. The cycles continued to shift every 3-12 weeks as I sought out a GP. Explaining my experiences to my GP led me to be referred to a mental health nurse as a kind of middle-man to a psychiatrist, who I again explained my experiences to and he agreed that I was displaying bipolar or cyclothymic behaviours and agreed to refer me to a psychiatrist.

Whilst waiting for my appointment my symptoms proceeded to worsen into one of the worst feelings of my entire life, this turned out to be a bipolar mixed episode. I was completely out of control, suicidal thoughts were flooding my mind constantly, racing so fast they were unescapable. I would cry and cry for no reason, unable to settle myself, my agitation was through the roof. I was unable to sit still and felt so uncomfortable, I was delusional and having hallucinations, I wanted to run away. Feeling the symptoms of mania – high energy, agitation, racing thoughts, psychosis, alongside depression – low mood, suicidal ideation, low self esteem, tearfulness, led me to display a completely erratic string if emotions, I was terrified. I felt unsafe, like I could hurt myself or ruin my relationships or my life so easily in this state.

The Misdiagnosis

It was in this overwhelming condition that I saw the psychiatrist, this time instead of telling him the timeline I had prepared and explained previously, I somehow treated this more as a therapy session and each one of these mixed symptoms came to surface.

  • I spoke about how afraid I was that through my depression and anger that I would lose my loved ones.
  • I discussed how my bouts of rage were getting me in trouble at work
  • I explained how my delusional thinking led me to believe my co-workers were “out to get me”
  • I spoke about my depression and uncontrollable bursts of crying
  • I described my psychotic experiences, auditory visual and tactile hallucinations that I was having

The doctor asked me if my life was stressful, I laughed and said yes. Of course I felt stressed I was in a mixed episode! He asked if I had self- harmed, which I had thought about. This then led to the diagnosis of borderline personality disorder.

Being on the wrong medication

Initially I tried to embrace the diagnosis and agreed to take an antipsychotic that I could take when I feel stressed to soothe anger, irritability and psychotic symptoms. The medicine along side researching coping techniques started to help and for a while I felt like this was the correct diagnosis. Borderline personality disorder is predominantly treated with DBT, which are skills that could be useful to everybody in regards to stress management, which is the number one trigger for a bipolar episode. So at first it helped.

After a month or so another period of depression hit and I couldn’t cope, after much resistance I agreed to also go on an antidepressant. This completely messed me up. I started cycling between moods every 5 days, then every 3 days, then every 2 days, it was unbearable. I had a review with the mental health nurse I saw initially and I was so incredibly manic, I was talking a mile a minute, bouncing around so happy but luckily still straight minded enough ro be afraid of the depression crash that I explained what had been happening. I explained how impossible it was to make plans when im happy then crash before they come around, how I had been feeling impulsive and wanting to drink heavily and quit my job. The nurse felt I needed a second opinion and got me booked in for two weeks time, which is incredibly fast for the UK.

The re-diagnosis

After being put forwards for a second opinion I continued to cycle every two to four days between euphoric hypomania and depression with psychotic symptoms on both sides. This started causing severe difficulties at work as the depression worsened each time to the point where I was going home early because I couldn’t function.

I saw the second psychiatrist and this time came prepared, told the entire story including my experiences on the borderline medication and the psychiatrist confirmed that throughout our chat he has tried to match me to Borderline, but couldn’t. However, I displayed classic bipolar symptoms including mixed episodes, depression in an early age and atypical depression at a young age. The doctor changed my medication to continue my antidepressants but change my antipsychotic to a mood stabilizing one.

Current experience and afterthoughts

I have only been on new medication for a few days but have not yet crashed, instead I seem to be maintaining a very mild state of hypomania which I have to say I am enjoying very much. I wake up with joy, passion, desire, something I lost during depression.

I understand now that due to the heights of mania causing every emotion to pour out of me, something I have seen described by psychiatric professionals with bipolar disorder, combined with the agitation and self destructive behaviours that associate with depression and mixed episodes that I was displaying mood shifts closer to the borderline spectrum. Without taking my history into account I understand why this led to a diagnosis of borderline personality disorder.

I see this as a positive thing, as I do believe I have some borderline traits and that therapy could definitely help me improve aspects of my life, and also I now feel so validated that after a five year fight, that I will go into in more detail in another post, finally led me to the right diagnosis of bipolar disorder.

For anybody in this predicament I would recommend that you persevere through the frustrations until you are satisfied with your diagnosis, but also to be open to any advice you may receive. It helped me immensely to watch videos on youtube around mental health, particularly LizziesAnswers and RecoveryMum (youtube) for bipolar and borderline.

Photo by Kostya Kisleyko from FreeImages

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