Mental Health Matters
Forensic Edition
May 2012
Published by: Lepage Associates


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Disorders the Public Commonly Perceives in the Opposing Party: Bipolar, Borderline, and AD/HD Have Made it into the Public Dialect  

(but does the general public really know how to detect them?)

Skeptical attorney


It is not uncommon to hear conversations about how an ex-spouse, in-law, co-worker, or even a friend is "borderline" or "bipolar" or "ADD." When a person is forgetful, seems scattered or unfocused, he or she is quickly deemed "ADD". When someone is moody, he or she is assumed to be "bipolar." Or, if someone's behavior seems erratic and overly emotional, that person must be "borderline." With more awareness in the general public about these mental health conditions, perhaps bolstered by the numerous advertisements for psychotropic medications, these diagnostic labels are being used with more frequency and more lightly. This might not be much of a problem in casual conversation, but when these diagnoses are perceived in an opposing party, the misuse or inaccuracy of these labels can be misleading, confusing, or potentially damaging.


Symptoms Sometimes Look the Same

Part of the problem with the misperception of these disorders comes from the fact that there are many overlapping symptoms amongst mental health diagnoses such as Bipolar Disorder (BD), Borderline Personality Disorder (BPD), and Attention Deficit/Hyperactivity Disorder (AD/HD - 'ADD'). Symptoms often noted in another and then mistakenly attributed to these diagnoses include emotional instability, someone appearing to need to be the center of attention, difficulty with concentration and attention, intense anger or rage, and feeling depressed and hopeless. While it may be true that people who suffer from AD/HD may be impulsive and participate in risky behavior, the same is also true of people with Borderline Personality Disorder or Bipolar Disorder. Likewise, while it may be true that some people with Bipolar Disorder may seem require much attention when in a manic phase, the same is sometimes also true of people with Borderline Personality Disorder. People who have Bipolar Disorder may experience mood instability, but so do people with Borderline Personality Disorder. Some of the most commonly misattributed symptoms are difficulty concentrating, forgetfulness, and being scattered, which are typically assumed to be AD/HD; however, these symptoms might be due to a disorder of attention, but they might also be symptoms of an anxiety disorder, depression, or any number of other diagnoses.


Common Confusion Between Bipolar Disorder and Borderline Personality Disorder

Two of the most commonly confused mental health diagnoses are Bipolar Disorder and Borderline Personality Disorder. While mood instability is common to both, Bipolar Disorder is classified as a mood disorder, not a personality disorder. The overlap in symptoms between Borderline Personality Disorder and Bipolar Disorder can include an unstable self-image, impulsivity, irritability or intense anger, anxiety, depression, and suicidality. There are however, significant differences between the two. While people with Bipolar Disorder often suffer from a hypersensitivity to rejection, people with Borderline Personality Disorder typically have a prominent fear of real or imagine abandonment. Impulsivity, though common to both disorders, is usually characterized by self-harming behaviors in people with Borderline Personality Disorder whereas people with Bipolar Disorder engage in behaviors that may be risky but are less harmful to the self. Borderline Personality Disorder is also characterized by recurrent suicidal behavior, gestures, or threats as well as extreme reactivity to interpersonal distress. This means that when the person with this disorder becomes highly emotionally distressed, he or she is likely to have suicidal thoughts and perhaps engage in self-harming behavior such as cutting. The emotional distress in this case is so overwhelming that the only way to make it subside seems to be to end one's life or to inflict bodily pain as a source of distraction from intolerable emotional pain. Often this emotional distress and pain result from difficulty in interpersonal functioning for the person with Borderline Personality Disorder. Interpersonal relationships are, in general, much less stable for someone with Borderline Personality Disorder, as compared to the relatively more stable relationships for someone with Bipolar Disorder.


More than Just Symptoms are Needed for a Diagnosis

Complicating matters further, when symptoms are present, this might not be indicative of a true disorder. In some cases, a reaction to stress precipitates symptoms and behaviors that otherwise do not characterize an individual's personality or overall functioning. Being involved in a situation that resulted in a court case could involve just such a stressor. A snapshot of a person's behaviors is not sufficient for a diagnosis without putting those behaviors in context.


In other cases, a medical condition rather than mental illness may be the cause or contributor to symptoms. Sometimes symptoms are induced by medications or illicit drugs. Without an in-depth investigation of an individual's symptoms including a comprehensive picture of the person's past and current life circumstances, a history of the presenting problem, and an understanding of contributing factors from the individual's family background and upbringing, making an accurate diagnosis is not possible.


Accurate Diagnosis is Critical for Treatment

Even amongst experts on Borderline Personality Disorder there is controversy about the distinction between this and Bipolar Disorder, thus confusion in the general public between the two is understandable. Some would include Borderline Personality Disorder on a Bipolar spectrum, while others argue that they are two entirely separate disorders. Generally speaking however, the two diagnoses are regarded by clinicians as distinct in etiology, presentation of symptoms, and treatment. This highlights the importance of an accurate diagnosis for treatment. Effective treatments do exist for both disorders but without an accurate diagnosis, the likelihood of a successful treatment is clearly reduced. Successful treatment exists for AD/HD as well and testing exists that can diagnosis AD/HD with reasonable accuracy.


It is important to remember that a potential explanation for any of the myriad of 'symptoms'/behaviors listed here could also be reactions to a high level of stress. Examples could include: being in an unhappy marriage, an abusive relationship, a harassing workplace environment, worry over deportation, being falsely accused of a crime, fear of jail time, being a party in a contentious high-conflict lawsuit, etc. In such instances while the person does not meet criteria for a diagnosis of BD, BPD, or AD/HD, he or she would likely still benefit from supportive therapy to help with their stress.


Don't Lose the Person in the Diagnosis

In situations such as legal proceedings where tensions are probably quite high it is important to keep in mind that there is always more to a person than a list of symptoms and a diagnosis. Whether a label such as "borderline," "bipolar," or "AD/HD" is being used casually or as the result of an actual diagnosis, the impact of its use should not be taken too lightly. These diagnoses serve, first and foremost, as an aid to understanding and therefore helping the people who suffer from their symptoms to be able to seek effective treatment.


Lepage Associates
Lepage Associates
Solution-Based Psychological
 and Psychiatric Services

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