How would you best diagnose this behavior?

[rf993]

I need help to find the proper diagnosis for someone I know.  They have a moderately serious mood / depression disorder.  When I say moderately I don’t mean to diminish the seriousness of the situation – it is very serious.  I am talking about on the grand scheme of very serious or as serious as possible meaning requires constant hospitalization, possibly sedation, suicide is a serious risk without constant professional supervisor to absolutely minor “I feel a little bit blue today and I don’t know why.”  
What I see in this person is clear cut classic text book symptoms of a mood/depressive disorder but I don’t know which one fits.  We are not talking about someone who feels normal levels of emotions to normal events in life but rather someone that absolutely has a chemical imbalance or such in their body that does not allow them to experience feelings, emotions and experiences in the same way that “normal” people do.  To make matters worse this person doesn’t realize it.  I have told them but they are just so skeptical because throughout the various mood cycles there is just a feeling of emptiness, lack of enthusiasm and lack of true happiness that they don’t have anything to compare it to.  They believe my words but it’s very difficult to sink in because they just haven’t ever experienced anything outside of the limitations of the “emotional box” that they have been in possibly forever or at least since teenage years.  I want to present this person with a good clinical description from a trusted [medical] source that fits them as well as possibly.  I think that it will help them believe that I am not BSing them.  After all I am not a medical professional of any kind.  One of the few good things is that this person can recognize when I state a symptom i.e. “sleep disturbances” or “rapid changes in mood” they will acknowledge that they have this.  One of the very worst things is “well maybe that is just normal” “I don’t know how other people feel, etc.”  If I can produce something from a qualified source I think it will help acknowledgement on a bit deeper of a level.

I thought bipolar disorder was a good fit until I read about the timing of the mood swings – 1 once a year or “rapid cycle” 4 times per year.  Mood swings in this person can happen within weeks, days, hours or possibly even minutes.  Let me get into the symptoms:

• Difficulty sleeping, sleep disturbances, difficult to get a good night’s rest, frequent tiredness.  Restless sleep and oversleeping can both occur although lack of sleep is more common.
• Rapid mood swings within short periods of time.  Instability due to the rapid mood swings.
• Frequent feelings of emptiness/lostness and/or confusion
• History of cutting
• Impulsivity (over-indulgence in alcohol, more minor overspending/shopping)
• Brief history of eating disorder
• History of abusive and/or unstable/chaotic romantic relationships
• History of unsafe sex
• Inability to experience good emotions on a deep level (particularly romantic)
• General lack of control over emotions.
• Moderate anxiety over issues that should be no big deal (occasional)
• Sensitivity (sometimes extreme) to the treatment received from others.
• Occasional lack of sensitivity/awareness in coldness/indifference in their treatment of others.
• “high in intimacy- or novelty-seeking, can be hyper-alert[6] to signs of rejection or not being valued and tend towards insecure, avoidant or ambivalent or fearfully preoccupied patterns in relationships.  increased levels of chronic stress and conflict in romantic relationships, decreased satisfaction of romantic partners.”  Is a description I read that seems to fit to some degree.
• History of unhappy childhood and one alcoholic parent.

I think difficulty sleeping is self explanatory.

Moods are always rapidly changing.  Indifference, crying and laughing and smiling could take place within one hour.  Various levels of sadness and happiness are common, extreme examples of each occur occasionally.  The baseline or “normal” in between mood includes a lack of feeling, enthusiasm or excitement for things in general.  Sometimes the mood swings are reactive over-reactions but other times seemed to be caused by absolutely nothing at all.

Feelings that are only described as “lost” and/or “empty” are common with approximate frequency of once per week or more.

There is history of cutting (on the arms).  I have seen this before and I would describe it as moderate because the scars are not terribly deep or noticeable.  I have seen it much worse and also less severe.  I believe this to be mostly history but there was one relapse that I know of in the last 2-4 months.  I don’t believe there have been any other instances in the last 5 months or so and I believe that the person has mostly if not entirely gotten over this.  The one instance that I know of took place with 2 hours of crying and extreme sadness followed by partying, drinking, happiness, etc.

This person over-drinks frequently.  How frequently and how much I cannot pinpoint but I would say once a week to an extreme level of intoxication and more than is healthy a couple more times per week.  There has not been an extended period of time without ANY alcohol in this person’s history since middle teenage years.  Alcohol use/abuse seems to trigger emotional swings.  During intoxication I have witnessed extreme depression / emotional pain with repeated statements of “this is normal” “nothing is wrong” “everybody feels like this sometimes.”  I believe extreme intoxication can also trigger a “happy” mood but I haven’t witnessed.  The lost/confused/empty feeling VERY frequently occurs 1 or 2 days after heavy drinking, or sometimes for two days straight.

There was a history of an eating disorder in the past but I believe that it was short-lived and not terribly serious and that it is in fact history now.  I cannot be certain, however.

There is a history of abusive relationships and difficulty or inability to get out.  Even after ending it, difficulties letting it go.  The description I read that said “intense and unstable” relationships also sounds like a good way to describe it.  Intensity in both good and bad feelings seems to always be present.

There is a history of risky sex behaviors.

There is a desire to experience more deep emotional / romantic emotions but probably an inability to feel/experience because general life experience / emotion seems to be lacking no matter what the current mood state.

Symptoms that I do NOT see / do not seem to be there but are part of the BPD, bipolar, depression I read about:

• I am not aware of suicide attempts (doesn’t mean it didn’t happen in the past) and I don’t think that it is a serious risk now.
• I don’t see a lot of “Frantic efforts to avoid real or imagined abandonment” but extreme attachment in an early relationship followed by relative indifference
• I have never seen anger of any kind and am not aware of extreme or inappropriate anger.
• “They tend to view the world generally as dangerous and malevolent, and themselves as powerless, vulnerable, unacceptable and unsure in self-identity.” This does not fit, this person takes accountability for their actions and recognizes their own fault in poor choices yet seems to be unable to stop making poor choices.
• No Decreased sex drive.
• No constant overwhelming sadness
• No loss of appetite / weight-loss.

This person is still functional, they have many friends, a successful career that is seemingly entirely unaffected by these issue.  This person is very good about hiding their mood swings in a professional environment.  They have undergone treatment from a therapist and experimented with various prescribed medication but unsuccessful and they are resistant to the idea of trying this again.  They acknowledge that they need to cut down on drinking and that it is a problem and that it exacerbates the mood swings.

[rf993]

Ok guys thanks for the input but it really sounded like it had more in common with borderline than bp... i.e. the self-mutilation etc...  all the points i made.

All of the descriptions of BP don't seem to fit.  None of htem mention mood swings that are so fast paced or any of the other behaviors.  

I appreciate the thought of just send them to the forum but i don't think they will do that.  THey aren't ready to accept it.  I thought if I could turn them on to some medical text that describes they way they feel to them they would wake up...  doesn't this make sense?  When I describe it they agree but I'm no doctor.

[Venora Moonwind]

bi polar cqan cycle as many times as 10 in a day. show them this forum and we can try to help them. Unforunatly until they realize they need the help little can be done except to tell them about the resources available. you are a good fried to be concerned.
Love Venora

[Rozanna]

Check out BP one more time sounds like a person who has BP to me..