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BIPolar DISORDER People with bipolar disorder experience unusually intense emotional
states that occur in distinct periods called "mood episodes." An overly joyful or
overexcited state is called a manic episode, and an extremely sad or hopeless state is
called a depressive episode. Sometimes, a mood episode includes symptoms of both mania
and depression. This is called a mixed state. People with bipolar disorder also may be
explosive and irritable during a mood episode.
Extreme changes in energy, activity, sleep, and behavior go along with these changes in
mood. It is possible for someone with bipolar disorder to experience a long-lasting period
of unstable moods rather than discrete episodes of depression or mania.
A person may be having an episode of bipolar disorder if he or she has a number of
manic or depressive symptoms for most of the day, nearly every day, for at least one or
two weeks. Sometimes symptoms are so severe that the person cannot function normally
at work, school, or home.
Symptoms of bipolar disorder are described below
Symptoms of depression or a depressive episode
include:
Mood Changes

A long period of feeling worried or empty
Loss of interest in activities once enjoyed, including
sex.
Behavioral Changes

Feeling tired or "slowed down"
Having problems concentrating, remembering, and
making decisions
Being restless or irritable
Changing eating, sleeping, or other habits
Thinking of death or suicide, or attempting suicide.
National Institute of Mental Health
Borderline Personality Disorder
Borderline personality disorder (BPD) is a serious mental illness, one of a group of
conditions called personality disorders. BPD is one of four personality disorders within
Cluster B, the erratic and dramatic group of disorders. People with these disorders have
intense, unstable emotions and a distorted self-image. People with BPD also display
unpredictable and impulsive behavior, have unstable relationships, and suffer from identity
confusion. BPD can be summarized as an inability to regulate emotions, especially regarding
relationship issues.

The instability often felt by people with this disorder can disrupt family and work life, as well
as impact their self-identity. People with BPD are likely to have other mental health problems,
as well, such as substance abuse, anxiety disorders, eating disorders, and depression. BPD
is more common in women than men. It usually surfaces in the teen years or early adulthood.

What are the symptoms of borderline personality disorder?
People with BPD have extreme and long-standing instability in their emotional lives, which
affects their behavior and self-image. Symptoms that are common in people with BPD
include the following:

Intense but chaotic personal relationships
Unpredictable, dangerous and/or impulsive behavior, such as excessive spending, risky sex,
reckless driving, substance abuse, shoplifting, and binge eating, or physically self-
destructive behavior, such as self-injury or suicide attempts
Rapid mood swings, and periods of intense depression, irritability, and anxiety (which might
last only hours)
Intense or inappropriate anger
Confusion regarding self-image, sexual orientation, and choice of careers or friends
Recurring feelings of emptiness and boredom
Frantic avoidance of real or imagined abandonment
Discomfort with being alone
Brief periods of confused thinking and perception during times of great stress
Extreme "black and white" views of people and experiences (They are either entirely good or
entirely bad.)
What causes borderline personality disorder?
The exact cause of borderline personality disorder is not known, but most researchers
believe that it is caused by a combination of biological and psychological factors. People with
this disorder might be born with a vulnerability to the disorder, which is then triggered by
stress or other factors.

For example, research suggests that a malfunction in the brain might be responsible for the
impulsiveness, mood instability, anger, and negative emotions that are common in people
with this disorder. Psychological "triggers" might include childhood trauma, such as abuse,
neglect, prolonged separation, or inconsistent parenting. A disruptive family life and poor
communication within the family also are risk factors for the development of BPD.

How is borderline personality disorder diagnosed?
If symptoms are present, the doctor will begin an evaluation by performing a complete
medical history and physical examination. Although there are no laboratory tests to
specifically diagnose personality disorders, the doctor might use various diagnostic tests—
such as X-rays and blood tests—to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she may refer the person to a
psychiatrist or psychologist, health care professionals who are specially trained to diagnose
and treat mental illnesses. Psychiatrists and psychologists use specially designed interview
and assessment tools to evaluate a person for a personality disorder.

Because the symptoms of BPD include erratic behavior and profound mood swings, it is
difficult to distinguish from bipolar disorder (formerly manic-depressive disorder). A qualified
health care professional will determine if the symptoms best indicate BPD, bipolar
depression, or both.

How is borderline personality disorder treated?
Treatment for borderline personality disorder often includes psychotherapy (a type of
counseling) and medication. Medication generally is given to target specific symptoms—
rather than to treat the disorder itself—and might include drugs to stabilize mood, or to treat
depression or anxiety. Anti-psychotic medications might also be used if the person suffers
from severe periods of distorted thinking.

Psychotherapy is the main treatment for most personality disorders, including BPD. The
focus of therapy is on increasing self-awareness and stability in relationships, as well as on
helping the individual become less impulsive, and to use better judgment in his or her
behavior and decisions.

A special type of behavior therapy, called dialectical behavior therapy (DBT), might be useful
for people with BPD. The focus of DBT is on acceptance and change, and therapy is aimed
at enhancing the person’s behavioral abilities and improving motivation to change negative
behavior. DBT is usually an intensive treatment process, involving group and individual
therapy.

Brief stays in the hospital might be necessary during times of high stress or when symptoms
are particularly distressful. Many people with this disorder attempt suicide, prompting
hospitalization.

What are the complications of borderline personality disorder?
Without treatment, people with borderline personality disorder are at greater risk for:

Substance abuse
Eating disorders
Depression
Self-injury
Suicide
In addition, BPD is linked to high conflict, divorce, and separation from family members and
friends. It also can lead to various financial and legal problems.

What is the outlook for people with borderline personality disorder?
The outlook for people with borderline personality disorder varies. Although BPD can be a
life-long problem, people with the disorder can get better. In most cases, however, recovery
is slow and difficult. With help, some people are able to improve and lead rewarding work
and social lives. Others are unwilling or unable to stick with treatment, leading to a poor
outlook. For unknown reasons, however, this disorder tends to "burn out" in middle age, and
people with BPD often begin to see improvement in function by the time they reach 35 to 40
years old.

Can borderline personality disorder be prevented?
There is no known way to prevent BPD.

© 1995-2010 The Cleveland Clinic Foundation. All rights reserved.

HISTRIONIC PERSONALITY DISORDER
What is histrionic personality disorder?
Histrionic personality disorder is one of a group of conditions called dramatic personality disorders. People with these
disorders have intense, unstable emotions and distorted self-images. For people with histrionic personality disorder, their
self-esteem depends on the approval of others and does not arise from a true feeling of self-worth. They have an
overwhelming desire to be noticed, and often behave dramatically or inappropriately to get attention. The word histrionic
means “dramatic or theatrical.”

This disorder is more common in women than in men and usually is evident by early adulthood.

What are the symptoms of histrionic personality disorder?
In many cases, people with histrionic personality disorder have good social skills; however, they tend to use these skills
to manipulate others so that they can be the center of attention.

A person with this disorder might also:

Be uncomfortable unless he or she is the center of attention
Dress provocatively and/or exhibit inappropriately seductive or flirtatious behavior
Shift emotions rapidly
Act very dramatically as though performing before an audience with exaggerated emotions and expressions, yet appears
to lack sincerity
Be overly concerned with physical appearance
Constantly seek reassurance or approval
Be gullible and easily influenced by others
Be excessively sensitive to criticism or disapproval
Have a low tolerance for frustration and be easily bored by routine, often beginning projects without finishing them or
skipping from one event to another
Not think before acting
Make rash decisions
Be self-centered and rarely show concern for others
Have difficulty maintaining relationships, often seeming fake or shallow in their dealings with others
Threaten or attempt suicide to get attention
What causes histrionic personality disorder?
The exact cause of histrionic personality disorder is not known, but many mental health professionals believe that both
learned and inherited factors play a role in its development. For example, the tendency for histrionic personality disorder
to run in families suggests that a genetic susceptibility for the disorder might be inherited. However, the child of a parent
with this disorder might simply be repeating learned behavior. Other environmental factors that might be involved include
a lack of criticism or punishment as a child, positive reinforcement that is given only when a child completes certain
approved behaviors, and unpredictable attention given to a child by his or her parent(s), all leading to confusion about
what types of behavior earn parental approval.

How is histrionic personality disorder diagnosed?
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical
examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use
various diagnostic tests to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or
psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and
psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder.

How is histrionic personality disorder treated?
In general, people with histrionic personality disorder do not believe they need therapy. They also tend to exaggerate
their feelings and to dislike routine, which makes following a treatment plan difficult. However, they might seek help if
depression — possibly associated with a loss or a failed relationship — or another problem caused by their thinking and
behavior causes them distress.

Psychotherapy (a type of counseling) is generally the treatment of choice for histrionic personality disorder. The goal of
treatment is to help the individual uncover the motivations and fears associated with his or her thoughts and behavior, and
to help the person learn to relate to others in a more positive way.

Medication might be used to treat the distressing symptoms, such as depression and anxiety, that might co-occur with
this disorder.

What are the complications of histrionic personality disorder?
Histrionic personality disorder can affect a person's social or romantic relationships and how a person reacts to losses or
failures. People with this disorder are also at higher risk than the general population to suffer from depression.

What is the outlook for people with histrionic personality disorder?
Many people with this disorder are able to function well socially and at work. Those with severe cases, however, might
experience significant problems in their daily lives.

Can histrionic personality disorder be prevented?
Although prevention of the disorder might not be possible, treatment can allow a person who is prone to this disorder to
learn more productive ways of dealing with situations.

© Copyright 1995-2009 The Cleveland Clinic Foundation. All rights reserved.
Symptoms of mania or a manic episode include:

Mood Changes

A long period of feeling "high," or an overly happy or
outgoing mood
Extremely irritable mood, agitation, feeling "jumpy" or
"wired."
Behavioral Changes

Talking very fast, jumping from one idea to another,
having racing thoughts
Being easily distracted
Increasing goal-directed activities, such as taking on new
projects
Being restless
Sleeping little
Having an unrealistic belief in one's abilities
Behaving impulsively and taking part in a lot of
pleasurable,
high-risk behaviors, such as spending sprees, impulsive
sex, and impulsive business investments
.
BPD
BIPOLAR
HISTRIONIC