bipolar disorder, Dr. Paul Markovitz  Q. My daughter was diagnosed with clinical depression 11 years ago. When I took her to a doctor here he said she was Bi-Polar and put her on Lithium and Thorazine and cogentin. All through the past 11 years I have watched her very closely and her last Psychiatrist added another diagnosis that being BPD. Now after reading about BPD my daughter seems to be more on the BPD side than Bi-Polar. I think that because of family history--Bi-Polar, my sister and cousin have Bi-Polar, that the doctors treating my daughter automatically treated her for Bi-Polar. I never saw her in any real manic state--depressed yes, leading to pscyhosis, but more on the BPDisorder. My question--can Bi-Polar be misdiagnosed? Can it be she just has BPD? What are the treatments for BPD? It is so heart wrenching to see this beautiful woman/child of mine suffering so all these years. Right now she is on Soc.Ser.Dis. and going to a day program in art therapy. She has a degree in art and feels comfortable expressing her self in the medium. Next month she will be 43 years old and I don't see any progress happening in her life.

  A. You have posed a number of intriguing questions that many of us in psychiatry have been asking for years. Your daughter was labeled bipolar for a number of reasons. First, she probably meets criteria for bipolar and thus is a bipolar. What you are really getting at in your question is whether this is the behavior that the doctors should be treating. Second, if she is seeing a doctor, they will get paid for a BP diagnosis, but not a borderline diagnosis. We all like getting paid for our work, so they will call her bipolar. Finally, you can be both BPD and bipolar. I do not know what her problem might be biologically. I do have a very simple rule of thumb. If what you are doing is not working, try something else. While it is possible your daughter will not get any better then she currently is, I doubt this is the case. You do have some great options in New York City. Eric Hollander's group in NYC does great work with BPD and Don Klein's cohort of psychopharmacologists are probably the best of all time assembled in one place. Klein is without question one of the greatest psychiatrists of all time. May want to give their universities a call for a second opinion.