Borderline personality disorder and bipolar disorder are often confused.1,2 While they seem similar, bipolar disorder includes significant periods of depression and mania (a state of restless excitement that can lead to psychosis). Borderline personality disorder affects all aspects of someone’s ability to function due to extreme and rapid emotional, cognitive, and behavioral instability.
What Is Borderline Personality Disorder (BPD)?
The traits associated with borderline personality disorder fall into five categories of dysregulation: emotions, relationships with others, behaviors, thinking, and internal self.2 Dysregulation means being unable to effectively manage these symptoms and maintain stability. These areas of dysfunctions are relational and impact interactions with others, the environment, and someone’s own internal state.
Signs and symptoms of borderline personality disorder may include:
- Attaching easily to others and fearing abandonment
- Hating being alone and moving through BPD relationship cycles
- Chronic patterns of emotional and behavioral instability
- Chaotic, intense relationships, which may include domestic violence
- Shifting between extreme opposites
- Intense emotions
- High emotional sensitivity
- Sudden bouts of BPD euphoria and positivity
- Impulsivity and risky behaviors
- Self-harm and suicidality
- Experiencing a sense of emptiness or numbness
- Inappropriate, intense anger or borderline rage
What Is Bipolar Disorder?
Bipolar disorder causes extreme mood swings between highs (mania, which can become psychosis) and lows (depression). Mania may appear once in a lifetime, or a few times per year. There can also be stable periods with normal moods.
Bipolar disorder can be diagnosed as mild, moderate, severe, or with psychosis. There are many other specifiers that can be added to the diagnosis: anxious distress, mixed features, rapid cycling bipolar, melancholic features, mood-congruent psychotic features, catatonia, peripartum onset, and seasonal pattern.4
Signs of a manic episode for those with bipolar disorder may include:7
- A heightened sense of self-importance
- Sleeplessness, or feeling no need for sleep
- Increased energy, activity, restlessness, agitation
- Euphoric mood
- Being impatient and “on the move”
- Extreme irritability
- Poor concentration and decision-making
- Racing thoughts
- Impulsive behaviors, like reckless spending or risky sex
- Provocative, intrusive, or aggressive behavior
- Misuse of substances
Signs of a depressive episode may include:7
- Feelings of hopelessness and pessimism
- Loss of interest or pleasure in activities once enjoyed
- Changes in appetite, significant and unintended weight loss or gain
- Sleeplessness or sleeping too much
- Restlessness and irritability
- Feelings of guilt, worthlessness, and helplessness
- Difficulty concentrating
- Bodily symptoms not caused by physical illness or injury
- Thoughts of death or suicide or making plans for suicide
BPD Vs. Bipolar Disorder
Bipolar disorder is a mood disorder whereas borderline personality disorder is a personality disorder. It is important to understand the distinction as the dysfunction in both can overlap, but impact the individual in different ways–which is where the differing diagnoses come to play.
Symptoms
| Borderline Personality Disorder | Bipolar Disorder |
|---|---|
| Chronic emotional instability with frequent, rapid changes | Mood instability over longer periods of time with periods of normal mood in between |
| Thinking and behaving in extreme opposites | Poor cognitive ability during depressive or manic episodes |
| Unrelenting crisis | Crises appear during height of depressive or manic episodes |
| Extreme fear of abandonment and fear of being alone | Likely to isolate during depressive episode and can be overly social during manic episode |
| Sleep disorders; chaotic, not enough, wrong hours | Sleeping too much or sleeping too little |
| Constantly feels something is wrong with them | Denies anything is wrong |
| Intentional self-harming behaviors | Impulsive behavior that can lead to self-harm |
| Continuous and unchanging pattern of instability that impacts functioning | Uncharacteristic changes in functioning noticeable by others when moving from one episode to another |
| BPD can be accompanied by depression and has more emotional reactivity and volatility | Bipolar can look a lot like major depressive disorder; estimates are that 75% of the time the mood is disabling depression |
| Suicidality is chronic | Suicidality is intermittent |
Possible Causes
There are many causes of BPD and bipolar disorder including genetic, environmental, and traumatic experiences which can lead to the onset of BPD symptoms. Sometimes it happens quickly and other times it develops over a long period of time.
Causes of BPD may include:
- History of abuse: A history of abuse can lead to BPD due to the damage in the child or teens brain.
- Family history of BPD: A family history of BPD or mental health issues can play a role in parenting styles which can impact the child.
- History of depression or anxiety: A history of depression or anxiety can be a precursor diagnosis or a smaller diagnosis of a larger issue.
- Inconsistency in childhood: Children with unpredictable home environments can develop BPD due to a lack of stability.
- Trauma: Trauma changes the brain and can lead to personality disorders.
- Attachment style dysfunction: Attachment trauma from caregivers can lead to BPD due to the lack of a secure caregiver and feeling as though they are alone and unsafe.
- Low self-esteem: Poor self-esteem and low self-worth can lead to overcompensation in other ways and cause the onset of BPD.
- Brain abnormalities: Physical brain damage can impact personality.
- Genetics: A family history of BPD from a genetic lens can also influence the offspring’s chemical makeup.
Bipolar disorder can be caused by:
- Family history of bipolar disorder: A family history of bipolar disorder can trigger someone to develop bipolar disorder due to the unstable nature of living with someone with the condition.
- Trauma: Trauma changes the brain and can impact how you manage and regulate your moods.
- Drug and alcohol misuse: Substance use can influence our thoughts and feelings and long-term use can change our brains.
- Sleep disturbances: Low quality sleep impacts your brain and processing as well as memory and emotional regulation. Prolonged sleep issues can mimic bipolar symptoms and lead to the onset of bipolar disorder.
- Overwhelming stress: High levels of cortisol in the body can impact a lot of processes in the body, including how you regulate your emotions which can lead to drastic mood swings seen with bipolar disorder.
- Genetics: A family history of bipolar disorder can be relevant in the onset of bipolar disorder.
Diagnosis of Borderline Personality Disorder vs. Bipolar Disorder
Before treatment is determined, the most important step is getting the correct diagnosis. Due to the overlapping characteristics of BPD and bipolar disorder, these disorders can be confused, and a misdiagnosis could mean ineffective treatment and poor outcomes.3
Diagnosis should be sought through a healthcare provider, either a primary care physician or mental health specialist, such as a psychiatrist or a psychologist, prior to beginning any treatment.
There are several factors that can help determine whether BPD or Bipolar disorder should be diagnosed, including:9
- Family history of mental illness: Understanding the family history and pathology of mental health issues as well as family issues is important in understanding the diagnosis you may be dealing with.
- Sleep patterns: Learning about your sleep patterns can help narrow down what types of issues you are having and how they relate to BPD versus bipolar disorder.
- Relationship patterns: Relationship patterns are important as well, as those with BPD and bipolar disorder can have distinctly different types of patterns.
- Self-harm behaviors: Learning about if, when, and how often self-harm thoughts and behaviors occur is also important as those with BPD may be more prone to these behaviors.
- Duration of mood episodes: People with BPD experience changing mood states that last minutes, a few hours, or a few days. People with bipolar disorder experience enduring mood states and may have one or more extreme mood states in a year.
Can You Have Borderline Personality Disorder & Bipolar Disorder?
It is possible to have both BPD and bipolar disorder. Currently, about 20% of people with BPD also have a diagnosis of bipolar disorder.8 Given the great overlap of the symptoms of both conditions, it’s common to misconstrue one diagnosis for the other. Sorting through the symptoms of both can take time, but learning about both disorders can help in understanding which symptoms are related to bipolar disorder and which are BPD symptoms.
Treatment for BPD Vs. Bipolar Disorder
Treatments for BPD and bipolar disorder are different, though therapy is recommended for both. BPD is less frequently treated with medication, with the exception of medicating co-occurring disorders like anxiety or depression. Bipolar disorder is quickly and effectively treated with medication. Research on bipolar disorder has found that using medication and psychotherapy together provides the best outcome.
Both BPD and bipolar disorder are serious mental health conditions that greatly affect a person’s life. The good news is that both can be treated effectively by mental health professionals. Treatment may not make all symptoms go away, but it can reduce the effects so you can live a happier, healthier life.
Treatment for BPD
BPD has been found to respond well to dialectical behavioral therapy (DBT) as well as cognitive behavioral therapy (CBT). DBT is currently the frontline approach for treating BPD. There may be times when a psychiatrist or other prescriber recommends medication as well.
There is some controversy about medication use for BPD because it is a personality disorder. Personality disorders have a biological aspect, but there is not enough solid research to identify a targeted, consistent, and effective medication for personality disorders.
Treatment for Bipolar Disorder
Treatment options for borderline personality disorder include:
- Cognitive behavioral therapy (CBT): CBT for bipolar disorder focuses on changing negative thought processes to more positive thoughts. It helps to identify triggers of a bipolar episode and understand why a mood swing can occur.
- Medications: Mood stabilizers and/or SSRIs can make a big impact on the quality of life of someone living with bipolar disorder.
- Interpersonal and social rhythm therapy (IPSRT): Helps people learn about their mood and improve their own mood by learning more about their body mechanics and systems.
- Family therapy: Family therapy is a great way for everyone to get a voice and learn how to support the individual with bipolar disorder as well as validate their emotions as well.
- Electroconvulsive therapy (ECT): Helps people relieve some of the symptoms of bipolar disorder by sending electric currents through the brain.
- Transcranial magnetic stimulation (TMS): Helps people manage low mood by using magnetic stimulation in the brain to create movement with brain nerves.
Can BPD or Bipolar Be Prevented?
BPD and bipolar disorder cannot be prevented, but there are a lot of preventative measures you can take to ensure you and your loved ones are okay. Lifestyle changes, working on yourself, and having an emotion-positive environment are some ways to ensure that the wrath of these conditions don’t creep in.
Bipolar Disorder
Below are some tips to prevent heightened symptoms of bipolar disorder:
- Follow your treatment plan: Don’t deviate from your treatment plan even if you are feeling better—that just means it’s working.
- Avoid using substances: Don’t use substances as they can make mood swings worse.
- Identify and avoid triggers: Learn your triggers and do what you can to avoid them or ways to cope with them if they come up.
- Maintain a balanced diet: A lot of our chemicals in the brain are made in our gut, so eating well is important.
- Practice stress management skills: Learning coping skills with stress management can make a big difference in your ability to manage a lot of emotions.
- Adjust your sleep routine: Consistent sleep is crucial for mental health, so if that means going to sleep earlier to support your mind, it is important to consider it.
- Maintain a consistent schedule: Routine helps us stay regulated; having a structure every day is important.
Borderline Personality Disorder
Below are some tips to prevent heightened symptoms of BPD:
- Avoid using substances: Using alcohol and other substances can make mood and emotional regulation more challenging.
- Focus on minimizing stress: Lowering stress and focusing on what you can control is key.
- Practice relaxation strategies: Mindfulness meditation can make a big difference on your mood.
- Seek treatment at the first sign of symptoms: Don’t wait to get help if you are finding yourself struggling.
Final Thoughts
If you or someone you love is dealing with BPD or bipolar disorder, there is help available. Working with a therapist or a family-focused therapy group is a great way to help your loved one access help. Together, you and your therapy team will come up with a plan to support everyone. Remember, there is always hope.
Bipolar Vs. BPD Infographics
