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Borderline Personality Disorder vs. Bipolar Disorder: Understanding the Differences

Published: December 21, 2021 Updated: May 11, 2022
Published: 12/21/2021 Updated: 05/11/2022
Headshot of Emma Jane Watson, M.Ed., MSW, LICSW
Written by:

Emma Jane Watson

M.Ed., MSW, LICSW
Headshot of Trishanna Sookdeo, MD, MPH, FAAFP
Reviewed by:

Trishanna Sookdeo

MD, MPH, FAAFP
  • Symptoms of Borderline Personality Disorder (BPD)BPD Symptoms
  • Symptoms of Bipolar DisorderBipolar Symptoms
  • BPD vs. Bipolar DisorderVersus
  • What Causes Bipolar vs. BPD?Causes
  • Can You Have Bipolar and BPD?Comorbidity
  • Diagnosis of Borderline Personality Disorder vs. Bipolar DisorderDiagnosis
  • Treatment for BPD vs. Bipolar DisorderTreatment
  • Additional ResourcesResources
Headshot of Emma Jane Watson, M.Ed., MSW, LICSW
Written by:

Emma Jane Watson

M.Ed., MSW, LICSW
Headshot of Trishanna Sookdeo, MD, MPH, FAAFP
Reviewed by:

Trishanna Sookdeo

MD, MPH, FAAFP

Borderline personality disorder and bipolar disorder are often confused.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.

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Symptoms of Borderline Personality Disorder (BPD)

The traits associated with BPD fall into five categories of dysregulation: emotions, relationships with others, behaviors, thinking, and internal self.5 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.

Early research suggested higher rates of BPD in women; however, current research shows a comparable rate of BPD diagnosis in men and women. Women with BPD more often report feelings of emptiness and emotional instability, whereas men identify more with impulsivity.7

The depth of emotional misery experienced due to BPD increases the risk of death by suicide by nearly 50 times that of the general population.7Additionally, 75% of adults with BPD report at least one incident of self-harm during their lifetime.7 It is estimated that between 1 to 6% of the general population have BPD. Due to impulsive risk taking, self-harm, and suicidality, individuals with BPD are often hospitalized.7

Signs and symptoms of borderline personality disorder may include:

  • Attaching easily to others and fearing abandonment
  • Hating being alone
  • Chronic patterns of emotional and behavioral instability
  • Chaotic, intense relationships, which may include domestic violence
  • Shifting between extreme opposites: love, hate; kind, cruel; strong, weak; capable, helpless; persecutor, victim
  • Intense emotions with extreme highs and lows that seem uncontrollable and rapidly changing
  • High emotional sensitivity; crying easily and being “thin skinned”
  • Acting emotionless, aloof, or uncaring
  • Exhibiting deep despair and emotional misery expressed as, “I can’t take it anymore.”
  • Coming across to others as unstable or volatile
  • Viewing the world as hurtful
  • Appearing competent, but internally feeling incapable, useless, or worthless
  • A good actor, but worrying they will be found out as a fraud
  • Lying or exaggerating frequently
  • Impulsivity with poor problem solving skills
  • Risky behaviors, like gambling, spending, stealing, sexual promiscuity, reckless driving, extreme sports, drug or alcohol use, binge eating
  • Often have a history of trauma
  • Living in a state of unrelenting crisis and high drama
  • Engaging in intentional self-harm, such as cutting, burning, skin picking, overdoses, or breaking bones
  • Having frequent thoughts of suicide
  • Using threats, such as suicide, or running away, to influence others
  • Experiencing a sense of emptiness or numbness
  • Not being able to identify who they really are
  • Frequently feeling misunderstood, different, weird, or like they don’t fit in
  • Lacking close friends
  • Inappropriate and intense anger, enough to fight or throw things
  • Being paranoid, or distrustful of others
  • Dissociating from reality, losing track of time or staring off into space

Symptoms of Bipolar Disorder

Bipolar disorder is a severe psychiatric illness that affects about 2% of the population.1,4 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. It is estimated that depression accounts for about 75% of bipolar mood states over time.22 This may be why bipolar disorder has the highest rate of completed suicide of any psychiatric disorder.2

For a diagnosis of bipolar disorder, an individual must meet criteria for a manic or hypomanic episode. To be considered mania, an individual must have high energy or activity with an elevated, expansive, or irritable mood that lasts for at least one week and is present most of the day, nearly every day. To be considered hypomania, the mood must last at least four consecutive days and be present most of the day, almost every day.1

Signs of a manic episode for those with bipolar disorder may include:9

  • A heightened sense of self-importance
  • Sleeplessness, or feeling no need for sleep
  • Taking on purposeless tasks without stopping
  • Increased energy, activity, restlessness, agitation
  • Euphoric mood
  • Thinking up “great” ideas that may actually be implausible
  • Being impatient and “on the move”
  • Extreme irritability
  • Poor concentration
  • Poor decision-making
  • Moving thoughtlessly from one activity to another
  • Racing thoughts, fast talking, jumping between ideas
  • Impulsive spending sprees or sexual behavior
  • Provocative, intrusive, or aggressive behavior
  • Misuse of drugs, alcohol, and prescription medications
  • Denial that anything is wrong

Signs of a depressive episode may include:9

  • Sad, anxious, or empty-feeling mood nearly every day
  • 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
  • Decreased energy and fatigue nearly every day
  • Feelings of guilt, worthlessness, and helplessness
  • Difficulty concentrating, remembering, or making decisions nearly every day
  • Bodily symptoms not caused by physical illness or injury
  • Thoughts of death or suicide or making plans for suicide

Bipolar disorder can be diagnosed as mild, moderate or severe, or with psychosis. There are many other specifiers that can be added to the diagnosis: anxious distress, mixed features, rapid cycling, melancholic features, mood-congruent psychotic features, catatonia, peripartum onset, and seasonal pattern.1

BPD vs. Bipolar Disorder

The difference between BPD and bipolar disorder can seem subtle, but there are several symptoms that can help determine which disorder is present.

Key Differences Between BPD & Bipolar Disorder

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
Dichotomous thinking: 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
Poor problem solving Poor decision making
More self-harm and suicide attempts More completed suicides
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
More likely to fear dying More likely to have recurrent thoughts of death (not fear of dying)
Continuous and unchanging pattern of instability that impacts functioning Uncharacteristic changes in functioning noticeable by others when moving from one episode to another
Intense emotions and high emotional sensitivity Normal emotions with episodes of extreme highs and lows
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
Singular personality trait is chronic instability Three mood states: manic, normal, depressive
Suicidality is chronic Suicidality is intermittent

What Causes Bipolar vs. BPD?

There are a number of causes for both BPD and Bipolar disorder which at times overlap. These causes are environmental, genetic and can be hereditary.

Causes of BPD may include:

  • History of physical, mental and sexual abuse
  • Death of a caregiver
  • Family history of BPD
  • History of depression, anxiety or bipolar disorder
  • Inconsistency in childhood
  • Trauma
  • Attachment style dysfunction
  • Low self-esteem

Bipolar disorder can be caused by:

  • Family history of Bipolar Disorder
  • Death of a caregiver
  • Trauma
  • Drug and alcohol abuse
  • Sleep disturbances
  • Overwhelming stress

Can You Have Bipolar and BPD?

It is possible to have both BPD and bipolar disorder. Given the great overlap of the symptoms of both conditions, it’s common to misconstrue one diagnosis for the other; however, some people actually have both diagnoses. Currently, about 20% of individuals with BPD also have a diagnosis of bipolar disorder.10 Sorting through the symptoms of both can take time, but learning about both disorders can help in understanding which symptoms are that of bipolar disorder and which are related to BPD.

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.7 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:3

  • What triggers the mood shift? BPD shifts are triggered by sensitivity to the environment. Bipolar swings are neurological and aren’t triggered by changes in the environment.
  • How do they react when depressed? Individuals with BPD can still be impulsive and reactive when depressed. Bipolar depression is disabling.
  • What are their thinking patterns? Individuals with BPD use severe dichotomous thinking and swing between extreme opposites, i.e., fantastic and horrible. Individuals with bipolar disorder do not display dichotomous thinking.
  • What’s the emotional response to stressors? People with BPD show deep, intense emotional pain that evokes strong empathy. People with bipolar disorder often don’t express emotional pain, making it hard to empathize with them.
  • What is their care seeking behavior? Individuals with BPD openly seek care, hoping for exclusivity, and are highly sensitive to rejection (even the smallest slight). Individuals with bipolar disorder initiate care impulsively on their own without considering others and leave them to “clean up” the mess.
  • How do they handle conflict? People with BPD use splitting (everything is all good or all bad); if they are challenged, they become angry. People with bipolar ignore undesirable realities; if confronted, they deny the significance of it.
  • What are the lengths of their mood states? 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.
  • What is the nature of their shifting states? People with BPD shift their mood without shifting their level of energy. People with bipolar shift both mood and amount of energy.

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.

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. This includes both group and individual psychotherapy with a specific approach aimed at helping those with BPD learn how to navigate and handle their feelings. These skills help teach those with BPD how to better relate to others and handle challenges.

There may be times when a psychiatrist or other prescriber may recommend 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, effective medication for personality disorders.

Most medications used for BPD are in these categories:7

  • Antidepressants
  • Anti-psychotics
  • Mood stabilizers
  • Anti-anxiety agents
  • Nutraceuticals

Treatment for Bipolar Disorder

Cognitive behavioral therapy (CBT) is quite often used to treat bipolar disorder. CBT is the frontline treatment option for bipolar disorder as well as other mood disorders. CBT challenges those with bipolar disorder as it 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. Long term, CBT for bipolar disorder can help to give awareness of issues which otherwise would have gone unmanaged.

Medications are often an important part of treatment for those with bipolar disorder. Common medications include:

  • Lithium
  • Mood stabilizers
  • Anti-psychotics
  • Antidepressants
  • Anti-anxiety agents

Lithium has been used for decades and is the most well-known bipolar medication; however, it can become toxic in high doses and must be monitored with blood tests.2

Additional Resources

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For Further Reading

  • Best Books About Borderline Personality Disorder
  • Best Books on Bipolar Disorder
  • Mental Health America
  • National Alliance on Mental Health
  • MentalHealth.gov
10 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • American Psychiatric Publishing. (2013). Diagnostic and statistical manual of mental disorders (5th edition). Arlington, VA: Author.

  • Goodwin, G. M., Haddad, P. M., Ferrier, I. N., Aronson, J. K., Barnes, T., Cipriani, A., Coghill, D. R., Fazel, S., Geddes, J. R., Grunze, H., Holmes, E. A., Howes, O., Hudson, S., Hunt, N., Jones, I., Macmillan, I. C., McAllister-Williams, H., Miklowitz, D. R., Morriss, R., Munafò, M., … Young, A. H. (2016). Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. Journal of psychopharmacology (Oxford, England), 30(6), 495–553. https://doi.org/10.1177/0269881116636545

  • Lester, G.W. (2018). Advanced diagnosis, treatment, and management of DSM-5 personality disorders. Ashcroft Press, and PESI.

  • Lima, I., Peckham, A. D., & Johnson, S. L. (2018). Cognitive deficits in bipolar disorders: Implications for emotion. Clinical psychology review, 59, 126–136. https://doi.org/10.1016/j.cpr.2017.11.006

  • Linehan, M. M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York, NY: Guilford.

  • Meier, S., Pavlova, B., Dalsgaard, S., Nordentoft, M., Mors, O., Mortensen, P., & Uher, R. (2018). Attention-deficit hyperactivity disorder and anxiety disorders as precursors of bipolar disorder onset in adulthood. The British Journal of Psychiatry, 213(3), 555-56. https://doi.org/10.1192/bjp.2018.111

  • Ritschel, L. A., & Kilpela, L. S. (2014). Borderline Personality Disorder. Encyclopedia of Clinical Psychology, First Edition.

  • Sanches, M. (2019). The limits between bipolar disorder and borderline personality disorder: a review of the evidence. Diseases, 7(3), 49.

  • Pipich, Michael. (June 2020). Bipolar Disorder: Types, Causes, & Treatments. Retrieved from https://www.choosingtherapy.com/bipolar-disorder/

  • Zimmerman, M., & Morgan, T. A. (2013). The relationship between borderline personality disorder and bipolar disorder. Dialogues in clinical neuroscience, 15(2), 155–169. https://doi.org/10.31887/DCNS.2013.15.2/mzimmerman

update history

We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.

  • Originally Published: November 17, 2020
    Original Author: Emma Jane Watson, M.Ed., MSW, LICSW
    Original Reviewer: Trishanna Sookdeo, MD, MPH, FAAFP

  • Updated: December 21, 2021
    Author: No Change
    Reviewer: No Change
    Primary Changes: Updated for Readability; Added “What Causes Bipolar vs. BPD?” and “Can You Have Bipolar and BPD?” Revised “Treatment” section. New content written by Silvi Saxena, MBA, MSW, LSW, CCTP, OSW-C and reviewed by Dena Westphalen, PharmD.

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