Both bipolar disorder and borderline personality disorder (BPD) are mental health conditions that significantly impact mood and behavior. Extreme mood swings, including manic and depressive episodes, characterize bipolar disorder. BPD involves emotional instability, impulsive behavior and struggles in relationships.
Misdiagnosis of these two different conditions can mean inappropriate treatment and worsening symptoms.
Below, we highlight some things to know when comparing bipolar disorder vs. borderline personality disorder.
Bipolar Disorder
Bipolar disorder is a psychiatric illness with mood swings, including emotional highs, known as mania or hypomania, and lows, which are depression. Mood changes in bipolar disorder can affect energy and activity levels, sleep patterns and overall functioning.
There are a few types of bipolar disorder.
Bipolar I disorder involves at least a single manic episode, which may come first or be followed by hypomanic or depressive episodes. The manic episodes are severe and can lead to significant impairment.
Bipolar II disorder diagnoses involve at least one depressive occurrence and at least one hypomanic episode but without full-blown manic episodes.
Cyclothymic disorder includes numerous periods of hypomania signs and depressive symptoms that last for at least two years, but the symptoms don’t meet the criteria for a major depressive episode.
The symptoms in people with bipolar disorder, including dramatic mood swings, can last for days, weeks or longer.
During manic episodes, a person may experience high energy levels, euphoria, a reduced need for sleep and impulsive behaviors.
Depressive episodes are marked by feelings of fatigue, hopelessness, sadness and trouble concentrating.
Borderline Personality Disorder (BPD)
Borderline personality disorder causes instability in moods, behavior, self-image and relationships. Someone with BPD may experience intense emotions and have trouble regulating them, which can lead to significant challenges in their lives, personally and professionally.
Emotional instability is a characteristic symptom of BPD, where a person may shift quickly from feeling intense happiness to deep despair. Impulsive behavior is also a key feature and can manifest as risky activities, self-harm or substance abuse. People with BPD very often face problems in their relationships, and they may quickly shift between seeing others as all good or all bad.
Someone with BPD may struggle with a distorted sense of self, feelings of emptiness and a lack of identity.
It can lead to panic about abandonment, causing erratic behaviors in relationships, often leading to conflict and instability. The cycle perpetuates feelings of isolation and loneliness, so it’s hard for someone with this personality disorder to form and maintain stable and healthy connections with others.
Key Differences in Bipolar Disorder vs. Borderline Personality Disorder
One big distinction between BPD and bipolar is the nature of the mood changes. In bipolar disorder, the mood shifts are episodic. That means a person might experience distinct periods of mania or depression lasting for days, weeks or longer. These episodes are often separated by periods of mood stability.
In contrast, when comparing bipolar disorder vs. BPD, BPD leads to more frequent, reactive emotional changes. A person’s mood can fluctuate dramatically within hours or days, and it’s often triggered by relationship stressors or perceived rejection.
Symptom duration also differs between the two disorders. In bipolar disorder, a manic or depressive episode can persist for an extended time, which does allow for more predictable patterns. In BPD, emotional shifts are more volatile. These shifts can create chaos as a person is struggling to manage feelings and reactions in real time.
Impulsivity is another area of difference between the disorders. While both conditions can involve impulsive behaviors, in BPD, the actions often stem from intense emotional responses and are directed toward self-harm or reckless decisions during an emotional crisis.
BPD can significantly impact relationships, causing individuals to swing between idealizing and devaluing others.
In bipolar disorder, relationship issues can arise during mood episodes but tend to be less chaotic and more predictable compared to what’s seen in BPD.
Bipolar disorder is thought to have a strong genetic component, and family history plays a significant role, although environmental stressors can trigger episodes. BPD is often linked to a combination of genetic, environmental and mental factors, including childhood trauma and instability in family relationships.
Diagnosis and Treatment
Diagnosing borderline personality disorder and bipolar involves detailed measures defined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). For bipolar disorder, the diagnosis usually requires the existence of at least one manic or hypomanic episode along with depressive episodes.
Thorough assessment and psychological evaluations are needed for an accurate diagnosis.
Differential diagnosis can also be a key component of the assessment process. A mental health professional will evaluate the duration, frequency and triggers of mood episodes to distinguish between bipolar disorder and BPD. For example, while bipolar disorder includes episodes of mood changes, as was touched on, BPD involves more rapid fluctuations in emotions. The differentiation ensures individuals receive the appropriate treatment that’s tailored to their condition.
Treatment Options
Treating bipolar disorder usually requires a combination of medicine, therapy and lifestyle changes.
Mood stabilizers like lithium and some anticonvulsants are frequently prescribed to help regulate mood swings and prevent manic and depressive symptoms from recurring. Antipsychotic medications may also be used, especially during acute manic episodes.
Psychotherapy plays a critical role in managing bipolar disorder, while cognitive-behavioral therapy and family-focused therapy can help people develop coping strategies and improve communication with their loved ones.
Lifestyle changes, such as retaining a regular sleep schedule and avoiding substance use, can also help stabilize mood and enhance overall well-being.
Borderline personality disorder treatment often includes dialectical behavior therapy (DBT), which is a specialized form of CBT that helps address emotional instability and relationship challenges. DBT teaches skills for emotional regulation, distress tolerance and interpersonal effectiveness.
Other therapy approaches, like schema therapy, can also be useful.
Medication isn’t the primary treatment for BPD, but sometimes medications like mood stabilizers or antidepressants may be prescribed to manage specific symptoms.
Both bipolar disorder and BPD benefit from individualized treatment plans considering a person’s unique needs and any co-occurring disorders.
Find Treatment Now
Bipolar disorder and borderline personality disorder do share some similarities, like mood instability, but they are different in the nature and duration of mood changes, impulsivity and relationships. Accurate diagnosis is crucial as effective treatment strategies vary for each condition.
Proper treatment not only alleviates symptoms but can improve overall quality of life.
If you or someone you know is experiencing symptoms related to bipolar disorder or BPD, we encourage you to contact Agape Behavioral Center. Don’t hesitate to reach out.
References:
- National Institute of Mental Health (NIMH): Borderline Personality Disorder
- National Institute of Mental Health (NIMH): Bipolar Disorder
