It is common for people to confuse bipolar disorder and borderline personality disorder (BPD), primarily because both diagnoses may have similar symptoms, such as depression, intense emotional responses, and highly impulsive behavior. However, bipolar disorder and borderline personality disorder are two separate and distinct psychological conditions, which means those suffering from them display different symptoms and will have different and, yet, similar treatment options.
When deciding whether a person is experiencing bipolar or borderline personality disorder, it is important to understand the unique traits of each condition.
Bipolar Disorder vs. BPD
Bipolar disorder is a mood disorder, like major depressive disorder, that causes extreme mood fluctuations. Bipolar disorder can strongly impact a person’s activity levels, emotions, thoughts, and functionalities, and episodes can sometimes last months.
Unlike bipolar disorder, BPD is a type of personality disorder that causes a person to relate, feel, think, and act differently than others. Those with BPD have difficulty regulating their emotions, and often, they experience a constant cycle of varying moods, behaviors, and self-image.
Symptoms of Bipolar Disorder
Individuals with bipolar disorder suffer from profound shifts in mood that vary over time. Patients often alternate between depression (lows) and mania (highs) with intermittent periods of normal mood. Common symptoms of bipolar depression include:
• Feelings of guilt and worthlessness
• Fatigue
• Inexplicable aches and pains
• Crying spells
• Periods of extreme sadness
• Pessimism and indifference
• Noticeable changes in appetite and sleep pattern
• Difficulty making decisions and concentrating
• Social withdrawal
• Thoughts of death or suicide
• Difficulty finding pleasure in usual interests
Common symptoms of mania include:
• Decreased need for sleep
• Elevated mood
• Racing thoughts, speech, or both
• Grandiose ideas
• Poor judgment
• Inflated sense of self
• Impulsive or reckless behavior
• An exaggerated sense of optimism or confidence
• Delusions and hallucinations (in some severe cases)
There are varying forms of bipolar disorder. Patients with bipolar I are more likely to experience extreme highs and lows while patients with bipolar II tend to experience hypomania (a less severe form of mania). Bipolar patients may also experience mixed episodes in which they experience both mania and depression simultaneously.
During periods of depression or mania, patients may need to be hospitalized if they are unable to function or are deemed a threat to themselves or others. Some patients may exhibit rapid-cycling bipolar I or II and experience four or more mood episodes within a year. Rapid-cycling bipolar disorder does not take place over a few hours—these cycles may continue for weeks at a time.
Symptoms of Borderline Personality Disorder
As previously mentioned, individuals with BPD often suffer from an unstable self-image and intense, difficult to regulate emotions. They are often impulsive, and their self-destructive behaviors can place a major strain on their interpersonal relationships. BPD patients may also experience many of the following symptoms:
• Frequently changing values and interests
• A pattern of intense and unstable relationships with others, for whom feelings cycle between love and hate
• An uncertain view of one’s role in the world
• Black and white thinking (the tendency to view situations, thoughts, and people as either totally good or bad)
• Distorted or unstable sense of self
• Changing opinions about others quickly (e.g., believing someone to be an enemy one day and a close friend the next)
• Self-harming behaviors, such as burning, overdosing, or cutting
• Difficulty trusting others
• Attempts to avoid real or imagined sources of emotional pain or abandonment
• Reckless or careless behavior, such as drug abuse, unsafe sex, overspending, and dangerous driving
• Intense fear of loneliness
• Frequent feelings of emptiness
• Constant thoughts of suicide
• Intense feelings of anxiety, depression, and anger
• Dissociation (the feeling of being outside of one’s own body)
It is important to note, however, that not everyone experiences BPD in the same manner. Some people may only have a few symptoms that rarely interfere with their daily functioning, while others may have numerous symptoms that may prevent people from reaching their vocational, academic, and relational goals. Stressful or emotionally painful events can also cause patients to experience BPD symptoms more intensely. From the perspective of others, such events may seem relatively unimportant or disproportionate to the emotions they elicit in the BPD patient.
Diagnosing Bipolar Disorder and BPD
To accurately diagnose a person with BPD or bipolar disorder, a trained mental health professional will ask them a series of questions about the duration and frequency of their symptoms. They may also ask about the person’s drug use and family medical history. Therapists and psychiatrists often use questionnaires or other assessments to collect such information.
If a person has experienced at least one episode of mania that has lasted for at least seven days or required hospitalization, they may be diagnosed with bipolar I disorder. If they have experienced an episode of hypomania and a major depressive episode, they may be diagnosed as bipolar II.
Naturally, there are cases where it is difficult to distinguish between the two conditions. To properly diagnose a patient, a physician or therapist may focus much of their attention on identifying specific symptoms. Some of these symptoms include:
• Self-harm: A significant percentage of BPD patients engage in self-harming behaviors. Although some bipolar patients may also self-harm, it is more common in BPD patients.
• Sleep: Bipolar patients often suffer from disturbed sleep patterns during bouts of depression and mania. Individuals with BPD can maintain a regular sleep pattern.
• Mania: Although patients with BPD can act impulsively, their impulsivity is usually not related to mania.
• Cycling moods: Except for those suffering from rapid-cycling bipolar disorder, individuals with bipolar disorder often have mood cycles that can last days, weeks, or months. BPD mood shifts typically only last a few hours or days.
• Unstable relationships: BPD patients have intense relationships that are often compounded by interpersonal conflict.
Once an individual is accurately diagnosed, they can work with their licensed mental health professional to create an effective treatment plan.
Psychotherapy Options
There is a wealth of psychotherapies available to patients suffering from BPD and bipolar disorder, however, dialectical behavior therapy (DBT) or cognitive behavior therapy (CBT) tend to be the most common. They entail the following:
• CBT (Cognitive Behavioral Therapy): One of the most common types of therapy in the world, CBT therapy helps patients identify certain core believes and behaviors and change them over time. CBT can also help patients learn how to self-soothe without resorting to dangerous behaviors. When working with a CBT therapist, patients will often identify recurring thought patterns and decide whether they are useful or constructive. CBT is also known to be a useful tool for patients suffering from anxiety.
• DBT (Dialectical Behavioral Therapy): Psychologist Marsha M. Linehan developed DBT—an evidence-based treatment that’s also a form of CBT—in the 1980s to treat individuals who were suicidal. Utilizing traditional mindfulness techniques and other therapeutic approaches, DBT is specifically structured to help patients suffering from BPD. Geared towards highly emotional individuals, DBT therapy may help individuals accept their self-destructive behaviors, values, and beliefs, and gradually change them over time. Patients may also learn tactics to avoid self-harming or self-sabotaging behaviors.
For individuals with a diagnosis of bipolar disorder, please check out Sheri Van Dijk, MSW’s book The Dialectical Behavior Therapy Workbook for Bipolar Disorder. (You can buy her book on Amazon.com here.)
• Self-Compassion Training: As a DBT therapist, I’m particularly fond of self-compassion as a therapeutic approach that can help people with both bipolar disorder and BPD. Regardless of any diagnosis, becoming self-compassionate is an important life skill.
Christopher Germer, PhD is a leader in this field. I love his books The Mindful Self-Compassion Workbook and The Mindful Path to Self-Compassion. (You can find his books on Amazon.com here.)
• Peer support groups: Often underutilized tools, peer support groups can be of immense help for both individuals who have been diagnosed with BPD or bipolar disorder. A peer support group is typically composed of several people with lived experience who can help, and groups are often led by certified peer support specialists. During a group session, individuals can expect support and encouragement while learning how to manage their symptoms. Some support groups may help guide participants to additional mental health resources in their communities.
In particular, I love recommending NAMI Connection, Recovery International, and organizations such as Emotions Matter as a great place to start when people are looking for information and support.
The type of treatment a patient chooses should be based on their own unique mental health needs and goals. Individuals with BPD or bipolar disorder should be encouraged to play an active role in their treatment.
The Importance of Proper Diagnosis and Treatment
Although bipolar disorder and BPD have many commonalities, there are several key differences between the two conditions. A licensed mental health professional can help diagnose and then provide treatment recommendations.
Both BPD and bipolar disorder are highly treatable and most people will have a good (or even excellent) prognosis with evidence-based treatment.
For additional information, please check out:
Treating BPD Without Medications
DBT for Family Members and Friends
Sometimes obstacles can become opportunities. Please email me today at amanda@hopeforbpd.com for additional information about treatment consultation.