Borderline personality disorder (BPD) and bipolar disorder are distinct diagnoses. Some symptoms overlap, and both can occur in the same person, so assessment must consider the pattern of symptoms over time rather than mood changes alone.
Changing moods is often a part of the natural response to stressful situations. However, these shifts can be so extreme for some that they indicate a psychiatric disorder, like BPD or bipolar disorder. Both conditions usually have partial similarity in mood shifts which often confuses many people, even some clinicians. Some may even believe that both disorders are similar, if not the same, or somehow connected.
Is borderline personality disorder the same as bipolar disorder? How can you differentiate between the two? This article will compare the two diseases regarding symptoms, causes, diagnosis, and treatment.
Following are some prominent symptoms of BPD:
- Dramatic emotional changes that may last from a few hours to a few days
- Inappropriate anger
- Impulsive or unsafe behaviors
- Feelings of emptiness
- Thoughts of self-harm
- Poor self-worth
- Distortion of self-image
- Chronic depression
- Unstable relationships
- Fear of abandonment
Some people with BPD experience intense anger or act impulsively when distressed, but aggression is not inevitable. Emotional changes may be associated with interpersonal stress or perceived rejection. Individual experiences vary, and these features alone do not establish the diagnosis.
On the other hand, the symptoms of bipolar disorder include dramatic changes in mood states. It usually has two different states of mood i.e.
- Periods of irritable, expansive, or elevated mood, called manic episodes
- Periods of sadness, hopelessness, and emptiness, called depressive episodes
Bipolar disorder involves episodes of mania or hypomania, often with depression. Bipolar I requires a manic episode; a depressive episode is not necessary for that diagnosis. BPD involves broader difficulties with emotions, relationships and self-image and is not simply a disorder of depressive episodes. Features of mania can include:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Elevated mood
- Irritability
- Euphoric feelings
- Excessively talkative
- Clouded judgment
- Racing thoughts
- Easy distraction
- Increased activity or risky behavior
Depressive episodes, on the other hand, are characterized by:
- Low mood
- Feelings of guilt
- Limited expression
- cognitive and memory impairment
- Lack of will and energy
- Soft, slow speech
- Weight changes
- Recurring thoughts of death
- Overemphasis on negative feelings
- Insomnia
Between the cycles, bipolar people often experience symptom-free periods that may last for weeks, months, or even years. This is in contrast to people with BPD, who usually have more persistent emotional symptoms existing on a day-to-day basis.
Multiple complex factors can lead to bipolar or BPD in individuals.
Both conditions arise through complex interactions among biological, genetic, developmental and environmental factors. Interpersonal stress may trigger emotional changes in BPD; stress or disrupted sleep may also precede bipolar episodes. Neither disorder can be explained by a single chemical imbalance.
Borderline Personality Disorder Causes
BPD is associated with genetic, developmental and environmental influences. Childhood adversity can increase risk, but not everyone with BPD has experienced trauma, and most people who experience trauma do not develop BPD. The condition is not caused by a personal failure to cope.
Radiological studies have shown that individuals with BPD have various brain functional and structural changes. These changes are particularly prevalent in areas that control emotional regulation, like the amygdala or orbitofrontal cortex.
Bipolar Disorder Causes
Bipolar disorder has a substantial genetic contribution, involving many genes rather than a single cause. Sleep, stress and other environmental factors can influence episodes. Research into brain systems continues; there is no routine chemical test that diagnoses bipolar disorder.
A mental health professional begins to diagnose BPD or bipolar disorder by asking an individual some questions about their symptoms, severity, and duration. They may also inquire about the individual’s personal and family medical history, focusing on whether or not someone in their relatives has a mental illness. Some experts prefer using questionnaires to gather data about the symptoms and use it to establish a diagnosis.
Bipolar I requires at least one manic episode, generally lasting at least one week or of any duration if hospital care is necessary. Bipolar II requires at least one hypomanic episode and one major depressive episode, with no history of mania; the episodes need not occur in a particular order. A clinician also assesses substances, medicines and other medical explanations.
In cases where a doctor finds it challenging to differentiate bipolar disorder from BPD, they may focus on specific symptoms to distinguish them from each other. These symptoms include:
Sleep
A reduced need for sleep while still feeling energetic is an important sign of mania or hypomania. Sleep problems also commonly occur in BPD and many other conditions, so insomnia alone cannot distinguish them.
Duration of Cycling Mood
Bipolar mood episodes usually last days to weeks or longer. BPD-related emotional shifts often develop more quickly, sometimes over hours, and may relate to interpersonal events. Rapid cycling in bipolar disorder means at least four distinct mood episodes in a year, not simply several mood changes in one day.
Self-harm
Self-harm and suicidal thoughts can occur in both BPD and bipolar disorder. Neither should be dismissed or used alone to distinguish diagnoses. A person who may act on suicidal thoughts, has seriously injured themselves or cannot remain safe needs immediate emergency help.
Unstable Relationships
Individuals with BPD usually have conflict-riddled and highly complex relationships. Bipolar individuals may also experience difficulty maintaining relationships due to the nature and severity of their symptoms.
Mania
Individuals with bipolar disorder may commonly adopt impulsive behaviors during an active episode of mania. Similar impulsiveness might be observed in people with BPD, but the behavior is not related to mania.
Mentioned below is some additional information to distinguish BPD from bipolar disorder:
Family History
Both disorders can cluster in families. Their genetic contributions are complex and involve many variants; family history informs assessment but does not determine whether a person has either condition.
Past Trauma
While the cause of BPD remains unclear, many people with this disorder have experienced trauma in their childhood. Some examples of trauma leading to BPD include abuse, extreme adversity, unstable family, abandonment, exposure to conflict, etc.
The most crucial common highlight of treatment for BPD and bipolar disorder is the need for a personalized plan tailored to each client for a wholesome recovery.
Treatment for BPD
In the case of BPD, psychotherapy is usually the first-line treatment. There are multiple types of empirically-supported therapies that can successfully manage BPD symptoms. These include:
- Dialectical behavioral therapy (DBT) provides help with emotional management.
- Mentalization-based therapy (MBT) helps clients better understand what happens in their minds during an active episode of symptoms.
The use of medications for BPD symptom management is rare since their benefits are less clear to the experts at the moment. Sometimes, a psychiatrist may prescribe some drugs to control specific symptoms, like depression, mood swings, and other co-occurring mental issues.
Apart from therapeutic management, people with BPD are also encouraged to adopt certain lifestyle adjustments that introduce more balance in their mood. Additionally, they can benefit from certain self-care habits, like getting adequate sleep, exercising every day, and actively participating in psychoeducation.
Treatment for Bipolar Disorder
Bipolar treatment usually combines medication, psychological care and support for regular sleep and daily routines. Mood stabilisers and certain antipsychotics are commonly used. Antidepressants require particular caution because they can contribute to mania or mood instability; they should not be used alone for bipolar I depression. Medication choices require specialist assessment.
In addition to medication, psychotherapies, such as cognitive behavioral therapy and psychoeducation, can also benefit bipolar individuals. Additionally, an expert may suggest joining family-focused, social rhythm and interpersonal therapy to improve the chances of recovery.
Another treatment modality used in resistant cases of bipolar disorder is electroconvulsive therapy or ECT. ECT refers to a brain stimulation process used for managing severe and refractory episodes of depression or mania. Alternatively, some experts may use transcranial magnetic stimulation to treat the depressive phases.
Both conditions are treatable. Bipolar disorder commonly needs long-term relapse-prevention care. Many people with BPD experience substantial improvement or remission with effective treatment. Care should be reviewed as needs change.
