Up to 40% of individuals with bipolar disorder receive an initial misdiagnosis. While this disorder shares specific symptoms with borderline personality disorder (BPD), its core characteristics and treatment approaches differ significantly. Misunderstanding these conditions not only hinders effective treatment but also perpetuates myths and stigma surrounding mental health. Let’s explore the main differences between borderline personality disorder and bipolar disorder.
Understanding Borderline Personality Disorder (BPD)
Borderline personality disorder (BPD) is a complex mental health condition characterized by intense emotions and a distorted sense of self. At its core, BPD is about instability – in moods, behavior, self-image, and functioning.
A person with BPD can exhibit a wide range of behaviors and emotional patterns. From chronic feelings of emptiness and boredom to extreme anger, individuals with BPD experience severe emotional reactions even to insignificant situations or triggers. Other symptoms and characteristics include:
- Intense emotional swings without a clear trigger
- Fear of abandonment
- Unstable relationships
- Impulsive behaviors
- Low self-esteem
- Suicidal behavior
Understanding Bipolar Disorder
Bipolar disorder is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.
Bipolar disorder is primarily categorized into two types, each with its unique pattern of symptoms. Bipolar I disorder is defined by manic episodes that last at least seven days—bipolar II pattern of depressive episodes and hypomanic episodes without the full-blown manic episodes of bipolar I.
Manic Episodes:
- Feeling jumpy or wired
- Decreased need for sleep
- Loss of touch with reality
- Engaging in risky behavior
Depressive Episodes:
- Low energy and motivation
- Loss of interest in daily activities.
- Feeling sadness, emptiness, hopelessness
- Trouble concentrating
Differences Between BPD vs. Bipolar Disorder
Distinguishing between borderline personality disorder and bipolar disorder is crucial for accurate diagnosis and effective treatment. Despite some symptom overlap, these conditions have distinct characteristics.
1. Mood Swing Duration
BPD: Mood swings in BPD are typically intense but brief, often lasting just a few hours.
Bipolar Disorder: Mood swings, incredibly manic or depressive episodes, last for days, weeks, or even months.
2. Trigger for Mood Changes
BPD: Mood swings are often triggered by external events, like interpersonal conflicts.
Bipolar Disorder: Mood changes can occur without an external trigger and are more cyclical.
3. Relationship Patterns
BPD: Relationships are often intense, unstable, and filled with fear of abandonment.
Bipolar Disorder: While relationships can be strained, the patterns are not as consistently tumultuous as in BPD.
4. Self-Image
BPD: Individuals with BPD often experience a chronic and significant disturbance in self-identity.
Bipolar Disorder: Self-image changes are more likely to be influenced by mood states, such as feeling invincible during a manic phase.
5. Diagnostic Criteria
BPD: Diagnosis is based on a pervasive pattern of instability in relationships, self-image, and affects, along with marked impulsivity.
Bipolar Disorder: Diagnosis hinges on the presence of manic or hypomanic episodes, typically alternating with depressive episodes.
6. Symptom Patterns
BPD: Emotional instability, fear of abandonment, and intense relationships are hallmarks.
Bipolar Disorder: Characterized by alternating episodes of mania/hypomania and depression.
Overlap and Misdiagnosis
The intersection between these conditions can be particularly challenging for anyone trying to differentiate them, even for healthcare professionals, which can lead to misdiagnosis.
Some factors that can cause confusion between the two disorders are:
- Symptom Overlap: The shared symptoms, such as mood swings and impulsive behavior, can lead to confusion.
- Lack of Awareness: Both among the general public and some healthcare providers, there’s a lack of understanding of the distinct nature of each disorder.
- Variable Presentation: Symptoms can vary significantly between individuals and over time, making a clear-cut diagnosis challenging.
Treatment Approaches for BPD and Bipolar Disorder
Treatment for borderline personality disorder and bipolar disorder needs to be tailored to each condition’s unique characteristics, though there may be some overlap in the approaches.
Treatment for BPD
- Psychotherapy: This is the cornerstone of BPD treatment. Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), and Schema Therapy can be effective.
- Skills Training: Focuses on improving emotional regulation, interpersonal effectiveness, distress tolerance, and mindfulness.
- Medication: While there’s no specific medication for BPD, some drugs may be prescribed to treat co-occurring issues like depression or anxiety.
- Group Therapy: Can be beneficial in providing support and teaching social skills.
Treatment for Bipolar Disorder
- Medication: Mood stabilizers, antipsychotics, and antidepressants can play a crucial role in managing Bipolar Disorder.
- Psychotherapy: Therapies like CBT and psychoeducation are essential to help manage the disorder and prevent relapse.
- Lifestyle Management: Regular sleep patterns and avoiding stress can help manage symptoms.
- Support Groups: Offer emotional support and education about the disorder.
Overlapping Treatment Strategies
- Psychoeducation: Both disorders benefit from educating patients about their condition.
- Self-Care and Lifestyle Adjustments: Regular exercise, healthy eating, and stress reduction techniques benefit both.
- Family Therapy: Can be helpful in both conditions to improve family dynamics and support.
Living with BPD or Bipolar Disorder
Living with borderline personality disorder or bipolar disorder presents unique challenges, but with the right strategies and support, individuals can lead fulfilling lives.
Strategies for Managing BPD
- Developing Coping Skills: Learning and practicing mindfulness, distress tolerance, and emotion regulation skills can significantly help.
- Building a Support Network: Engaging with supportive friends, family, or support groups can provide crucial emotional support.
- Routine and Structure: Establishing a daily routine can provide stability and predictability.
- Therapy and Treatment Adherence: Regular therapy sessions and adherence to any prescribed treatment are vital to managing BPD.
Strategies for Managing Bipolar Disorder
- Monitoring Mood Swings: Keeping track of mood changes can help manage the disorder.
- Medication Management: Consistent medication adherence is crucial in stabilizing mood swings.
- Healthy Lifestyle Choices: Regular exercise, adequate sleep, and a balanced diet can help manage symptoms.
- Educating Oneself and Others: Understanding the disorder and educating those around you can foster a supportive environment.
Seeking Professional Help
Recognizing the need for professional help is a critical step in managing borderline personality disorder or bipolar disorder. Both conditions require a nuanced understanding for proper diagnosis and treatment, making the role of mental health professionals indispensable.
At Onyx Behavioral Health, our team is always available to discuss treatment options with you and your family. Professional help is not just about managing symptoms; it’s about empowering individuals with BPD or Bipolar Disorder to lead more stable, fulfilling lives.
Michaela Welk, LMHC
Bunny Berman
Tank
Richard E. LoSardo, MD
Christopher Payne
Bernard Benjamin
Tiffany Bellino