Last reviewed:
Feb 20th 2023
LSW
Borderline personality disorder (BPD) and bipolar disorder are often confused as they share many similar symptoms, such as mood instability and impulsive behavior. However, they are distinct conditions that require different treatment plans.
Borderline personality disorder (BPD) is a chronic psychiatric disorder characterized by pervasive affective instability, self-image disturbances, impulsivity, marked suicidality, and unstable interpersonal relationships. [1] BPD is also characterized by mood changes (called emotional dysregulation or affective instability). Mood changes in patients with BPD are often instantaneous, going from feeling good to being very distressed within minutes.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the symptoms exhibited by people with BPD are:
The cause of BPD is not known, and it is suggested that BPD is the product of an interaction between genetic, neurobiological, and psychological influences that affect brain development. [1]
Patients with bipolar disorder experience recurrent episodes of pathologic mood states, characterized by depressive or manic symptoms, which are interspersed by periods of relatively normal mood. [3] Mood shifts in bipolar patients often go from depression (persistent feeling of sadness or loss of interest) to mania (periods of euphoria, delusions, or hyperactivity) or hypomania (a less severe episode of mania). The duration of mood episodes is highly variable, both between patients and in an individual patient over time, but, in general, a hypomanic episode may last days to weeks, a manic episode lasts weeks to months, and a depressive episode may last months to years. [3]
During periods of mania, symptoms include:
According to research, risk factors for bipolar disorder are numerous, both genetic and environmental; however, some findings are inconsistent. Due to inconsistent findings, difficulty identifying whether risk factors cause bipolar disorder or are a result of the condition, and lack of a specific biological cause of the condition, it is difficult to determine what causes bipolar disorder to develop in a particular patient. [4]
Bipolar disorder and BPD are among the most prevalent and frequently diagnosed psychiatric conditions. Both are associated with increased morbidity, elevated rates of suicide, and considerable functional impairment. [5] Another area where they share similarities is their causes, both being thought to be caused by a variation of genetics, environmental factors (trauma, stress, and childhood abuse) and brain differences.
Despite some similarities, the two conditions can be distinguished in several ways:
While the concept of bipolar disorder has, over the past several years, been fully incorporated by culture, most of the general public is not yet completely familiar with the diagnosis of BPD, despite its popularity among psychiatrists and mental health providers. [5]
In order to diagnose BPD or bipolar disorder, a mental health professional will ask the patient about their symptoms, asking them to describe their severity and duration. They will also ask about any family history of mental illness and about any history of trauma.
There are cases where it is difficult to distinguish BPD from bipolar disorder, and so the mental health professional may wish to focus on specific symptoms. These include:
One of the chief differences between the two conditions is the way in which they are treated.
Despite psychotherapy also being useful, bipolar disorder is mostly treated using medication. Mood stabilizers such as lithium are commonly used to prevent extreme mood changes between highs and lows. Other kinds of medication prescribed include antipsychotics (such as aripiprazole) and anti-convulsants (such as carbamazepine).
BPD on the other hand is primarily treated using psychotherapy. Therapies used to treat BPD include dialectical behavior therapy (DBT), cognitive behavioral therapy (CBT) and group therapy. Medication that can be prescribed to treat BPD includes mood stabilizers, antidepressants, and anti-anxiety medications.
Resources: