Understanding Personality Disorders and Bipolar Disorder

Many people wonder, “Is bipolar a personality disorder?” Since bipolar disorder can affect your personality, and since borderline personality disorder shares many features with bipolar disorder (e.g., emotional instability and impulsivity)^[1], this question is a valid one.

However, despite some similarities, bipolar disorder is not a personality disorder. The current Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR) lists ten personality disorders^[2]. The DSM-V also clearly outlines the criteria for diagnosing bipolar disorder and each personality disorder.

Understanding the differences between these mental health conditions is paramount because, with a proper diagnosis, people with these disorders can make positive strides toward better mental health.

What is Bipolar Disorder?

Bipolar disorder is characterized by unstable mood swings. As such, it’s classified in the DSM as a mood disorder. People with bipolar disorder experience dramatic mood swings that range from depression to mania.

Bipolar disorder occurs in three forms^[3]:

• Bipolar I disorder features at least one manic episode that lasts one week or longer. Some people with bipolar I also experience depressive symptoms or hypomania.
• Bipolar II disorder is characterized by one or more hypomanic episodes and at least one major depressive episode. Typically, people with bipolar II have more depressive episodes than mania.
• Cyclothymia is a condition in which mood swings are not as severe, but they occur frequently and the shift between moods occurs very quickly. Cyclothymia is unique in that it persists over at least 2 years.

Despite some differences, each type of bipolar disorder listed above shares the common features of manic and depressive episodes. Each type of bipolar disorder also features shifts in concentration, activity levels, and moods, resulting from their characteristic mood swings.

What are Personality Disorders?

A personality disorder can be broadly defined as a pattern of maladaptive behaviors, rigid thinking, and emotional responses that cause a great deal of distress. These behaviors, thoughts, and emotional reactions must deviate significantly from what would be expected. Furthermore, people with personality disorders may have difficulty functioning in certain situations or in life in general because the distress caused by their disorder is so profound.

In fact, to be diagnosed with a personality disorder, at least two of the following four areas of life must be affected: how one responds emotionally, how one relates to other people, how one thinks about oneself and others, and how one controls one’s behavior^[2].

The ten personality disorders are as follows:

• Antisocial personality disorder
• Avoidant personality disorder
• Borderline personality disorder
• Dependent personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder
• Obsessive-compulsive personality disorder
• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder

Is Bipolar Disorder a Personality Disorder?

Going back to the original question, “Is bipolar a personality disorder?”, the answer is no—the DSM-V clearly identifies bipolar disorder and personality disorders as separate illnesses. As mentioned earlier, bipolar disorder is classified as a mood disorder, which is a distinct category of mental illnesses separate from personality disorders.

However, the differences between bipolar and personality disorders go well beyond categorization. For example, personality disorders are characterized by behaviors that are consistent over a long period of time (e.g., extreme shyness associated with avoidant personality disorder)^[2]. On the other hand, bipolar disorders are characterized by highly unstable moods, behaviors, emotions, and shifts in cognition, which cause little stability, at least during manic and depressive episodes^[3].

A third difference between bipolar and personality disorders is in their presentations. People with bipolar disorder have a disrupted mood, which can put stress on their ability to engage socially, have a career, and even perform activities of daily living^[4]. While some personality disorders, like borderline personality disorder, feature intense mood swings, most personality disorders have a much broader scope of symptoms. So, rather than the primary feature being mood swings, a personality disorder usually presents with distorted thinking patterns, low self-esteem, and emotional dysregulation, to name a few^[2].

In other words, since bipolar disorder does not involve a pervasive pattern of behavior, thoughts, and emotions that are consistent from one situation to the next, it is not classified as a personality disorder.

Bipolar vs. Personality Disorders: Symptoms

In a broad sense, mood disorders (like bipolar disorder) affect one’s mood. Someone with bipolar disorder can have mania, depression, or a mixture of the two. Usually, these symptoms last at least a week, but they often last much longer. Whether the symptoms are manic, depressive, or both, they can be extremely intense. Common symptoms include the following^[4]:

• Extreme elation
• Feeling wired
• Racing thoughts
• Talking fast
• Feeling powerful or important
• Feeling extremely sad
• Trouble concentrating
• Lack of interest in virtually all activities
• Inability to accomplish even simple tasks
• Feelings of hopelessness

The types of symptoms and their severities depend on the type of bipolar disorder and the characteristics of the person with the disorder, too.

As discussed earlier, personality disorders might affect one’s mood, but the symptoms go well beyond that. Personality disorders involve rigid ways of thinking and behaving that result in inflexible emotional responses to an array of events. These reactions are long-standing and cause difficulties in personal relationships because of the emotional and behavioral elements of these disorders.

Despite many differences between bipolar and personality disorders, there are some similarities. For example, one of the hallmark symptoms of borderline personality disorder is mood swings—a shared symptom of bipolar disorder. Likewise, during manic phases, people with bipolar disorder might exhibit grandiosity, which is also a characteristic of people with narcissistic personality disorder^[2].

Furthermore, during depressive phases, people with bipolar disorder can experience feelings of worthlessness and low self-esteem and avoid social situations. These are all symptoms of avoidant personality disorder, too^[2]. Having said that, the etiologies of these common symptoms differ between bipolar disorders and personality disorders. For example, the depressive symptoms of bipolar disorder are a result of a depressed mood. The symptoms of avoidant personality disorder, on the other hand, are the result of long-held personality traits.

The question then becomes, “Does bipolar disorder affect your personality?” In short, yes, it can. People with bipolar disorder might have traits like aggressiveness, neuroticism, and disinhibition. Likewise, research shows that people with bipolar disorder are prone to extraversion, anxiety, and embitterment^[5]. One might call these traits bipolar personality, but only colloquially—bipolar personality is not a clinical term.

Bipolar vs. Personality Disorders: Impact

When comparing mood disorders vs personality disorders, it’s easy to see both similarities and differences regarding how they affect daily life. For example, bipolar and personality disorders can severely disrupt one’s ability to work, sleep, maintain relationships, and perform activities of daily living. Moreover, both types of disorders can disrupt concentration, cause emotional dysregulation, and lead to diminished self-care.

Likewise, the impact of these disorders is evident in the following areas:

• Inability to cope with stress
• Difficulty making decisions
• Difficulties in social situations
• Inability to manage one’s behavior (e.g., engaging in harmful or impulsive behaviors)

Yet, while both disorders can wreak havoc on one’s day-to-day life, they are both highly treatable. The combination of therapy and medications is quite effective in helping manage the symptoms of bipolar and personality disorders. What’s more, these treatments can be even more effective if the disorder is identified and treated early on^[2][4].

Bipolar vs. Personality Disorders: Diagnosis

As mentioned earlier, the DSM-V offers clear criteria for diagnosing bipolar disorder and personality disorders. Mental health professionals can easily reference the DSM-V for details on these disorders, consult with other professionals, and make an appropriate diagnosis.

Diagnosing Bipolar Disorder

A bipolar I disorder diagnosis requires at least one manic episode of one week or longer. People who have bipolar I disorder may also have depressive symptoms. Three or more of the following behavioral changes must also be present^[3]:

• Racing thoughts
• Increased physical activity
• Decreased need for sleep
• Faster speech
• Distractibility
• Increased impulsivity or risky behavior

Meanwhile, bipolar II disorder might be diagnosed if one or more major depressive episodes and one or more hypomanic episodes have occurred. People with this type of bipolar disorder typically return to normal functioning between episodes^[3].

Cyclothymia is the third type of bipolar disorder. This milder form of bipolar disorder still involves mood swings, but they are less intense (albeit, the symptoms occur more frequently). A diagnosis of cyclothymia requires there to be hypomanic and depressive episodes over the course of at least two years. During that two-year period, at least half of the time must be spent in a manic or depressive state, and these states must last for more than two months at a time^[3].

Diagnosing Personality Disorders

The diagnostic criteria for personality disorders depend on the type of personality disorder that’s suspected. For example, a hallmark characteristic clinicians look for with antisocial personality disorder is selfish, impulsive, and perhaps unlawful behaviors that show a lack of care for other people. But, when histrionic personality disorder is suspected, clinicians look for attention-seeking behavior, high emotionality, and a desire to be the center of attention^[2]. In other words, mental health professionals have to rely on the distinctions made between the personality disorders in the DSM-V to arrive at an accurate diagnosis.

As we’ve already explored, some personality disorders can be difficult to distinguish from bipolar disorder. Borderline personality disorder, in particular, shares common traits with bipolar disorder (e.g., impulsivity, mood dysregulation), and without care during the assessment and diagnosis portion of treatment, a misdiagnosis might occur^[1].

However, the diagnosis issue can proceed further than this. On the one hand, the mere presence of comorbid conditions—two mental illnesses at the same time—makes formulating correct diagnoses that much more difficult. This is especially true if the symptoms are severe; extreme symptoms of a personality disorder can overlap with those of a severe depressive or manic episode and make them difficult to distinguish^[6].

On the other hand, a more accurate diagnosis can often be made if a thorough patient history is undertaken. Doing so can help clinicians establish whether relevant symptoms are long-standing (which would indicate a personality disorder) or if they are short-lived (which may be indicative of bipolar disorder)^[6]. Conducting a patient history might also reveal a family history of one or both disorders, which can also be helpful in making a proper diagnosis.

Bipolar vs Personality Disorders: Treatment

The treatments for bipolar and personality disorders share some commonalities. For example, both disorders respond well to psychotherapy. Common types of psychotherapy include the following:

• Cognitive-behavioral therapy
• Dialectical behavior therapy
• Psychoanalysis
• Group therapy

However, where the treatment of these disorders diverges somewhat is in the use of medications. For bipolar disorder, medications (e.g., atypical antipsychotics or lithium) are a first-line treatment, especially for bipolar I and bipolar II types. Often, people with bipolar II disorder will be prescribed antidepressants, but only for a short period, as antidepressants can potentially induce a manic or hypomanic episode. Cyclothymia might require medication, but psychotherapy on its own is often effective^[4].

People who have personality disorders are typically not prescribed medications. Instead, psychotherapy is the first-line treatment, with some medications used as supplemental treatments for symptoms of certain personality disorders. For example, anxiolytics, antidepressants, or mood stabilizers might be prescribed to address anxiety, depression, and mood swings, respectively, for people with borderline personality disorder^[2].

Another point to make is this: treatment for bipolar disorder and personality disorders is typically ongoing, especially in severe cases. People with one of these disorders might be in therapy for years and may take medication for the rest of their lives to help manage their symptoms. Of course, milder cases of personality disorders might respond well to periodic psychotherapy. The same is often true for people with cyclothymia.

Can You Have Bipolar Disorder and Personality Disorders at the Same Time?

Yes, bipolar disorder can co-occur with a personality disorder. However, some personality disorders have a higher comorbidity with bipolar disorder than others. The most common bipolar-personality disorder comorbidity is seen with borderline personality disorder. Roughly 10 percent of people with bipolar I disorder also have borderline personality disorder. The incidence of comorbidity is even higher between bipolar II disorder and borderline personality disorder, as they occur together at roughly 20 percent^[7].

Additionally, bipolar I and antisocial personality disorder have a comorbidity rate of 4.1%.^[8] The prevalence of bipolar disorders and other personality disorders is not as well documented. However, in broad terms, research indicates that roughly one-quarter of people with bipolar disorder have a comorbid personality disorder^[9].