Borderline Personality Disorder vs. Bipolar: A Comparison Guide

One of my colleagues thought she had bipolar disorder all this while. Until a proper diagnosis and investigation of symptoms revealed she actually had BPD or borderline personality disorder.

Yes, they are different but may seem similar sometimes. So, how do you clearly identify what is what? According to the National Institute of Mental Health, approximately 4.4 percent of adults in the US suffer from bipolar disorder. And around 82.9 percent of those affected struggle with serious impairment in the form of severe mood disorders.

Whereas an estimated 5.9 percent of the American adult population battles borderline personality disorder. More women are affected by BPD than men. Also, about 78 percent of teenagers having borderline personality disorder reported being suicidal.

These statistics can get worse in a few years to come. So, I cannot stress enough on proper awareness, diagnosis, and effective treatments. The awareness begins with doing away with the associated stigma. And most importantly, understanding how BPD and bipolar disorder differ. This article is your detailed guide to their comparison.

Borderline Personality Disorder (BPD) vs Bipolar Disorder: A Comparison Guide

This section will explore the different aspects comparing Bipolar disorder and borderline personality disorder.

1. Definitions of BPD and Bipolar Disorder

This section explains the basic definitions of BPD and bipolar disorder.

What is Borderline Personality Disorder?

Borderline personality disorder or BPD indicates emotional dysregulation. Patients with BPD struggle with controlling their emotions. The significant impairment in emotional control triggers impulsive behavior and affects their personal as well as professional lives.

What is Bipolar Disorder?

Bipolar disorder is a mental illness that triggers extreme mood, energy, and focus fluctuations. The abnormal shifts in activity levels and emotions make it challenging for the patient to keep up with their daily routine.

2. What Causes BPD and Bipolar Disorder?

In this section, we will discuss the various factors that are likely to trigger BPD and bipolar disorder.

Borderline personality disorder Causes

BPD cannot be necessarily attributed to a specific cause. Genetics may play a primary role and the condition could be passed on to you from your parents. However, there could be many other factors involved, too.

A region of the brain called the amygdala functions like an emotion regulator. So, a dysfunctional amygdala can stunt brain development and trigger borderline personality disorder.

Also, a compromised hippocampus and the orbitofrontal cortex of the brain can affect everyday functioning. It can hamper your decision-making abilities and self-control skills eventually causing borderline personality disorder.

Another cause of BPD could be the faulty performance of the brain neurotransmitters such as serotonin. Apart from this, the temperament of the patient in general could also lead to BPD in the future.

Having an undiagnosed mental condition such as bipolar disorder can also trigger BPD later. Additionally, previous trauma, physical or sexual abuse, and neglected childhood needs are some other major reasons for developing BPD.

Bipolar disorder Causes

Similar to BPD, The origin or exact cause of bipolar disorder is not known. You could be genetically predisposed to it if the disorder runs in your family. I have also known some mentally sensitive people with a traumatic past who were later affected by bipolar disorder.

Child abuse, sexual assault in the past, and toxic parenting are some other triggers of bipolar disorder.

The causes of BPD and bipolar disorder may seem more or less the same, with a slight symptom overlap. However, how these conditions manifest and progress with time is the key differentiator.

3. How do BPD and Bipolar Disorder Manifest?

Let us understand what BPD and bipolar disorder look like, in this section of our guide.

Both disorders have some common signs such as impulsivity and depression. However, bipolar disorder patients generally experience extreme mood shifts, thoughts, and emotions in a short period.

How to identify Borderline Personality Disorder?

BPD is not episodic, unlike bipolar disorder. Also, the condition does not quickly oscillate between emotional highs and lows. It follows a particular pattern. So, that emotional state of mind can go on for longer periods. Here are some symptoms to help you recognize BPD:

• Extensive periods of emotional emptiness
• Impulsive behavior
• The depressive phase is more or less pervasive
• The emotional fragility is consistent
• It is also characterized by low self-esteem and fear of abandonment

Bipolar disorder, on the other hand, is way different and manifests differently. We do not see BPD patients constantly oscillating between deep pleasure and deep sadness. Some of the symptoms of the depressive phase in bipolar disorder overlap with BPD. But these emotions in BPD do not break, they are always there!

How to identify Bipolar Disorder?

If you or your loved one is bipolar, the moods would erratically swing between mania and depression. The condition is highly episodic.

You may feel you are up for something. Fast forward to a few hours or days later, you may feel down and the entire plan could flush down the drain. Another way it could manifest is a few weeks of depression followed by a couple of days of mania and hypomania. Here are some signs of a manic episode:

• Impulsive actions
• Excessive excitement and enthusiasm
• Leaning more towards over-expressing and talking too much
• More prone to sudden anger and hissy fits
• Extreme fixation on a specific subject
• Being extra idealistic and aspirational
• Excessive pride, self-esteem, and inflated sense of grandiosity

The depressive phase can be characterized by the following symptoms:

• Overwhelming exhaustion
• Insomnia
• Tendency to hide away and isolate from the rest
• Feelings of extreme sadness
• Excessive anxiety

Another way to recognize bipolar disorder is to check for psychotic symptoms such as delusions and hallucinations. How they manifest depends on your episode, whether you are manic or depressive.

So, if you are experiencing mania, psychosis can further elevate your short-term excitement. And make you feel “exquisite” like you are the king of the world. However, during your depressive episode, your psychosis will create the opposite effect and aggravate depression. It will lead you to believe in an illusion of a ruined world and a devastated career or life for you.

Psychosis is absent in patients suffering from BPD.

Now, is it possible to have both BPD and bipolar disorder? Yes, it is totally normal to suffer from both BPD and bipolar disorder. Multiple types of both these illnesses (bipolar I, bipolar II, Impulsive BPD, Petulant BPD, etc) can further complicate your diagnosis.

So, I would advise a thorough check-up and evaluation of your mental health to ensure you get the right treatment at the right time. However, the presence of bipolar disorder can skew the investigation of BPD.

A correct diagnosis of BPD requires you to be emotionally stable or neutral for some time. If you are bipolar and going through one of your mood episodes, BPD will go undetected, unfortunately.

4. Effective Treatments for BPD and Bipolar Disorder

This section will explore the various effective treatments available for BPD and bipolar disorder.

How to treat borderline personality disorder?

Unfortunately, there are no medications to treat BPD or borderline personality disorder. Therefore, evidence-based talk therapy is the most effective approach tried and tested so far.

The most popularly used techniques with the best treatment outcomes are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). These counselling approaches help patients identify problematic behaviour and thought patterns. And further, coach them to regulate their emotions and manage stress better.

Although there is no medication approved for the treatment of BPD, certain antidepressants, mood stabilizers and anticonvulsants might be prescribed by your psychiatrists. These are targeted to help you improve your coping mechanisms and alleviate some symptoms. The drugs on the list are as follows:

• Lithium
• Valproate
• Lorazepam
• Diazepam
• Risperidone
• Alprazolam
• Clonazepam
• Bupropion
• Lamotrigine and more

Note: Your psychiatric provider will determine the dosage and prescribe the right set of drugs based on the severity of your condition. So, I would advise you to stay away from self-medication which can be lethal.

How to treat bipolar disorder?

Psychotherapy, mainly CBT or cognitive behavioral therapy works the best when it comes to effective bipolar disorder treatments. This technique can drastically alleviate certain problematic symptoms such as depression, anxiety, and insomnia experienced during the depressive phase.

There are some other approved methods to address the condition such as Electroconvulsive therapy and light therapy. However, the exact line of treatment is customized to fit individual patient needs and symptom severity.

For better management of bipolar disorder, the FDA has also approved several different medications. These are strictly prescribed by licensed psychiatrists depending on how your condition manifests. For example, lithium is known to alleviate suicidal thoughts.

Mood stabilizers such as olanzapine, haloperidol, and more are commonly prescribed to control extreme mood swings. In January 2023, the FDA approved an injectable form of one of the most preferred mood stabilizers, risperidone called Rykindo for the treatment of bipolar disorder.

Conclusion

I hope this guide helps you get rid of the confusion between BPD and bipolar disorder, once and for all. If you still have trouble figuring out which condition you are dealing with, you can leave your doubts in the comments. I will try my best to answer. Nevertheless, you must consult a licensed mental health provider to clear things up.