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Bipolar vs. Borderline Personality Disorder: What's the Difference?

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When I first started looking at the literature regarding serious mental illness (SMI), I became confused by the abbreviation BPD. At first, I thought it was a typo or an alternative for bipolar disorder. Of course, I found out that it wasn’t — BPD stood for borderline personality disorder.

Even if you know what the abbreviation means, it’s easy enough to get confused between the two. In fact, bipolar is often misdiagnosed as borderline, or vice versa. There are some similarities between the two disorders as well. Both involve mood swings. Both can cause reckless behavior. Both can be associated with childhood trauma. And both can lead to suicidal ideation or attempts. They’re both very serious diagnoses.

According to psychologist Dr. April Foreman, BPD “is characterized largely by the inability to regulate emotions, which can cause a person with BPD to have painful and unstable interpersonal relationships.

Sounds familiar, doesn’t it? The same could be said of bipolar disorder. So what’s the difference between the two?

Mental Health America explains that bipolar is a mood disorder while BPD is a personality disorder:

“People with bipolar disorder experience episodes of mania and depression.” While “personality disorders involve patterns of thinking and behavior that affect all aspects of a person’s life. People with BPD often have an insecure attachment style, meaning that they have a hard time trusting other people to stick around.”

Not to get picky about it, but as a person with bipolar, I’ve experienced intense emotional pain and feelings of emptiness, desperation, hopelessness, and loneliness while in the throes of a major depressive episode. (Not so much anger.) They did, however, last for months rather than a few hours at a time.

People with BPD can also experience dissociation, paranoia, and reckless behavior. They tend to have intense, unstable relationships. Dissociation is sometimes also seen in manic episodes of bipolar disorder, and reckless behavior is a symptom of bipolar mania as well. Bipolar disorder can cause difficulty with relationships too. In between mood episodes, the person with bipolar can achieve stability, while that’s less likely for BPD.

So it seems that BPD might be seen as “bipolar on fast-forward.”

The short timespan of BPD episodes is one of the major differences between the two conditions. (It’s been described as “pervasive instability.”) But since the two sets of symptoms overlap, even clinicians sometimes mistake one for the other. BPD appears to have a strong genetic component; the cause of bipolar is thought to be a combination of brain functions, genetics, and early trauma.

When it comes to treatment, there are more options for bipolar than BPD. With BPD, medication is generally limited to symptomatic relief, such as with antianxiety agents. Dialectic behavioral therapy is the treatment of choice, along with psychotherapy. There are dozens of medications available for bipolar, as we know from TV commercials if nothing else.

It’s important to note that the two diagnoses can coexist. When they both affect a person, which is possible, they can be even more difficult to diagnose and treat. It’s easy to see how that can happen. Mood swings, reckless behavior, and potential dissociation can be effects of either one. Seeing a person only once a week, as many therapists do, can make it difficult to track the symptoms and see the patterns. And if the person sees a therapist or psychiatrist less often than that, the difficulty is compounded. Symptomatic relief may seem sufficient at first, but long-term is no solution.

Am I satisfied with my bipolar diagnosis? I’d have to say I am. While I despise the long-lasting mood swings, those are now largely controlled on medication. My destructive relationships haven’t been quick but have still been intense, and now I’ve achieved stability in that too. All things considered, I’ll stick with what I’ve got — not that I have a choice in the matter. If I had lived with BPD, I hope I would have done as well.

Originally published: April 13, 2024
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