It can be difficult, even for clinicians, to tell the difference between bipolar disorder and borderline personality disorder (BPD). This may be because both disorders have some similar symptoms, and in anywhere from eight to 18 percent of cases, patients with one of these disorders are found to also suffer from the other one. Both of these disorders cause patients to have problems regulating their moods; however, there are some big differences between how people with bipolar disorder experience their moods and emotional states, and how people with BPD experience them.
BPD symptoms typically appear in adolescence and may develop even earlier. Symptoms of BPD are usually present from the beginning of a person’s life, and they make up the sufferer’s personality — that’s why BPD is known as a personality disorder. Bipolar disorder symptoms, on the other hand, consist of mood and emotional changes that are different from the person’s normal personality, which usually appears in late adolescence or early adulthood. While medication is necessary for the treatment of bipolar disorder, psychotherapy is the most effective form of treatment for BPD.
BPD and Bipolar Disorder Cause Different Mood Symptoms
Though both BPD and bipolar disorder are characterized by changes in mood, BPD mood changes occur much more rapidly than bipolar disorder mood changes. A person with BPD may experience several severe mood changes each day, with emotional states that last anywhere from a few minutes to a few hours. That’s because people with BPD experience what’s known as affective dysregulation, or overwhelming, unpleasant, and painful emotional reactions to things that are going on in their lives.
Their most common mood symptoms include sadness, anger, paranoia, fear of abandonment, and anxiety. They may react to these mood changes with fits of rage, threats of suicide, and self-harm.
An important point to remember is that most often, mood changes in people suffering BPD occur in reaction to something that’s happening in their lives, usually perceived rejection or abandonment by someone they care about. It’s also vital to note that, unlike people with bipolar disorder, people with BPD do not cycle from sadness, anger, anxiety, or other negative emotions into a euphoric or elated manic state. They go from a state of emotional upheaval to merely feeling not upset for a brief time, and do not experience euphoria.
For people with bipolar disorder, the disordered emotional states they experience last much longer, typically for days, weeks, or months. While it’s possible that bipolar mood swings can occur due to some triggering stress, there often isn’t any such trigger — the mood changes just happen for no apparent reason. While people with bipolar disorder may experience many of the same emotional states as people with BPD — including feelings of anger and rage — they will demonstrate one particular emotional state that people with BPD almost never display. That emotional state is mania or hypomania, characterized by grandiose thinking and euphoria, as well as possible anger or irritability.
Both people with BPD and bipolar disorder will demonstrate impulsivity, although people with BPD may demonstrate this quality as an overarching personality trait, while people with bipolar disorder tend to display it mostly during manic and hypomanic phases. BPD is driven largely by a fear of abandonment, and leads to rocky, emotionally intense relationships, low self-esteem, suicidal behavior, self-harming behavior, emotional emptiness, and anger management problems.
When a person with bipolar disorder is in a manic phase, he or she will talk more often and more quickly, make lots of grand plans, take more risks, seem to have a lot more energy than normal, need less sleep, and appear to be elated or irritable. When depressed, a person with bipolar disorder exhibits classic symptoms of depression. There will often be periods of normalcy, too, in which the person with bipolar disorder reverts to his or her old self again.
Correct Diagnosis Is Vital
Whether you have bipolar disorder or BPD, correct diagnosis is vital to appropriate treatment. People with bipolar disorder need medication to manage the symptoms of the illness. Medications like Abilify and Seroquel can be used to treat bipolar disorder symptoms, as can certain antidepressants. Psychotherapy is also a valuable tool to educate people with bipolar disorder about their condition and help them learn how to manage their symptoms.
Since BPD is a personality disorder, it can be difficult to treat, but with the right combination of therapy and medication, up to 85 percent of people with BPD can experience remission. While psychotherapy is more important for people with BPD, some medications can be used to control mood swings, depression, impulsivity, and suicidal thoughts. Psychotherapy for BPD usually involves dialectical behavior therapy, which can help patients learn to gain control over their emotions, build healthier thought patterns, and have more fulfilling relationships.
Bipolar disorder and borderline personality disorder often look so similar that it can be difficult even for professionals to tell the difference. But getting the correct diagnosis can make all the difference to your prognosis. Don’t be afraid to ask your doctor why he or she gave you your diagnosis, and to talk about any concerns you may have.