Borderline Personality Disorder vs. Bipolar Disorder
Bipolar disorder and borderline personality disorder are two conditions that may appear similar due to symptoms like impulsivity and extreme mood shifts. But despite being two different conditions, misdiagnosis is common. According to one study, 40 percent of people who met the criteria for BPD were misdiagnosed with bipolar disorder. So, let’s look at the two conditions, how they differ, and where they share similarities.
What is Bipolar Disorder?
Bipolar disorder is a class of mood disorders characterized by extreme mood disturbances in the form of manic, hypomanic, and major depressive episodes. Bipolar I disorder involves manic and depressive episodes, though only a manic episode is required for a diagnosis. Meanwhile, bipolar II disorder involves hypomanic and depressive episodes, both of which are required for a diagnosis. With professional guidance and treatment like inpatient treatment at URP Behavioral Health, you’ll start to see a change in symptoms.
Symptoms of Bipolar Disorder
Symptoms are categorized into manic/hypomanic and depressive episodes. During a manic episode, you may experience:
- Elevated or irritable mood
- Inflated sense of self
- Decreased need for sleep
- Pressured and loud speech
- Racing thoughts
- Distractibility and poor concentration
- Increased levels of goal-directed or purposeless activity
- Engaging in risky behavior
Meanwhile, major depressive episodes are characterized by:
- Low mood and feelings of hopelessness
- Lack of interest in daily activities
- Change in appetite, resulting in unintentional weight loss/gain
- Sleep disturbance or oversleeping
- Psychomotor agitation or retardation
- Feeling fatigued without physical exertion
- Excessive guilt over minor failings
- Inability to concentrate and make decisions
- Recurrent thoughts of death
Causes of Bipolar Disorder
Several risk factors can increase the risk of developing bipolar disorder. These include:
- Genetics: As one of the most inheritable mental disorders, researchers theorize that there’s a strong genetic component to bipolar disorder.
- Brain Chemistry and Structure: Changes in neurotransmitter levels in the brain and differences in brain structure can potentially lead to bipolar disorder.
- Stressful Environment: While a stressful or traumatic life event may not cause bipolar disorder directly, it can trigger it in people who are genetically predisposed.
- Substance Abuse: a scientific review of multiple studies found that substance abuse is a risk factor for bipolar disorder because it alters brain chemistry.
Similarities Between Bipolar Disorder and BPD
To an outsider, the symptoms of bipolar disorder and BPD may appear similar. That’s because a few of them overlap, such as:
- Acting impulsively and making decisions without thinking them through
- Having low self-esteem and self-worth
- Experiencing extreme changes in mood
- Engaging in self-destructive behaviors that can have painful consequences, like substance abuse
- Having suicidal thoughts or engaging in self-harm behavior
- Having strained relationships with loved ones
Nevertheless, both of these are from completely different categories requiring different criteria for diagnosis and treatment options.
Differential Diagnosis
Episodic vs. Rapid Mood Changes
Although both disorders show mood changes, the nature of these shifts is distinct. In bipolar disorder, you experience episodic mood disturbances in the form of mania and depression. On the other hand, BPD causes intense feelings of anger, loneliness, and desperation.
Consistent vs. Inconsistent Mood Changes
Your therapist will also look at the timeline of your mood changes. Mood episodes in bipolar disorder last for a few days, at the very least. That means you’ll experience consistently low or elevated mood for the entire period of time. But in BPD, mood shifts occur for shorter periods, lasting only a few hours at a time.
Low Mood and Elation vs. Intense Emotionality
In BPD, mood changes rarely involve feeling elated. Elevated mood is commonly associated with bipolar disorder, where your mood shifts from feeling sad and hopeless to euphoric and elated.
Triggers
In BPD, how people treat you has a major effect on how you feel. This is especially when you think that someone will abandon you. Real or perceived abandonment can lead to intense emotions of anger and fear. This can also result in self-destructive behaviors and even self-harm. In bipolar disorder, it’s possible that mood shifts occur due to stress, but they can occur due to no reason as well.
Relationships
While both disorders can put a strain on relationships, BPD leads to an intense fear of abandonment, which affects your ability to have stable relationships. When you have BPD, your feelings for people may go from extreme to dislike. Although mood changes associated with bipolar can cause difficulties in relationships, there’s no fear of abandonment.
Treatment For Bipolar Disorder vs. BPD
In terms of treatment, both bipolar disorder and BPD can benefit from psychotherapy. Also known as talk therapy, it can help you manage symptoms, alleviate stress, and improve psychosocial functioning. However, psychotherapy is best suited for bipolar disorder when it’s combined with medication such as mood stabilizers and antipsychotics.
Meanwhile, psychotherapy for BPD is most effective when it uses the DBT approach, which helps with distress tolerance and emotional regulation. Although there’s no specific medication for BPD, your healthcare provider may prescribe antidepressants if you develop depression as a result of BPD symptoms.
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