The Difference between Bipolar Disorder and Borderline Personality Disorder

The Difference between Bipolar Disorder and Borderline Personality Disorder

The Difference Between Bipolar and BPD

Bipolar disorder and borderline personality disorder (BPD) are serious medical illnesses that can disrupt a person’s ability to live a normal life. Both disorders are characterized by unstable moods, relationships and behavior, leaving many to wonder if bipolar and borderline personality disorder are related. Here’s more information about the similarities and differences between bipolar disorder and borderline personality disorder.

Is Bipolar a Mood Disorder?

First, let’s examine what bipolar disorder is. The question is often asked, is bipolar disorder a personality disorder? Bipolar is considered a mood disorder characterized by swings between intense highs and lows. During the highs, people can feel euphoric and on top of the world; this is generally considered a manic stage. This is also a period that can be marked by uncontrollable actions, with no regard for the consequences. The lows are marked by feelings of depression, with an attendant lack of energy or enthusiasm. It may be difficult to get out of bed or focus on anything important, and the tasks and responsibilities of daily life may begin to suffer.

There are two major forms of bipolar disorder: Bipolar I is considered more intense, while bipolar II is less severe. There are other types of bipolar as well, such as mixed bipolar disorder, where the manic and depressive stages occur simultaneously, and rapid-cycling bipolar disorder, where many mood swings take place during the course of a year.

The mood swings of bipolar disorder can occur at any time and can permeate all areas of a person’s life. Now let’s segue to looking at borderline personality disorder vs. bipolar.

Similarities Between Bipolar Disorder and BPD

Bipolar disorder and borderline personality disorder share many similarities, including:

Mood Changes

It’s normal and healthy to experience changes in your mood. No one goes through life feeling the same every day, all the time. However, drastic mood swings and rapid changes in mood can be a symptom of a medical problem—more than one, in fact. In the case of bipolar disorder and BPD, there is a great deal of confusion generally about mood changes and how they might differ in patients with the two disorders.

Bipolar disorder causes those extreme shifts in mood from depression to mania (a mood characterized by abnormal elation and energy, racing thoughts and speech, a decreased need for sleep, etc.). BPD is also associated with mood changes, causing people to frequently switch between feeling fine to feeling extremely distressed in a matter of minutes.

As an example of this, you might see a person with BPD who is desperately attached to a friend, family member or partner one moment, and then storming off in a rage away from that person the next time you see them. Or the person you know might seem to be incredibly upbeat and energetic at times, even engaging in some risk-taking behavior that surprises you—only to be depressed and inactive at another time.

Impulsive Behavior

No one wants to be seen as thoughtless or fickle, but impulsive behaviors can create this situation. Sooner or later everyone makes a foolish or reckless decision. However, people exhibiting impulsive behavior regularly take chances that seem dangerous, or even do serious things without first thinking their consequences through. They may even seem surprised when their impulsive behaviors cause trouble—because they just didn’t consider the possible results before they took action. When they are feeling “good,” it’s all about acting on that feeling, and rational thinking or other people’s emotions aren’t taken into consideration.

Both bipolar disorder and BPD cause people to act impulsively. These impulsive behaviors can include rash spending sprees, reckless driving, foolish financial investments, risky sexual behaviors, binge eating, substance abuse and self injury. As you can see, these behaviors are risky and can cause serious harm to anyone involved in the situation.

Impulsive behaviors can be frightening to friends and loved ones. Seeing someone you love self-harm by cutting themselves, for example, is difficult and upsetting. Many times people close to the patient with impulsive behaviors aren’t sure what might be causing the problem, and they’re not even certain whether they should seek help for their friend or loved one. This is one reason why bipolar disorder and BPD are so difficult to treat.

Drug and Alcohol Abuse

For many people, social use of alcohol or prescribed medications don’t pose a problem. That’s because the concept of moderation, while requiring discipline, is an attainable goal most of the time. However, for people with untreated bipolar disorder or borderline personality disorder, moderation is difficult or impossible to achieve.

It’s not uncommon for people with untreated bipolar disorder or BPD to abuse alcohol or drugs as a way to cope with their symptoms. Substance abuse and mental disorders are often referred to as co-occurring conditions. Unfortunately, substance abuse only aggravates symptoms and can hinder or hide a true bipolar or BPD diagnosis.

As an example, for someone with bipolar disorder, stimulants may be a temporary fix for feelings of depression. When they are feeling low, they take a drug like cocaine and get an immediate high. Alcohol or opiates might be the same kind of bandage for people who are feeling too manic. The body is flooded with a pleasurable feeling of relaxation that is soothing in the moment. For those with borderline personality disorder, substance abuse might “take the edge off” the way it feels to rapidly go from rage to despair to terror, or between other extreme moods. However, with frequent and increasing use of drugs or alcohol, there is a danger of tolerance and dependency, which means someone would end up having to take more and more of the substance to get the high they are used to feeling. This is the path that can lead to addiction. In addition, substance abuse can affect different parts of the brain such as the prefrontal cortex and the basal ganglia, which can have a detrimental effect on someone who is already grappling with bipolar or borderline personality disorder. In fact, the more someone abuses substances, the greater risk they have of impaired brain function over the long term.

When a mood disorder and substance abuse co-occur in a patient, that usually calls for specialized treatment at a facility specializing in dual-diagnosis care. Because the issues are so intertwined with each other, working on both of them at the same time will give a patient better odds at recovery, compared to focusing on one primary disorder. 

Bipolar vs. Borderline Personality Disorder: The Differences

Although bipolar disorder and BPD share some similarities, there are some fundamental differences that separate the two. For example, bipolar disorder is a mental (or brain) disorder, while BPD is an emotional disorder. Both disorders are characterized by mood swings, but the length and intensity of these mood swings are different. While a person with bipolar disorder typically endures the same mood for days or weeks at a time, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. Bipolar mood shifts are distinguished by manic episodes of elation, but borderline personality disorder mood shifts rarely involve feelings of elation. The causes for these mood shifts also vary. BPD mood shifts are usually a reaction to an environmental stressor (such as an argument), while bipolar mood shifts seem to occur out of nowhere. Both disorders are difficult to live with, but the unpredictability of bipolar disorder can be particularly stressful.

Another difference between bipolar and borderline personality disorder is the types of emotions people with these disorders experience. People with bipolar disorder experience a fairly full range of emotions, but at inappropriate times, or to unhealthy degrees. People with BPD may view themselves as fundamentally bad or unworthy and are more prone to feelings of loneliness, emptiness and a severe fear of abandonment. And while both patients might feel like their mood changes come “from nowhere” at times, the BPD patient can typically identify the triggering incident that set them off.

Bipolar vs. Borderline Personality Disorder: Treatment

One of the most significant differences between bipolar and borderline personality disorder is treatment. The most important part of bipolar treatment is medication, followed by psychotherapy. BPD treatment, on the other hand, focuses on psychotherapy, not medication. Sometimes antidepressant drugs and mood stabilizers are prescribed based on specific target symptoms, but medication for BPD is often used as a last resort. The type of psychotherapy used to treat both disorders also varies. Bipolar disorder patients respond best to traditional therapies, such as Cognitive Behavioral Therapy, while BPD  patients tend to respond better to Dialectical Behavior Therapy. The Dialectical Behavior Therapy model is rooted in Cognitive Behavioral Therapy, but specifically addresses the needs of patients with borderline personality disorder, especially those who tend to self harm or have suicidal ideation. The focus is on building positive relationships, acceptance and emotional control. 

In addition to psychotherapy and pharmaceutical medications, some people have successfully eased their bipolar and borderline personality disorder symptoms with holistic treatments, such as yoga, acupuncture, meditation and herbal/natural supplements. These types of treatments help people with either disorder learn how to decompress from stress, relax and feel centered. They promote a sense of mindfulness that can help them better tackle tough times and cope with emotional issues in a healthier way.

The bottom line with either bipolar disorder or BPD is finding a treatment center that has the expertise and training to successfully distinguish between various mental and emotional disorders—and the capacity to treat them all. A holistic approach that accounts for the whole person, and their particular needs and situation, is the kind most likely to work. These disorders affect people mentally, emotionally, physically and spiritually, so treatment needs to address all of those areas for the opportunity to achieve a more complete sense of healing. 

Ideally, a treatment program will have qualified medical professionals who can create and oversee a comprehensive medication management program. If it is a dual-diagnosis treatment, there should also be medical professionals supervising the substance abuse detoxification process. Therapy plans should be customized to each patient and may include individual, group and family therapy sessions. A full health assessment can offer an accurate diagnosis and serve as the foundation for a treatment plan moving forward. Also part of that plan: complementary practices such as Tai Chi and massage therapy to promote emotional and mental re-balancing and centering. 

If you have a friend or loved one who seems to be struggling with the above symptoms, they may be dealing with bipolar or borderline personality disorder. Encourage them to seek treatment and take that first step towards healing.