Bipolar Disorders VS Borderline Personality Disorder

Psychological diagnoses can be complex and often misunderstood. Several diagnoses are very similar to one another and are even considered “rule-out” diagnoses that need to be taken into consideration when diagnosing a person. Two such disorders that are frequently confused are Bipolar Disorders and Borderline Personality Disorder. Although both share certain symptoms, such as mood instability and impulsive behavior, they are distinct disorders with different causes, symptom patterns, and treatment approaches. This blog aims to clarify the differences in bipolar disorders and borderline personality disorder by helping you better understand these conditions and how they impact those who live with them.

What are Bipolar Disorders?

According to the DSM-V-TR (2023), bipolar disorders are mood disorders characterized by manic, hypomanic, and depressive episodes.

A manic episode is described as “a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly everyday” (DSM-V-TR, 2023). During this period of time you must experience 3 or more of the following symptoms:

• Inflated self-esteem
• Decreased need for sleep
• More talkative that usual
• Racing thoughts
• Easily distractible
• Increase goal directed activity
• Excessive risky behaviors (unrestrained spending, sexual exploitations, etc)

A hypomanic episode is described the same as a manic episode, except the length of time for symptoms is only at least 4 days. It is considered to be a less severe form of mania due to its shortened duration of symptoms.

A depressive episode is described as “the presence of 5 or more of the following symptoms during the same 2-week period and represent a change from the previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure” (DSM-V-TR, 2023).

• Depressed mood
• Loss of interest or pleasure in daily activities
• Significant weight loss or weight gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Diminished ability to think, concentrate, or focus
• Recurrent thoughts of death or suicidal ideation

There are two types of bipolar disorder, Bipolar I Disorder and Bipolar II Disorder. Bipolar I disorder consists of manic episodes and depressive episodes. Bipolar II disorder consists of hypomanic episodes and depressive episodes.

What is Borderline Personality Disorder?

According to the DSM-V-TR, borderline personality disorder is “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity” (DSM-V-TR, 2023). Also present needs to be at least 5 of the following symptoms

• Efforts to avoid real or imagined abandonment
• Pattern of unstable and intense interpersonal relationships
• Identity disturbance (unstable sense of self or self-image)
• Impulsivity in at least 2 of the following areas: spending, sex, substance use, reckless driving, binge eating)
• Recurrent suicidal behavior, gestures, or threats or self harm
• Intense mood swings lasting a few hours to a day
• Chronic feelings of emptiness
• Inappropriate and intense anger or difficulty controlling anger
• Stress-related paranoid ideation or dissociative symptoms

Key Differences Between Bipolar Disorder and Borderline Personality Disorder

When looking over the criteria for each of these diagnoses, you can see that they have many things in common. Both include mood swings, instability of emotions, impulsivity, and difficulty with interpersonal relationships. Let’s look further into these commonalities so that you can see how different these two disorders really are.

          1. Nature of Mood Swings

• • Bipolar Disorder: Mood swings occur when there is a shift from a manic/hypomanic episode to a depressive episode or vice versa. Each of these episodes last days to weeks and can have very dramatic shifts.
  • Borderline PD: Mood swings occur very rapidly and intensely within hours or even minutes. They are quick and dramatic and are very noticeable by others.
  • Key Distinction: Bipolar mood swings are episodic and longer lasting while Borderline PD swings are situational and short-lived

          2. Triggers and Stability of Emotions

1. • Bipolar disorder: Mood swings occur within a depressive episode or a manic episode. They are minimally triggered by the environment or people around them.
   • Borderline PD: Mood swings and emotional responses are frequently triggered by external events. This could be due to interpersonal conflicts or fear of abandonment.
   • Key distinction: Bipolar mood changes are typically less dependent on immediate interpersonal situations, while borderline PD is highly sensitive to external triggers.
3.  3. Impulsivity and Behavior

1. • Bipolar disorder: Impulsivity is primarily seen only during a manic or hypomanic episode. During this time, one may engage in spending sprees, reckless behavior, sexual exploitations, or other impulsive activities.
   • Borderline PD: Impulsivity can be chronic and affect multiple areas of a person’s life. It is not isolated to specific episodes or in short spans of time. Impulsivity here affects relationships, self-image, ability to work, and other areas one needs to be present in.
   • Key distinction: Impulsivity in bipolar disorders are episodic and tied to mood states, whereas in borderline PD, it is more pervasive and related to identity and emotional dysregulation.

2.  4. Duration of Symptoms and Course of the Disorder

    

1. • Bipolar disorder: Symptoms can be very cyclical and come in clear episodes related to mood. There are also periods of stability between manic/hypomanic episodes and depressive episodes.
   • Borderline PD: Symptoms can be chronic and pervasive, affecting most aspects of a person’s life. There are not many periods of stability that occur throughout all areas of life.
   • Key distinction: Bipolar disorders have a pattern of episodic symptomatology, while borderline PD symptoms are ongoing and constant.

1.  5. Relationship with Self and Others

    

1. • Bipolar disorder: Relationships with other people may be affected during mood episodes. This can either be through the isolation of self during a depressive episode or the risky behaviors that occur during a manic/hypomanic episode. A person’s own self-image remains more stable over all.
   • Borderline PD: Both interpersonal relationships and self-identity are impacted immensely. A hallmark feature of borderline PD is the difficulty with self-identity and unstable, turbulent relationships.
   • Key distinction: Bipolar disorders typically involve mood-driven changes, while borderline PD involves deeper issues with self-worth and interpersonal dynamics.

Misdiagnosis and Overlap

As you can see, it is very easy for one to be misdiagnosed with either bipolar disorders or borderline PD. There are so many overlapping symptoms, like impulsivity, mood swings, and irritability. For many people with borderline PD, they first receive a bipolar disorder diagnosis as it can seem like the most likely cause for the symptoms. This occurs at times due to a historical  stigma that surrounds personality disorders. Many clinicians as well as patients do not want to give or have a diagnosis of borderline PD as they have been perceived as being “the most difficult” diagnosis to work with or cope with. Fortunately, the view around borderline PD is evolving and more people are open to the diagnosis.

The most effective way to avoid misdiagnosis between bipolar disorders and borderline PD is to have a thorough psychological evaluation completed. A complete psychological evaluation can provide insight into multiple aspects of a person’s life. By doing so, one will complete multiple assessments which assess what specific symptoms they experience, how frequently, and the intensity of them. This will help differentiate the commonly shared symptoms of bipolar disorders and borderline PD.

Treatment Approaches for Bipolar Disorder vs. Borderline Personality Disorder

1. Bipolar Disorder Treatment

   • The primary treatment for bipolar disorders is medication. This can be accomplished by scheduling an appointment with a psychiatrist to discuss your symptoms and what medications will be effective for treatment. You can anticipate the psychiatrist discussing mood stabilizers, antipsychotics, and antidepressants. Each of these classes of medications have been proven to be effective in treating the different symptoms of bipolar disorders.
   • Psychotherapy is another form of treatment that is effective for bipolar disorders. In fact, many professionals will tell you that the combination of mediation and psychotherapy is the most effective way to treat bipolar disorders. Therapy for bipolar disorders can focus on managing mood swings and improving coping strategies. The most evidence-based approach for treating bipolar disorders is Cognitive-Behavioral Therapy, which emphasizes the interactions between one’s thoughts, feelings, and behaviors.

2. Borderline Personality Disorder Treatment

    

   • The primary treatment for borderline PD is psychotherapy. The most evidence-based treatment for borderline PD is Dialectical Behavior Therapy (DBT). DBT was originally created specifically to treat borderline PD. DBT has four main modules it teaches which are: distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness. Therapy for borderline PD is considered to be long-term therapy in order to help improve one’s self-regulation and coping skills as well.
   • Medication is another effective form of treatment for borderline PD. Just like bipolar disorders, many professionals recommend medication alongside therapy for borderline PD. Medication for borderline PD is primarily for comorbid conditions like depression, anxiety, or impulsivity. Meeting with a psychiatrist who is familiar with treating borderline PD is the most effective way to find the best

Bipolar disorders and borderline personality disorder are two diagnoses that are often mistaken for each other. They share many of the same symptoms but with entirely different causes and intensity behind them. If you or someone you love has been diagnosed with bipolar disorders or borderline personality disorder, or misdiagnosed, please tap here to reach out to us at Integrated Care Clinic today.