Bipolar disorder and borderline personality disorder are both serious and life-impairing mental illnesses characterized by extreme mood swings and impulsive behaviors.
While they are separate and distinct disorders, they do share several defining characteristics, such as extreme emotions, mood instability, impulsivity, anxiety and depression.
“Patients with bipolar disorder or borderline personality disorder most commonly present for the treatment of depression, and both tend to be under-recognized and under-diagnosed,” says Dr. Mark Zimmerman, professor of psychiatry and human behavior at Brown Medical School and the director of outpatient psychiatry and partial hospital program at Rhode Island Hospital in Providence, Rhode Island.
Here’s what you need to know about the similarities, differences and available treatments.
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What Is Bipolar Disorder?
Bipolar disorder, formerly known as manic depression, is one of the most common mood disorders in the United States, affecting about 2.8% of the population, according to the National Institute of Mental Health. It affects men and women equally, with the average age of onset being age 25.
Bipolar disorder causes individuals to swing between extreme highs – called mania or hypomania – and depressed lows.
Manic and hypomanic episodes are both characterized by extreme, elevated moods and abnormally high energy levels. They share similar symptoms, but they differ in intensity, functional impairment and duration.
Mania is more severe in intensity and causes more noticeable changes in near every aspect of a person’s life. It can last for weeks and may require hospitalization. Hypomania, on the other hand, is a less severe form of mania and typically lasts for a few days without major disruptions to a person’s ability to function.
There are three main types of bipolar disorder that vary in intensity, but they all involve clear changes in mood, energy and activity levels.
Symptoms of a manic or hypomanic episode may include:
A depressive episode can vary in intensity, but it also causes noticeable changes in every aspect of a person’s life.
Symptoms may include:
Depression is more prevalent than mania or hypomania in most bipolar patients. The frequency of these mood episodes depends on the person, but in between these episodes, it’s common for people to experience periods of mood stability, allowing them to function relatively normally.
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What Is Borderline Personality Disorder?
Borderline personality disorder is a common mental health condition that affects 1.6% of the U.S. population, with 75% of diagnoses being women. Men may have the disorder in a similar proportion to women, but recent research suggests they are often misdiagnosed with bipolar disorder or depression instead.
Borderline personality disorder is characterized by intense emotional reactions to situational circumstances and impulsive, often destructive, behaviors.
These disproportionate reactions lead to a rollercoaster of emotional pain, life difficulties, unstable relationships and – in extreme cases – suicide.
An individual’s everyday emotional temperature is heavily influenced by in-the-moment external factors, such as a disagreement with a friend or getting a bad test grade. Those with borderline personality disorder have greater emotional sensitivity and struggle to manage their anger and negative emotions. They also have difficulty in returning to a more stable baseline emotional level.
Their feelings for others can change quickly from one extreme to the other, and they have a hard time reading other people’s emotions correctly, which leads to unstable relationships with family, friends and others.
“When relationships go bad, the person tends to employ psychological defenses that are the most immature and often the most destructive or self-defeating,” explains Dr. Dean MacKinnon, associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore. “Their emotional responsiveness is significantly stronger and more rapid than the average person.”
Similarities Between Bipolar Disorder and Borderline Personality Disorder
While bipolar disorder and borderline personality disorder are different diagnoses, they have several symptoms in common and sometimes occur at the same time.
“Approximately 20% of patients with borderline personality disorder also have bipolar disorder, and 20% of patients with bipolar disorder also have borderline personality disorder,” Zimmerman explains.
The defining symptoms of the disorders are the same: mood instability, impulsivity and functioning.
Because both conditions severely impair an individual’s ability to regulate emotions, they are often characterized by rapid and intense mood swings that profoundly affect a person’s ability to lead a “normal” life. As a result, individuals use impulsive, unhealthy and sometimes destructive coping methods – such as self-harm and risky financial or sexual decision-making – to deal with overwhelming emotions. There is often an increased risk of suicidality associated with both conditions.
“Both are psychiatric conditions in which there is long-term risk of emotional dysregulation and mood instability that can disrupt work, relationships and social functioning,” MacKinnon says.
It’s common for people with bipolar disorder or borderline personality disorder to have other mental illnesses, such as anxiety disorders and substance abuse, as well.
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Differences Between Borderline Personality Disorder and Bipolar Disorder
On the surface, borderline personality disorder and bipolar disorder share many similarities. However, there are many distinct aspects that set them apart.
Classification
Borderline personality disorder falls under the umbrella of personality disorders, while bipolar disorder falls under the umbrella of mood disorders.
A personality disorder is considered having maladjusted feelings, behaviors and patterns of thinking that do not follow social expectations and, consequently, cause chronic – rather than episodic – poor daily functioning. A mood disorder is a marked disruption to someone’s general emotional state with sustained – not fleeting – feelings of depression or excessive elation that interfere episodically with a person’s ability to function.
Triggers
Bipolar episodes are rooted in the body’s biological makeup, which makes episodes random and not related to specific situations, whereas the mood instability of borderline personality disorder are emotional reactions triggered by external situations.
Duration
Borderline personality disorder is a daily struggle to manage the chronic ups and downs of intense emotions, while bipolar disorder has finite and longer spans of mania and depression.
Mood instability
The mood instability of bipolar disorder is mania or hypomania and depression, while the mood instability of borderline personality disorder is emotional dysregulation, which is considered to be a poorly regulated emotional response that isn’t proportionate to the situation and is not within the traditionally accepted range of emotional reaction.
Sleep patterns
Changes in sleep patterns is a hallmark symptom of a bipolar episode, ranging from not needing as much sleep during a manic episode to oversleeping or having trouble sleeping during a depressive state. However, this is not a common symptom of borderline personality disorder.
Social functioning
Borderline personality disorder is characterized by patterns of unstable, volatile relationships, which can change from one extreme to another in a blink of an eye. People with bipolar disorder are able to have healthier relationships, even though they can be negatively affected in the manic and depressive episodes associated with the disorder.
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Understanding the Diagnosis
While both disorders cause mood instability and impulsive behaviors, each symptom presents differently. For example, this may present as chronic mood swings in those with borderline personality disorder versus defined periods of mania or hypomania and depression in bipolar disorder.
“To accurately diagnose these disorders, it is important that mental health professionals understand the defining features of each condition, so that they can ask the right questions during the clinical interview,” says Dr. Carla Sharp, professor of psychology at the University of Houston in Texas.
When someone has depression or a hypomanic or manic episode, it is very distinct from their usual behavior, which makes it easier to identify as a problem that needs treatment.
For people with borderline personality disorder, however, their frequent mood swings is their norm, so it can be challenging to identify.
“As with most personality disorders, the diagnosis simply describes who the person is most of the time, so they don’t come in seeking help for what seems normal – the way someone might look for help if their mood has become inexplicably manic or depressed,” MacKinnon says.
Current Treatment Approaches
The treatment of both disorders usually involves a combination of psychotherapy and medication to help stabilize mood changes and reduce symptoms. However, whether psychotherapy or medication is the primary treatment depends on the disorder.
“The distinction between bipolar disorder and borderline personality disorder is important because the two disorders suggest different treatment approaches,” Zimmerman says.
While psychotherapy – such as cognitive behavioral therapy – may be recommended for people with bipolar disorder, Zimmerman explains, the condition is primarily treated with medication, including mood stabilizers, antipsychotics, antidepressants and antidepressant-antipsychotic combination medications.
Because there are currently no drugs approved by the Food and Drug Administration to specifically treat borderline personality disorder, medication is often not the first-line treatment for the condition. Instead, psychotherapy – including dialectical behavior therapy and cognitive behavioral therapy – is the primary treatment.
Ultimately, with the right treatment and support, it’s possible to manage the symptoms of bipolar disorder and borderline personality disorder to live a healthy, fulfilling life. Talk with a mental health professional to get an accurate diagnosis and to talk about treatment options. If you or a loved one is experiencing a suicidal crisis or emotional distress, contact the 988 Suicide and Crisis Lifeline – available by phone, text or chat 24/7 – to speak with a licensed counselor.
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