Bipolar disorder vs borderline personality disorder: Distinguishing the two often creates a daunting challenge since several symptoms of both — like intense emotional shifts marked by impulsivity — overlap and can lead to confusing one for the other and vice versa.
Bipolar disorder (BD) and borderline personality disorder (BPD) can negatively impact sufferers in similar ways, from affecting their day-to-day functioning, quality of life, and relationships plus increased rates of substance abuse, suicide, and depression, among others.
Often, co-occurring disorders, both bipolar and borderline, are closely associated. According to studies, 20% of patients with BD-II and 10% of patients with BD-1 have also been diagnosed with BPD.
Understanding the traits that bipolar disorder and borderline personality disorder share and how they differ is important for accurate diagnoses and effective mental health treatment.
What Is Bipolar Disorder?
Bipolar disorder is a chronic, lifelong mood disorder and mental illness defined by extreme mood swings, energy, thinking patterns, behavior, and activity levels.
These unpredictable up-and-down states can range from euphoric states of excitement and activity to low periods of profound sadness, guilt, and hopelessness. Bipolar episodes on both ends of the spectrum may last for days, weeks, or even months at a time, making work, daily tasks, and experiences much more difficult.
Most of all, the prolonged departure from one’s normal self can cause distress for someone’s friends, family, and loved ones.
The average onset of bipolar disorder is 25 years old, but it can begin as soon as early childhood or as late as one’s 40s or 50s. Bipolar disorder statistics show that approximately 2.8% of U.S. adults are diagnosed with bipolar disorder each year.
Bipolar disorder was previously known as manic depression, but the medical and psychiatric fields have intentionally moved away from this label. According to the Cleveland Clinic, the words “manic” and “mania” created too much stigma and negativity due to its connotations with the word “maniac.” Bipolar disorder, in turn, is a more accepted clinical term and less emotionally charged.
Types of Bipolar Disorder
There are a few different types of bipolar disorder, which may involve significant fluctuations in mood.
- Bipolar I disorder: A person with bipolar I will have had at least one manic episode either preceding or following a hypomanic or major depressive episode lasting two weeks. A mixed state of depressive and manic symptoms may come at the same time. Diagnosis requires manic episodes lasting at least a week or to a severity necessitating hospitalization.
- Bipolar II disorder: Diagnosed if you’ve had at least one major depressive episode and hypomanic episode each, but not a full-blown manic episode. Bipolar II can sometimes be more debilitating than bipolar I since chronic bipolar depression is a more common symptom in bipolar II.
- Cyclothymic disorder: A milder form of bipolar disorder defined by a chronically unstable mood state and several moments of hypomanic and depressive symptoms lasting at least two years (one year for adolescents and teenagers). Cyclothymic patients may experience euthymia or normal mood, but these periods only last eight weeks or less.
- Other types of bipolar disorder, note the Mayo Clinic, may be caused by drug or alcohol use or a medical condition — stroke, multiple sclerosis, or Cushing’s disease.
What Are the Symptoms of Bipolar Disorder?
Everyone’s symptoms may vary if you’re struggling with bipolar disorder, with manic episodes and depressive episodes the most common symptoms.
Mania — and the less severe hypomania — is the side of bipolar disorder accompanied by almost unnaturally high or manic states conspicuously different from one’s normal way of acting. Bipolar disorder includes three or more of the following traits:
- A persistently elevated or irritable mood
- Increased energetic behavior and activity levels
- Racing, tangential thoughts
- Fast, pressured speech patterns and talkativeness
- Impulsive behaviors without any forethought
- Being easily distracted
- A decreased need for sleep
- Grandiose expression and inflated self-esteem
One troubling symptom of bipolar disorder is partaking in risky behaviors that could cause harm to yourself or others, such as sexual promiscuity, extreme spending or gambling, making poor investments, or reckless driving. Sometimes, mania may create a dissociative state or emotional break from reality called psychosis — symptoms can include hallucinations and delusions like schizophrenia.
Depressive episodes are the low points residing on the other end of bipolar disorder. The criteria for bipolar depression are a bit higher than mania. Here, a depressive episode needs to include five or more of these symptoms:
- Persistent, lingering feelings of sadness and a depressed mood
- A significant loss of interest in the activities you once enjoyed
- Marked changes in appetite or sleep — either eating or sleeping too much or too little
- Fatigue or a loss of energy
- Restlessness or acting slower than usual
- Short attention span and difficulty concentrating or being decisive
- Feelings of pronounced worthlessness or guilt consumes
- Thoughts about death or suicide
In addition to psychosis, other bipolar symptoms, notes the Mayo Clinic, may include anxious distress, a combination of uncontrollable anxiety and fear, and melancholic feelings of sadness. Symptoms can often be mixed, with depression and mania co-occurring, or rapid cycling, where you experience at least four mood episodes within the last year, vacillating between mania, hypomania, and extreme depression.
How Is Bipolar Disorder Treated?
Bipolar treatment typically involves a combination of prescribed medication and psychotherapy, usually talk therapy.
Common medications may include mood stabilizers such as lithium or valproate, which can help prevent mood episodes, with lithium proven to lower suicide risk. The National Institute on Mental Health notes that antidepressants must be taken with a mood stabilizer; without one, it can trigger a manic episode or rapid cycling.
Regular talk therapy, such as cognitive behavioral therapy, or CBT, is effective in helping people with bipolar disorder identify and manage their symptoms, change their behaviors, shift their thought processes, regulate sleep-wake cycles, and develop new perspectives and coping mechanisms.
Therapy, including new kinds tailored for bipolar disorder, like interpersonal and social rhythm therapy (IPSRT) and family therapy, offers support, education, and guidance to people with bipolar disorder and those close to them.
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The Link Between Bipolar Disorder and Substance Abuse
Research from the Substance Abuse and Mental Health Services Administration finds that between 30 and more than 50% of people with bipolar disorder will develop a substance abuse problem sometime during their lifetimes.
This link can be attributed to the likelihood that bipolar sufferers may attempt to self-medicate their mood swings or cope with the emotional challenges that come with their disorder. Substance use — which can lead down the road to dependency and, ultimately, addiction — can exacerbate one’s symptoms and complicate efforts at treatment.
What Is Borderline Personality Disorder?
A borderline personality disorder is a mental illness characterized by a person’s inability to regulate and manage their emotions. The root of this personality disorder happens completely within the context of one’s relationships, according to the National Education Alliance for Borderline Personality Disorder (NEA BPD) — many relationships may be impacted, sometimes just one.
With bipolar disorder, one’s mood shifts are driven by manic and depressive episodes, but these swings are sustained for longer periods, and most importantly, they’re not reactive as those in people with borderline personality disorder, often easily triggered into inappropriate, aggressive behavior
Borderline personality order statistics show the personality disorder’s predominance in its effects on sufferers. According to the NEA BPD:
- Borderline personality disorder affects 1.6% of American adults (about 14 million people) at some point in their lifetimes
- Alzheimer’s disease patients are affected by borderline personality disorder nearly 50% more
- It affects nearly as many people as schizophrenia and bipolar disorder combined or 2.25%
- 20% of patients in psychiatric hospitals are diagnosed with borderline personality disorder
- The disorder also impacts 10% of those seeking outpatient mental health treatment
How did the term “borderline” originate for this disorder? The NEA BPD says that it was coined because the condition was deemed situated right on the borderline of psychosis and neurosis. This has garnered some very negative connotations over the years, so the education alliance stipulates that the disorder’s name is strictly a term for diagnosis and not meant to judge people with it.
What Are the Symptoms of Borderline Personality Disorder?
Borderline personality disorder plays a prominent role in how one perceives themselves and others and their behavior. Signs and symptoms of borderline personality can manifest themselves in various combinations and range in severity:
- Intense and unstable relationships: A common hallmark of people with borderline personality disorder is their tendency toward unpredictably changing their opinions of others in an abrupt, dramatic fashion — called splitting, this idealization of someone (thinking they are “the one”), then quickly devaluing them (convincing themselves the person is uncaring or has wronged them), characterizes a pattern of volatile emotions and intense, unstable relationships for people with borderline personality disorder.
- Fear of abandonment: Related to relationship instability, it’s common for a person with borderline personality disorder to feel discomfort in being alone, and they may respond to this neglect, even if this fear is only perceived, with anger or fear, often going to extreme, frantic lengths to avoid abandonment by another person. This may mean pushing the person away, stopping them from leaving or stalking behaviors to track their every move.
- An unstable self-image: It’s not uncommon for people with borderline personality disorder to also have a distorted or constantly shifting sense of self. They may feel shameful or guilty about themselves or feel they don’t really exist, which can compel them to carry out destructive or unpredictable behaviors, perhaps in an attempt to punish themselves, like abruptly changing their image, goals, opinions, or social circle, or quitting a job or sabotaging a relationship.
- Self-harm or suicidal ideation: An unhealthy self-image may lead one with borderline personality disorder to physically harm themselves or think about or attempt suicide. These actions are believed to be triggered by real or perceived rejection, abandonment, or disappointment in a significant other or romantic partner.
- Impulsive behaviors: Engaging in highly risky and self-destructive behaviors, such as substance abuse, reckless driving, binge eating, excessive spending, unsafe and/or promiscuous sexual activity, and self-harm are other common symptoms.
- Intense emotional reactions: Rapid, extreme mood swings are part and parcel of borderline personality disorder. Severe emotional dysregulation — uncontrollable, inappropriate, and intense fits of anger (and difficulty calming down after emotional upset), plus fear, anxiety, hatred, but even happy, positive emotions like love — typify the highs and lows shared by borderline personality and bipolar disorders.
- Transient, stress-related paranoid ideation or severe dissociative symptoms: According to the Mayo Clinic, these periods of loss of contact with reality may last anywhere from a few minutes to a few hours.
How Is Borderline Personality Disorder Treated?
Though it’s proven challenging to treat, the most effective personality disorder treatment for borderline personality disorder is psychotherapy.
Dialectical behavior therapy (DBT) is considered the gold standard treatment for borderline personality disorder and, in fact, was developed specifically for people suffering from it. DBT focuses on becoming mindful and accepting of the reality of one’s life, plus teaching to develop skills in emotional regulation, improving interpersonal relationships, and curbing behaviors destructive to the self and to others.
CBT has also proven effective in treating borderline personality disorder because, much like DBT, it compels patients to obtain a better, clearer understanding of their behaviors and the root of them, and how to take the tangible steps to unlearn negative behaviors and develop new ones.
Some medications may also be used to address specific or co-occurring symptoms, such as depression, anxiety, impulsivity, or mood swings, but medication alone is not considered an effective main treatment for borderline personality disorder.
The Link Between Borderline Personality Disorder and Substance Abuse
Not dissimilar to bipolar disorder, individuals with borderline personality disorder have a high likelihood of engaging in drug or alcohol use. Studies show that a staggering 78% of people with the disorder will develop a substance-related disorder or addiction. The intense emotions, impulsivity, and difficulty with emotional regulation as symptoms can increase the risk of using substances as part of one’s tendency for self-destructive behaviors — in turn, worsening borderline personality disorder symptoms.
Bipolar Disorder vs Borderline Personality Disorder: Similarities and Differences
Both disorders can be confused due to some basic symptomatic similarities. “This partial similarity in mood shifts, going from an extremely high mood to a very low mood, causes many people, including some clinicians, to confuse the two disorders,” says Dr. Frank Yeomans, director of training at the New York-Presbyterian Borderline Personality Disorder Resource Center, in a 2022 interview with a hospital publication.
Despite the overlap, recognizing the differences between bipolar disorder and borderline personality disorder is imperative for successful mental health treatment.
between the two include mood changes and instability, impulsivity, anger, suicidal ideation, harmful behavior, and delusions.
However, the differences between bipolar and borderline personality disorders are distinct.
- Bipolar involves distinct episodes of mania/hypomania with hallucinations and depression, often separated by stable periods, symptoms not seen very much in borderline personality disorder.
- Psychosis is more common in bipolar disorder, not in borderline.
- An intense fear of abandonment is a core feature of borderline, not typically seen in bipolar disorder.
- Both disorders are easy to confuse, especially borderline with bipolar disorder II, due to less intense manic episodes between the two.
- Intense, sometimes toxic relationships in tandem with a fear of abandonment are more common in borderline, not bipolar.
- Although suicidal ideation is common in both disorders, people with borderline personality disorder are more likely to engage in self-harm without attempting suicide.
- In bipolar disorder, insomnia and disrupted sleep patterns are more commonplace.
The Importance of Mental Health Treatment
Making mental health a priority is important for anyone, even more so if you or someone you love may be showing signs and symptoms of bipolar disorder vs bipolar disorder. Mental health treatment can help you pave new inroads to your well-being by equipping you with the tools and support needed to understand the root of bipolar or borderline personality disorders, manage your symptoms, improve your relationships, create new ones, and lead a better, more fulfilling life.
Bipolar Disorder and Borderline Personality Disorder Treatment Options
At one of Footprints to Recovery’s treatment centers, we can treat both conditions, even if they co-occur together. Our team of therapists offers a full continuum of care, including behavioral therapy and addiction treatment, for anyone who needs it.
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Mental Health Treatment Professionals
Our staff in Illinois, Colorado, and New Jersey are proud to align themselves as Hope Instillers, Confidence Builders, and Recovery Connoisseurs with a mission, first and foremost, to help others in need and those struggling with an addiction mood or personality disorder. From mental health and substance abuse treatment to dual diagnosis care, don’t hesitate to reach out to us at Footprints to Recovery for help — because recovery is possible with the right support and treatment.
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- Bipolar disorder – Symptoms and causes – Mayo Clinic
- An Introduction to Bipolar Disorder and Co-Occurring Substance Use Disorders
- Bipolar Disorder – National Institute of Mental Health (NIMH)
- Bipolar Disorder (Manic Depression): Symptoms & Treatment
- BPD OVERVIEW | National Education Alliance for Borderline Personality Disorder
- Borderline Personality Disorder: Causes, Symptoms & Treatment
