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Borderline Personality Disorder vs. Bipolar Disorder

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Borderline personality disorder (BPD) and bipolar disorder are very different mental health issues. In fact, they are in separate categories of mental health problems. BPD is a personality disorder that primarily affects your thinking and behavior. Bipolar disorder is a mood disorder that primarily affects your mood, energy levels, and feelings. Still, both of these issues come with some common symptoms. They both can cause extreme shifts in behaviors. Bipolar disorder causes extreme moods, which can lead to isolation, low energy, and sadness for a few weeks and then a week of high energy, talkativeness, and being generally outgoing. 

BPD can cause similar shifts related to interpersonal relationships. If you know someone with BPD, you may have a combative relationship with them one day, and they may be very warm, friendly, and excited to be with you another day. These shifts can sometimes lead people to confuse the two issues.

Both disorders can also come with periods of depression. In some cases, both can cause severe depression and suicidal thoughts, expressions, or behaviors. They can both cause delusional thinking. BPD often causes paranoid delusions, while bipolar disorder usually involves delusions of grandeur. 

The timelines, specific symptoms, and the reasons behind certain behaviors may be distinct. People with BPD tend to focus on a fear of abandonment and impulsive thoughts and actions, while people with bipolar disorders are driven by extreme moods and energy levels.

Learn more about these two disorders and how they are diagnosed.

What is Borderline Personality Disorder?

Borderline personality disorder is a mental health issue characterized by feelings of emptiness, unstable emotions, and fear of abandonment. People with borderline personality often find themselves estranged from friends and family members after a period of unstable or contentious interpersonal relationships. You may find it hard to connect with other people in healthy ways due to angry outbursts, anxiety about abandonment, and extreme changes in your feelings for others. However, isolation often feeds into fears and anxiety about abandonment.

Borderline personality disorder can also cause impulsivity, which can cause you to make hasty decisions, engage in risky behaviors, and take potentially dangerous actions. Examples of this impulsive behavior can include reckless driving, risky sexual practices, overspending, or binge drinking. Impulsivity may also contribute to your difficulty controlling outbursts of anger. In some cases, you may experience frightening but imagined abandonment, paranoia, and dissociative episodes. These distressing symptoms may come and go.

Borderline personality disorder can also cause depression, thoughts of suicide, and self-harm. If you start to have increasing thoughts of death or suicidal thoughts, it’s important to speak to someone right away.

How is Borderline Personality Disorder Diagnosed?

When you speak to a doctor or mental health professional about your mental health symptoms, they may use a diagnostic tool called the Diagnostic and Statistical Manual of Mental Disorders which is currently in its fifth edition and also called the DSM-5. According to the (DSM-5), there is a list of nine common symptoms of BPD. If you experience five of them, you may be diagnosed with the disorder. Here are the nine common symptoms:

  • Chronic feelings of emptiness
  • Unstable emotions including sadness, irritability, and anxiety
  • Fear and avoidance of abandonment, whether real or imagined
  • Unstable self-image or a skewed sense of self
  • Impulsivity causing risky or reckless behaviors
  • Inappropriate and intense bursts of anger
  • Unstable or contentious personal relationships
  • Suicidal threats, behavior, or self-harm
  • Paranoia or dissociative episodes
borderline-personality-disorder-vs-bipolar-disorder

What is Bipolar Disorder?

Bipolar disorder is a mental health disorder that’s characterized by extreme moods. It’s in a larger category of mental health issues called mood disorders along with depression. Bipolar disorder is often thought of as sudden shifts between moods. While it does involve mood shifts, you may spend several weeks in a depressed mood before returning to normal for a while and then experiencing an extremely high mood. It’s less defined by the speed of a mood shift and more defined by the extremes of the moods you may experience. A very high mood is called a manic episode, while a depressed mood is major depression. Bipolar disorder can also involve more mild mood extremes like mild depression and hypomania.

Major depressive episodes are similar to the ones a person with major depressive disorder might feel. You may feel hopelessness, fatigue, lethargy, loss of interest in activities, isolation, and guilt. A manic phase is sometimes thought to be the upside of bipolar disorder because it usually involves a high mood. However, mania can come with serious consequences. Some people also experience anxiety or agitation during a manic episode that can be unpleasant. Most people feel embarrassed by the things they said or did once mania wears off. Manic episodes can cause you to make rash decisions, risky business moves, or frivolous purchases that can negatively impact your life. In some cases, severe mania can cause hallucinations or delusions like a psychotic disorder. 

How is Bipolar Disorder Diagnosed?

Bipolar disorder is diagnosed in two major types: Bipolar I and Bipolar II. These types are defined by the experience you have with manic episodes. There are other types that involve less severe moods that don’t qualify as type I or type II. Both manic major depressive episodes are identified by a set of symptoms. According to the fifth edition of the DSM, to qualify as a full manic episode, you have to experience three of seven common symptoms. These symptoms must last for one week or require hospitalization. The symptoms include:

  1. Grandiosity or increased self-esteem
  2. A decreased need for sleep (feeling rested after just three hours)
  3. Increased talkativeness and the pressure to keep talking
  4. A flight of ideas and racing thoughts
  5. Distractibility, drawing your attention to irrelevant stimuli
  6. Increased activity or psychomotor agitation
  7. Risky behaviors that may lead to consequences 

Experiencing fewer than three of these symptoms or experiencing them briefly may qualify as a hypomanic episode, mild mania that falls short of a full-blown manic episode. A major depressive episode also has a set of symptoms in the DSM. To qualify as a major depressive episode, you must experience five of nine common symptoms, which include:

  1. Depressed mood
  2. Loss of interest in hobbies or activities
  3. Significant and unintentional weight loss or gain
  4. Sleep disturbances
  5. Slowed or agitated psychomotor changes 
  6. Low energy or fatigue
  7. Worthlessness or excessive or inappropriate guilt
  8. Impaired cognitive functioning like concentration and decision making
  9. Thoughts of death and suicidal ideation

In addition to experiencing five of these symptoms, one of them must be either a depressed mood or a loss of interest in regular activities to qualify as a major depressive episode. Both mania and major depressive episodes can’t be better explained by other things like other mental health issues or drug use. 

Bipolar I

Bipolar I is defined by the occurrence of at least one manic episode. If you experience a full manic episode, it qualifies you as having bipolar I disorder, even if you haven’t experienced depression. However, it’s also common for people with bipolar I to experience periods of low moods that last for two weeks. 

Bipolar II

If you have bipolar II, you’ll experience a major depressive episode that lasts for two weeks. But you won’t experience a full manic episode. Instead, you’ll experience hypomania, which isn’t as severe as full-on mania. You may experience fewer mania symptoms, and the ones you feel won’t require hospitalization.

Cyclothymia 

Cyclothymia is related to bipolar disorder but it doesn’t meet the criteria for either bipolar I or bipolar II. You may experience hypomania and mild depressive episodes. While these episodes aren’t as extreme as bipolar disorder, these symptoms may be distressing, requiring treatment. 

Getting the Right Diagnosis

Mental health issues are complicated, and getting the right diagnosis can be a challenge. When you’re experiencing distressing mental health issues, finding the right diagnosis is important in getting the right treatment for your needs. When you’re seeking help with a mental health issue, you can start by talking to your regular doctor. Tell them what you’ve experienced, and make an effort to mention each of your symptoms and a rough timeline of when they occur. Mental health issues can have unique but overlapping sets of symptoms. A diagnosis may also require experiencing these symptoms for a certain amount of time. 

It may help to make a note of your symptoms and the timeline that they occur before you see your doctor. Your doctor may suggest prescribing medication to see if that clears up your symptoms. You can also request more tests to explore the problem further if they don’t suggest ordering tests themselves. It’s important to go through a physical exam and lab tests, even though you’re looking for a mental health diagnosis. There are diseases, disorders, and deficiencies that can cause some mental health symptoms that can be found in these tests. Getting a diagnosis like bipolar or borderline personality disorder will mean ruling out other possibilities.  

You should also go through a psychological evaluation, which can give doctors or mental health professionals a better idea about any potential mental illnesses. If your condition is moderate to severe, you may explore inpatient or outpatient treatment options or your doctor may suggest a range of medications or therapy options. 

Sources

National Institute of Mental Health. (2018, February). Depression. from https://www.nimh.nih.gov/health/topics/depression/index.shtml

National Institute of Mental Health. (2020, January). Bipolar Disorder. from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

National Institute of Mental Health. (2018, July). Anxiety Disorders. from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

MayoClinic. (2019, July 17). Borderline personality disorder. from https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237#:~:text=Borderline%20personality%20disorder%20is%20a,a%20pattern%20of%20unstable%20relationships

Substance Abuse and Mental Health Services Administration. (2016). Table 12, DSM-IV to dsm-5 Bipolar i Disorder comparison – Dsm-5 changes – Ncbi bookshelf. from https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t8/

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