Bipolar Disorder vs. Borderline Personality Disorder (BPD): What’s the Difference?



What is Bipolar Disorder?


Bipolar disorder is a chronic mood disorder that typically presents earlier in life (late adolescence/early adulthood). There is a strong genetic component associated with bipolar disorder. Bipolar disorder is divided into 3 types: Bipolar I, Bipolar II, and Cyclothymic Disorder. (USDHHS, n.d.) To understand each one let’s explore the main symptoms of Bipolar Disorder.


Symptoms (Ghaemi, 2014):

● Mania: elevated mood with increase in energy and activity (May have psychotic features, require hospitalization)

○ Distractibility

○ Irritability

○ Inflated self esteem

○ Decreased need for sleep

○ Increased activity

○ More talkative than usual

○ Disturbance in mood, observed by others

○ Racing thoughts

● Hypomania: some features but less severe

● 3 out 7 for 1 week, every day or most of the day

● Highly recurrent


Types of Bipolar


Bipolar I:

● Defined by Manic Episodes

● Lasting for 7 days or more

● Can have psychotic symptoms


Bipolar II:

● Hypomania and depression

● Depressive episodes more severe in Bipolar II


Cyclothymic:

● Periods of hypomania as well as depressive symptoms

● Lasting at least 2 years ( 1year- children and adolescents)


Treatment: Mood stabilizers, antipsychotics, and therapy.



What is a personality disorder?

Your personality is essentially the emotional and behavioral traits that make you who you are. It should be predictable to those around you as you have shown consistent responses to situations and others have come to see and appreciate that (Ganti et al., 2016). To have a personality disorder would be to say that the way you respond to situations is consistently unhealthy or upsetting to those around you. You may not even see it and feel that all who you interact with are reacting unfairly to you. However, with focus and motivation anyone can improve upon their reactions and in return find more fulfillment in their social lives, work lives, and beyond.


Types of Personality Disorders

According to Ganti et al. (2016), personality disorders are broken down into 3 clusters. Those clusters are known as cluster A, B, and C.

  1. Cluster A:

○ Patient is withdrawn and eccentric or odd

○ Might be reclusive, have poor trust, or have strange superstitions/ bizarre religious ideas

  1. Cluster B:

○ Patient is overly emotional, dramatic, or self-involved

○ Patients have huge ranges of emotions that can cycle very quickly: they might go from excessive praise and

adoration of a person to extreme anger or sadness over seemingly small incidents

○ Those around them will often report that their reactions are very extreme and difficult to predict

  1. Cluster C:

○ Patient is worried or fearful about the world around them

○ Patient may do unexpected things in an effort to make life feel more comfortable such as let others make

their decisions for them or become overly focused on little details when assigned a big project


For the sake of this article, we’re going to focus on a common disorder that is often misunderstood: borderline personality disorder. Borderline personality disorder falls under Cluster B.


Borderline Personality Disorder


Borderline personality disorder (BPD) is a diagnosis given to people with unstable moods, behaviors, and interpersonal relationships (Ganti et al., 2016). Carlat (2017) describes a mnemonic label that can help a person see the main facets of BPD. The mnemonic is I DESPAIRR.


Identity disturbance (client isn’t clear about what sort of person they are)


Disordered, unstable affect (moods are reactive and change quickly)


Chronic feelings of Emptiness (client reports often feeling empty inside)


Recurrent Suicidal behaviors, gestures, threats, or self-harm


Stress-related Paranoid ideations or dissociative symptoms (client feels like people gang up on

him and/or he loses touch with himself when he’s stressed out)


Frantic efforts to avoid real or imagined Abandonment (may buy someone extravagant gifts or

write wordy letters of adoration if they feel like the person is pulling away)


Impulsivity that becomes self-damaging (spending, binge eating, sexual impulsivity, drug use)


Intense Rage that is inappropriate and difficult to control


Intense and unstable interpersonal Relationships (client rotates from loving and glorifying a

person to hating and villainizing them. May go back and forth several times with how they see the

same person)


The person with BPD will exhibit at least five of the above traits to get diagnosed. BPD is seen in up to 6% of the general population and is diagnosed three times more often in women than in men (Ganti et al., 2016). The treatment of choice is Dialectical Behavioral Therapy (DBT) where a person can immerse themselves in learning to identify their triggering behaviors and the benefits of acting and reacting in a healthier manner (Ganti et al., 2016).


Comparison Tables

Differences

Bipolar

Borderline

Duration of Mood Change

Weeks to months

Seconds to minutes

Causes

Genetics and brain chemistry

Environment, attachment, trauma, coupled with genetics

Triggers

Random, less related to events or relationships

Interpersonal conflict

Treatments

Best outcomes seen with mood stabilizing medications + therapy

Best outcomes seen from committing to therapy

Behaviors

Little to no sleep, erratic behaviors, or rapid speech when manic; depressed phases have classic sadness

Impulsive and unpredictable behaviors, intense reactions to small trigger

Similarities

Bipolar

Borderline

Suicidality/Self harm

Depression often precedes any attempt

Gestures, threats, and visible self-harm are common

Behaviors

Impulsiveness

Impulsiveness

Treatments

Benefit from therapy

Benefit from therapy

Outcomes

Treatable

Treatable


In summary, borderline personality disorder and bipolar disorder have unique traits but also common features among them, including options for treatment and hope for remission of symptoms.



Resources


Carlat, D. J. (2017). The psychiatric interview (4th ed.). Philadelphia: Wolters Kluwer.


Ganti, L., Kaufman, M. S., & Blitzstein, S. M. (2016). First aid for the psychiatry clerkship (4th ed.). New

York: McGraw-Hill Education.


Ghaemi, S. N., Dalley, S., Catania, C., & Barroilhet, S. (2014). Bipolar or borderline: A clinical overview.

Acta Psychiatrica Scandinavica, 130(2), 99–108. https://doi.org/10.1111/acps.12257

U.S. Department of Health and Human Services. (n.d.). Bipolar disorder. National Institute of Mental

Health. Retrieved June 13, 2022, from https://www.nimh.nih.gov/health/topics/bipolar-disorder

Zimmerman, M. & Morgan, T. A. (2013). The relationship between borderline personality disorder and bipolar

disorder. Dialogues in Clinical Neuroscience, 15(2), 155-169. DOI: 10.31887/DCNS.2013.15.2/mzimmerman









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