Think of your emotions as the weather.
For those with bipolar disorder, emotions often feel like entire seasons– long periods of summer-like mania followed by a deep, dark, and winter-like depression.
For those with borderline personality disorder, emotions often feel like unpredictable storms rolling in and out– sudden and extreme weather that often only lasts for hours.
Both mental health conditions involve incredibly intense emotions, but the causes, patterns, and treatment plans are significantly different.
More notably, these two disorders are frequently confused– leading to misdiagnosis, incorrect treatment, and distress.
Iremia Psychiatric Care knows how challenging these mental health conditions can be. We provide expert diagnosis and patient-centered care to make sure you get the treatment you need.
Keep reading to learn:
- Key differences between bipolar and borderline personality disorders
- Why they’re often mistaken for each other
- What to do next if you are unsure you’ve received the right diagnosis
Whether seeking relief for yourself or supporting someone else, understanding the differences and getting the correct diagnosis is the first step toward effective care.
What’s the Difference: Bipolar Disorder vs Borderline Personality Disorder
Bipolar disorder is a mood disorder characterized by periods of extreme mania (high energy, impulsivity, and sometimes delusions) and deep depression (sadness, hopelessness, and low energy). These mood shifts last for more extended periods and often occur in cycles.¹
Bipolar disorder can be broken down even further into two types – type I and type II. Bipolar I Disorder is characterized by manic episodes that last at least seven days or are severe enough to require hospitalization. These manic episodes alternate with depressive episodes.
On the other hand, Bipolar II Disorder, instead alternates between hypomanic episodes and episodes of major depression. These hypomanic episodes are similar to manic episodes but aren’t as severe and long-lasting.
Borderline personality disorder is a personality disorder that affects emotional regulation, self-image, and relationships. Emotional shifts occur rapidly and are often triggered by an external event, stress, or perceived abandonment.²
Both conditions involve unstable emotions and impulsivity, but they stem from very different causes. So why are they often misdiagnosed?
- The cycling moods of bipolar disorder often resemble the emotional instability of borderline personality disorder.
- Borderline personality disorder’s depressive states and emotional reactivity often look like bipolar disorder’s depressive and manic cycles.
Distinguishing between the two can be difficult without expert insight into the timing and triggers of mood shifts. An accurate diagnosis is essential because it ensures you receive the personalized treatment you need for your condition.
How Do Mood Swings and Emotions Differ in Borderline Personality Disorder and Bipolar Disorder?
People with bipolar disorder have depressive and manic feelings that can last for days, weeks, or more and often have a cyclical pattern. There may or may not be a specific trigger that causes a manic or depressive cycle. Here are some things to watch for:
- Episodic and cycling mood shifts are key signs of this condition.
- Impulsive behaviors generally occur during manic episodes.
- Relationships are often strained through grandiose plans, impulsive actions, and overly social behaviors in manic states– while depressive cycles lead to isolation and withdrawal.
People with borderline personality disorder have intense emotional shifts that occur more rapidly– within minutes or hours. They occur in response to an external stressor, like a sense of rejection or conflict. Here are some emotions and behaviors to look out for:
- Persistent emotional instability, plus extreme sensitivity and reactivity to stress define this condition.
- Impulsive behaviors are linked to fear of abandonment and emotional stress.
- Relationships are strained due to emotional lability. An individual may quickly swing from extreme attachment to intense outbursts where loved ones are pushed away.
Emotional Dysregulation in Bipolar Disorder vs Borderline Personality Disorder
Now, let’s touch on one additional common experience with both mental health disorders– emotional dysregulation. Emotional dysregulation is when someone has a hard time controlling and responding to their emotions. From the outside, emotional responses appear excessive, dramatic, or outside of social norms– but these responses are incredibly real and valid to those experiencing them.
- In bipolar disorder, emotional dysregulation occurs during episodes of mania and depression. In a manic cycle, emotions are overly euphoric or irritable. While in a depressive cycle, emotions are overwhelmingly sad or detached.
- In borderline personality disorder, emotional dysregulation occurs more rapidly and is in response to a sense of rejection, conflict, or criticism. Emotion and mood change quickly and occur in response to external stressors.
What Causes Bipolar Disorder and Borderline Personality Disorder?
Bipolar disorder and borderline personality disorder have different causes. Looking at their causes is a key factor in determining the correct diagnosis.
Causes of Bipolar Disorder
- Bipolar disorder is strongly linked to genetics. Having a family history of bipolar disorder increases the risk of getting the condition.
- Imbalances in brain chemicals can cause bipolar disorder– neurotransmitters regulate emotions, mood, and behavior, and mental health conditions can arise when these brain chemicals are imbalanced.
- Environmental factors such as substance abuse, stress, and trauma can trigger bipolar episodes, but they do not cause the illness itself.
Causes of Borderline Personality Disorder
- Borderline personality disorder is strongly linked to early childhood neglect, trauma, or unstable relationships.
- Attachment issues often cause borderline personality disorder. If a child is unable to form a healthy attachment or trust with their primary caregivers, borderline personality disorder is more likely to develop.
- Trauma and environmental factors tend to have the most significant impact on developing borderline personality disorder, but genetics and neurochemicals can also play a part.
The Symptoms of Bipolar Disorder vs Borderline Personality Disorder
Both mental health conditions share similarities but also have critical differences. Here are some common symptoms and how they differ between bipolar disorder and borderline personality disorder:
Symptom | Bipolar Disorder | Borderline Personality Disorder |
Mood swings | Last days to weeks | Last minutes to hours |
Impulsivity | During manic episodes | Frequent and ongoing, tied to emotional distress |
Manic behavior | During manic cycles- high energy, risky behavior | Not present, however extreme reactivity can mimic a manic cycle |
Depression | Deep sadness, loss of interest, fatigue | Brief but intense emotional lows associated with a stressor |
Relationship problems | Often strained due to manic and depressive mood cycles | Often strained and unstable due to reactivity and fear of abandonment |
Self-harm or suicidal thoughts | Possible during depressive cycles | Associated with impulsive episodes |
Diagnosing Bipolar Disorder vs. Borderline Personality Disorder: How Do Providers Tell the Difference?
Mental health professionals refer to the Diagnostic and Statistical Manual of Mental Illnesses (DSM-5) criteria to differentiate between these two illnesses.
A thorough evaluation is also needed and includes a comprehensive medical history, psychiatric assessment, symptom tracking, and oftentimes input from family or close friends.
Diagnosing Bipolar Disorder
The diagnosis of BP is determined by distinct manic and depressive cycles that last for days to weeks or more. Identifying cyclical mood episodes is critical to a bipolar disorder diagnosis.
Diagnosing Borderline Personality Disorder
The diagnosis of borderline personality disorder is based on consistent emotional instability, fear of abandonment, and extreme reactivity and impulsivity. Identifying chronic mood instability is the key to making a borderline personality diagnosis.
How Common is Misdiagnosis?
The statistics are startling.
One study shows that up to 40% of people who meet the criteria for borderline personality disorder are misdiagnosed with bipolar disorder!³
Here’s why misdiagnosis is so common:
- Overlapping symptoms such as emotional instability, mood changes, dysregulation, impulsivity, and suicidal thoughts occur with both diagnoses.
- Bipolar disorder cycles can sometimes occur quickly and resemble borderline personality disorder.
- The extreme lability of borderline personality disorder may look like the manic cycle of bipolar disorder.
- Stigma surrounding personality disorders often causes them to be misdiagnosed or undiagnosed– even by professionals.
Can You Have Bipolar Disorder And Borderline Personality Disorder At the Same Time?
It’s possible to be diagnosed with both of these mental health disorders. This is called comorbidity, or having two diagnoses at the same time, and it can complicate diagnosis.
Evaluation by a skilled, experienced, and patient-centered mental health clinician is the best way to ensure a correct diagnosis – especially if you’re found to have both bipolar disorder and borderline personality disorder. Effective treatment only begins once the proper diagnosis is made.
Treatment for Bipolar and Borderline Personality Disorder: What Works Best?
Now, let’s learn about effective treatment options. There’s one main difference between the two– bipolar disorder often requires medication, and borderline personality disorder responds best to intensive therapy. Here’s what you can expect:
Treatment Options for Bipolar Disorder
Psychiatric medications are essential for people with bipolar disorder because it’s caused by imbalances in neurotransmitters. Medication is the most effective way to regulate these important brain chemicals. Common bipolar disorder medications include:
- Mood Stabilizers: Lithium and Valproate
- Antipsychotics: Olanzapine and Quetiapine
- Antidepressants: Sertraline, Bupropion, and others.
Treatment For Borderline Personality Disorder
Therapy is the gold standard and primary treatment for people with borderline personality disorder. This illness is caused by traumatic experiences, abuse, or neglect in early childhood. And therapy is the most effective way to learn tools to regulate emotions and improve relationships.
Here are some of the types of therapy used to treat borderline personality disorder:
- Dialectical Behavior Therapy (DBT): Helps in learning to regulate and manage emotions before becoming overwhelmed.
- Cognitive Behavior Therapy (CBT): Assists in recognizing emotions plus changing how one thinks and responds to them.
- Psychotherapy: Teaches individuals how to change behaviors, solve problems, and improve mood.
Lifestyle changes can be incredibly helpful in managing both bipolar disorder and borderline personality disorder– keep reading to learn more practical tips.
Living with Bipolar and Borderline Personality Disorder: Tips for Managing Daily Life
There are plenty of simple and practical things you can do to manage your mental health diagnosis. Here are some of our favorites.
Tips for Living With Bipolar Disorder
- Follow your medication schedule and maintain a routine.
- Track your mood swings and cycles. Make sure to note any patterns or trends.
- Manage stress, prioritize sleep, and avoid any triggers that tend to come before a manic or depressive episode.
Tips for Managing Borderline Personality Disorder
- Practice using the skills you learn in therapy to regulate your mood and emotions.
- Incorporate mindfulness exercises into your daily life.
- Establish a healthy support system and relationships to lean on.
You can also consider joining a support group to surround yourself with people who “get it” and help to build positive and supportive relationships. We suggest:
- The Depression and Bipolar Support Alliance (DBSA) for bipolar disorder, and
- Emotions Matter for borderline personality disorder.
Managing a mental health condition can be challenging, but stability and relief are possible with the right treatment options and support. It’s important to seek professional help and stay committed to your medication or therapy schedule.
And remember – you aren’t alone. Iremia Psychiatric Care is here for you at each step of your journey.
Bipolar Disorder or Borderline Personality Disorder: Do You Have the Right Diagnosis?
When it comes to bipolar disorder and borderline personality disorder, misdiagnosis is unfortunately common. If you feel that your current treatment isn’t working or that your symptoms don’t match your diagnosis, it may be time to seek another opinion or reevaluation.
A personalized and thorough evaluation by a skilled mental health provider is critical. Misdiagnosis often leads to ineffective treatment, suffering, and stress. And we want to help you avoid this.
Need support? If you’re struggling with mental health symptoms or are seeking a second opinion, contact Iremia Psychiatric Care for a compassionate and individualized evaluation today.
FAQ: Bipolar Disorder vs Borderline Personality Disorder
What is the main difference between bipolar and borderline personality disorder?
The most important difference between bipolar disorder and borderline personality disorder is the timing and duration of symptoms. Bipolar disorder has cyclical mood episodes that last for days to weeks, and borderline personality disorder has rapid emotional shifts that last for a shorter period of time– minutes to hours.
What does untreated BPD look like?
Untreated borderline personality disorder (BPD) is incredibly difficult– whether you are experiencing it yourself or a loved one is. You will see frequent and intense emotions that are often caused by stress, conflict, or feelings of neglect. Relationship problems, extreme distress, and impulsive behaviors like reckless spending or self-harm can also occur.
What does a bipolar crash feel like?
A bipolar crash is what happens following a manic episode– it’s a period of extreme mental and physical exhaustion. You may feel extremely tired, hopeless, or depressed. It is often described as “hitting an emotional wall,” where your motivation and energy suddenly and completely disappear.
References:
- Bipolar Disorder — (nih.gov)
- Borderline Personality Disorder — (nih.gov)
- Borderline Personality Disorder and the Misdiagnosis of Bipolar Disorder — (nih.gov)