People sometimes confuse borderline personality disorder and bipolar disorder because they can have similar symptoms, such as intense emotional responses, depression, and impulsive behavior.
In this article, we discuss the primary differences between BPD and bipolar disorder, including the symptoms of each condition and the most common treatment options.
BPD is a type of personality disorder that causes people to feel, think, relate, and behave differently than people without the condition.
Bipolar disorder is a type of mood disorder, which is a category of illnesses that can cause severe mood changes.
People with BPD experience an ongoing cycle of varying self-image, moods, and behaviors.
These patterns typically cause issues that affect a person’s life and relationships and the way in which they understand and relate to others.
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Bipolar disorder affects a person’s mood, energy, thoughts, activity levels, and functionality in cycles that can last for days to months. It is more common than BPD and affects an estimated 2.6 percent of the population in the U.S.
People with BPD experience instability in their self-image, moods, and behavior. These symptoms can lead to impulsive actions and problems with interpersonal relationships.
Symptoms of BPD include:
- uncertainty about one’s role in the world
- frequently changing interests and values
- a tendency to view things as either all good or all bad
- changing opinions about others quickly, e.g., perceiving someone as a friend one day and an enemy the next
- a pattern of unstable, intense relationships with family and friends, for whom feelings alternate between closeness and love to hate and anger
- unstable, distorted self-image or sense of self
- attempts to avoid imagined or real sources of abandonment, e.g., stopping communications with someone in anticipation of them cutting off ties
- self-harming behaviors, such as cutting, burning, or overdosing
- difficulty trusting people, sometimes because of an irrational fear of their intentions
- feelings of dissociation, such as feeling unreal, having a sense of being cut off from one’s body, and seeing oneself from outside the body
- recurring thoughts of suicide
- impulsive or reckless behavior, such as unsafe sex, drug misuse, reckless driving, and spending sprees
- intense episodes of depression, anger, and anxiety
- chronic feelings of emptiness
- fear of being alone
Not everyone with BPD experiences all of these symptoms. Some people may have only a few minor symptoms, while others experience severe and frequent symptoms.
Stressful or emotional events can trigger some of the symptoms of BPD. To other people, these events may appear minor or disproportionate to the response that they generate.
People with bipolar disorder can experience extreme mood shifts. In many cases, people will alternate between highs (manias) and lows (depressions) with intervals of stable mood.
Some of the most common symptoms of mania include:
- extremely elevated mood
- reduced need for sleep
- an exaggerated sense of confidence and optimism
- racing speech, thoughts, or both
- reckless or impulsive behavior
- grandiose ideas
- inflated sense of self-importance
- irritability or aggression
- poor judgment
- hallucinations and delusions, in severe cases
Symptoms of bipolar depression include:
- constant fatigue
- feelings of worthlessness and guilt
- inability to concentrate or make simple decisions
- unexplained aches and pains
- prolonged periods of sadness
- unexplained crying spells
- significant changes in sleep patterns and appetite
- irritability, anger, and agitation
- indifference and pessimism
- excessive anxiety or worry
- inability to find pleasure in former interests
- social withdrawal
- thoughts of suicide and death
Not everyone with bipolar disorder will experience depression. In fact, experiencing a manic episode is the only requirement for a bipolar I disorder diagnosis.
People with bipolar II disorder can experience the symptoms of depressive episodes, but they have hypomania, which is a less severe form of mania.
Manic episodes usually last for at least 7 days, and they can sometimes be so severe that hospitalization is necessary. Depressive episodes often persist for at least 2 weeks.
Some people have rapid-cycling bipolar disorder and experience four or more mood episodes within a year.
To diagnose either bipolar disorder or BPD, a mental health professional will ask a person questions about their symptoms, including their severity and duration.
They will also ask about the person’s family medical history, specifically whether any of their relatives have or had a mental illness.
They may use questionnaires to acquire information about symptoms and symptom history.
A bipolar I diagnosis requires that someone has had at least one classic episode of mania that lasted for at least 7 days or required hospitalization.
People who experience a major depressive episode and an episode of hypomania may receive a diagnosis of bipolar II disorder.
In cases where it is challenging to distinguish BPD from bipolar disorder, a doctor may focus on specific symptoms to help differentiate between them. These symptoms include:
- Sleep: People with bipolar disorder tend to have extremely disturbed sleep cycles during periods of mania and depression. People with BPD can have a regular sleep cycle.
- Cycling mood time: Aside from those with rapid-cycling bipolar disorder, people with bipolar disorder tend to have mood cycles that last for weeks to months. People with BPD usually have sudden, short-lived mood shifts that last for a few hours or days.
- Self-harm: According to some estimates, 75 percent of people with BPD have self-harmed. They may see self-harm as a means of emotional regulation or a way to control unstable or intense emotions. Although self-harm is less common in people with bipolar disorder than those with BPD, the suicide attempt rate is higher.
- Unstable relationships: Many people with BPD have very intense, conflict-riddled relationships. People with bipolar disorder may have difficulty maintaining relationships because of the severity of their symptoms.
- Mania: People with bipolar disorder act impulsively when they are experiencing a period of mania. People with BPD also tend to act impulsively, but this behavior is unrelated to mania.
Some additional information can help distinguish BDP from bipolar disorder, including:
- Family history: Mood disorders, such as bipolar disorder and depression, tend to run in families, although researchers have not yet identified a specific gene that is responsible. People with a close relative who has BPD also seem to have a higher risk of developing this condition.
- History of trauma: The cause of BPD remains unclear, but many people with this condition experienced trauma in their childhood or adolescence. Examples of trauma include abuse, abandonment, extreme adversity, unstable relationships in family life, and exposure to conflict.
It can take some time and patience to find the right treatment plan for both BPD and bipolar disorder.
Medication is not a standard treatment for BPD as its benefit is unclear, and there are no drugs that the U.S. Food and Drug Administration (FDA) have approved.
However, some medications may help manage certain symptoms, such as depression and anxiety, if they are present.
Psychotherapy, which may involve individual talk therapy or group therapy, is the most common treatment for BPD. Therapy can help teach people with BPD how to communicate and interact with others and how to express themselves.
Some examples of the type of psychotherapies that can help treat BPD include:
- Dialectical behavior therapy (DBT): Experts developed this method specifically for people with BPD. It revolves around ideas of acceptance and mindfulness, as well as being aware of and attentive to one’s current environment and emotional state. DBT may also help people reduce self-harm, improve relationships, and control intense emotions.
- Cognitive behavioral therapy (CBT): This type of therapy may help people recognize and change some of the core beliefs and behaviors that form their perception of the world. CBT may also help people with BPD learn how to interact better with others while reducing mood-related symptoms, anxiety, and self-harm.
Doctors usually recommend a combination of medications, psychotherapy, and lifestyle changes to manage bipolar disorder. Some of the treatment options for bipolar disorder include:
- Medications: Medications called mood-stabilizers can help balance mood highs and lows. Other possible medications include anticonvulsants, antipsychotics, and other medications.
- Psychotherapy: Many types of therapy, including CBT, can teach people with bipolar disorder to manage the challenges that their condition poses. Therapy can also help treat other mental health issues that can occur alongside the condition, such as anxiety, post-traumatic stress disorder (PTSD), and substance abuse.
- Self-management: People with bipolar disorder may be able to control their highs and lows by learning to recognize the early signs and patterns of mania or depression. On noticing symptoms, a person can call their doctor and possibly make changes to their therapy or medication regimens before the symptoms become so severe that hospitalization may be necessary.
- Complementary health approaches: Exercise, meditation, mindfulness, yoga, and other stress-relief techniques may improve the mental well-being of people with bipolar and help them cope with their symptoms.
BPD and bipolar disorder have some similar symptoms, but they are very different conditions. BPD is a personality disorder, and bipolar disorder is a mood disorder.
BPD can be challenging to treat. Research is ongoing to help develop new strategies to care for people with BPD and improve their quality of life.
It can take time to find the best medication and the right therapist, so it is vital to keep trying.
In general, a combination of medication and psychotherapy can be extremely effective for people with bipolar disorder. Additional tools, such as self-management and complementary health techniques, may also help reduce symptoms and improve overall mental health.
With effective treatment, people with bipolar disorder can often have extended periods without any symptoms.
People with BPD and bipolar disorder have a higher risk of thoughts of suicide than the general population.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.