Borderline personality disorder vs bipolar disorder: the two mental health conditions are often confused. Both are similar in the sense that they cause symptoms of impulsivity and mood swings. However, how they affect your daily life and how they should be treated are anything but the same.

What is Bipolar Disorder?

Sometimes referred to as manic depression, bipolar disorder is categorized by changes in energy/mood and your ability to function throughout daily responsibilities. People with bipolar will experience both manic and depressive episodes, each of which comes with their own set of symptoms: ¹

Manic Symptoms

• Being “jumpy” or “wired”
• Feeling very “up” or “high”
• Lack of sleep (potentially insomnia)
• Loss of appetite
• Participating in reckless activity
• Racing thoughts
• Sense of importance (or power)
• Talking very fast about a lot of different topics
• Unreasonable self-confidence

Depressive Symptoms

• Difficulty concentrating
• Feeling very “sad,” “down,” “hopeless,” and “empty”
• Inability to perform simple tasks
• Increase in appetite (potential weight gain)
• Loss of interest in activities you once enjoyed
• Restlessness
• Slow talking (forgetting a lot)
• Suicidal ideation
• Trouble falling to sleep

Unlike personality disorders, bipolar symptoms will not appear due to an interpersonal conflict. Rather, they will present themselves in intervals, lasting for days to weeks to months. ²

How is Bipolar Disorder Treated?

Since bipolar disorder is a lifelong condition, treatment needs to be consistent. This usually involves: ³

Medication

• Antidepressants
• Antipsychotics
• Mood stabilizers

Psychotherapy

• Cognitive behavioral therapy (CBT)
• Family-focused therapy
• Interpersonal and social rhythm therapy (ISRT)
• Psychoeducation

Furthermore, some people find relief from several holistic treatments and all-natural medicines, such as black cohosh.

What is Borderline Personality Disorder?

Similar to bipolar disorder, borderline personality disorder (BPD) is characterized by continuous patterns in mood and behavior that can lead to impulsive actions. However, it also incorporates self-image issues and causes problems in relationships. ⁴

People with BPD are likely to have their interests and convictions change rapidly due to their view of themselves. In turn, their beliefs may be extreme, whether good or bad. For example, a person seen as a friend one day may become an enemy the next.

BPD symptoms include:

• Abandonment issues (avoiding real or imagined abandonment)
• Anger issues
• Distorted sense of self
• Extreme changes in beliefs and moods
• Feeling of emptiness
• Impulsive behaviors
• Intense and unstable relationships
• Suicidal ideation and self-harming behaviors
• Trust issues

Unlike bipolar disorder, BPD symptoms are triggered by an interpersonal conflict. However, these conflicts may appear to be insignificant to those around them. For example, a brief moment without a loved one may lead someone to have a BPD episode.

How is BPD Treated?

Also different from bipolar disorder, BPD is much more difficult to treat. There are new and evidence-based treatments that are effective in leaving someone with fewer or less intense symptoms. These treatments are mostly made up of the following psychotherapies: ⁵

• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)

While there are no medications for BPD, some psychiatrists may make prescriptions to help manage specific symptoms, such as mood swings, depression, or co-occurring mental disorders.

BPD Misdiagnosed as Bipolar

BPD often looks like bipolar disorder and vice versa. While these mental health conditions aren’t necessarily independent of one another (for they do retain similar symptoms), a misdiagnosis may lead a psychiatrist to improperly treat your condition.

In one study, it was revealed that 40% of people who met the diagnosis criteria for BPD but not bipolar disorder were still misdiagnosed with Bipolar Type 2. ⁶ This was due to an overlap in symptoms, such as impulsivity, intense emotions, and suicidal ideation.

BPD may also be misdiagnosed as anxiety, depression, eating disorders, post-traumatic stress disorder (PTSD), and a substance use disorder.

Mood Disorder vs Personality Disorder

To further differentiate bipolar from BPD, it can help to understand the difference between a mood disorder vs. a personality disorder.

• Mood disorders are a person’s relationship with their emotions and how they handle them. Examples include bipolar disorder, depression, dysthymia, and seasonal affective disorder (SAD). ⁷

• Personality disorders are a pattern of thoughts, beliefs, and behaviors that aren’t normal. These patterns will vary depending on a person’s personality. Examples include obsessive-compulsive personality disorder, borderline personality disorder, and schizoid disorder. ⁸

While symptoms between the two conditions may be similar, how a person handles those symptoms will differ. Therefore, treatment for each disorder also varies.

Can You Have Bipolar and BPD?

Yes. While you need to be aware of the differences between bipolar and BPD, there is a chance you can have a dual diagnosis. To clarify whether you do or not, you must show signs unique to both bipolar and BPD:

Unique Symptoms of Bipolar Disorder:

• Depressive symptoms within your manic episodes (also referred to as a “mixed episode”)
• Manic episodes which cause euphoric and “high” feelings
• Troubles with the quality and quantity of sleep you receive

Unique Symptoms of BPD:

• Anger issues (intense and sometimes uncontrollable)
• Daily emotional changes triggered by relationships or other stressors
• Feelings of boredom and emptiness
• Intense relationships where you’re unable to regulate emotions
• Self-harming behaviors (i.e. cutting, burning, hitting, injuring yourself)

Which is Worse: Bipolar or BPD?

Each condition comes with its own set of difficulties. Therefore, one isn’t worse than the other. Whether you have BPD, bipolar disorder, or both, it’s important to receive the proper treatment to manage emotions.

Final Word

While BPD and bipolar disorder have a lot of similarities, their key differences require varying treatment methods. If you’ve been diagnosed with one and believe you struggle with the other, it’s important to note these concerns with your healthcare provider.

References

¹ Jain A, Mitra P. Bipolar Disorder. 2023 Feb 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644424.

² Sani G, Simonetti A, Reginaldi D, Koukopoulos AE, Del Casale A, Manfredi G, Kotzalidis GD, Girardi P. Free Interval Duration: Clinical Evidence of the Primary Role of Excitement in Bipolar Disorder. Curr Neuropharmacol. 2017 Apr;15(3):394-401. doi: 10.2174/1570159X14666160607085851. PMID: 28503111; PMCID: PMC5405609.

³ Nierenberg AA, Agustini B, Köhler-Forsberg O, Cusin C, Katz D, Sylvia LG, Peters A, Berk M. Diagnosis and Treatment of Bipolar Disorder: A Review. JAMA. 2023 Oct 10;330(14):1370-1380. doi: 10.1001/jama.2023.18588. PMID: 37815563.

⁴ Chapman J, Jamil RT, Fleisher C, Torrico TJ. Borderline Personality Disorder. 2024 Apr 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 28613633.

⁵ Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What Works in the Treatment of Borderline Personality Disorder. Curr Behav Neurosci Rep. 2017;4(1):21-30. doi: 10.1007/s40473-017-0103-z. Epub 2017 Feb 3. PMID: 28331780; PMCID: PMC5340835.

⁶ Ruggero CJ, Zimmerman M, Chelminski I, Young D. Borderline personality disorder and the misdiagnosis of bipolar disorder. J Psychiatr Res. 2010 Apr;44(6):405-8. doi: 10.1016/j.jpsychires.2009.09.011. Epub 2009 Nov 3. PMID: 19889426; PMCID: PMC2849890.

⁷ Sekhon S, Gupta V. Mood Disorder. 2023 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644337.

⁸ Newlin E, Weinstein B. Personality disorders. Continuum (Minneap Minn). 2015 Jun;21(3 Behavioral Neurology and Neuropsychiatry):806-17. doi: 10.1212/01.CON.0000466668.02477.0c. PMID: 26039856.