Borderline Personality Disorder vs. Bipolar: Understanding the Difference

The debate between borderline personality disorder (BPD) and bipolar disorder is an ongoing one—people often interchange both conditions, even though they’re not the same. Symptoms like reckless behavior and varying moods occur in both conditions, which causes people to interchange them accidentally. Understanding their differences can help you treat and manage the right symptoms.

In this guide, you’ll learn the primary differences between BPD and bipolar disorder, whether it’s possible to receive a dual diagnosis, and what you can do to manage your symptoms.

What is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a mental health condition characterized by a long-term pattern of unstable interpersonal relationships, extreme mood swings, and severe emotional dysregulation.

BPD is a Cluster B personality disorder. People with Cluster B disorders are more likely to behave irrationally and erratically. BPD affects roughly 1 out of every 100 people in the United States [*].

Causes of Borderline Personality Disorder

While there is no singular cause of borderline personality disorder, a person may be more likely to develop it as a result of adverse childhood experiences. For example, neglect, physical abuse, and family loss can lead to BPD symptoms.

Other risk factors include the following:

• Having a parent also diagnosed with BPD
• Having a concurrent mental health condition, such as anxiety or depression

Symptoms of Borderline Personality Disorder

BPD symptoms range from moderate to severe. To be diagnosed with BPD, individuals must meet five out of nine criteria:

• Fear of abandonment: The individual might struggle to be alone and will go through extreme lengths to prevent someone from leaving them.
• Unstable interpersonal relationships: The individual may idealize or devalue others.
• Identity disturbances: The individual might feel “lost” or have an unhealthy sense of self.
• Impulsive behaviors: The individual might act recklessly, engage in substance use, or do things without thinking about the consequences.
• Suicidal ideation: The individual might speak openly about ending their lives.
• Mood changes: The individual might experience rapid mood swings lasting hours or days.
• Feelings of emptiness: The individual might perceive themselves as worthless.
• Intense anger: The individual might have intense anger outbursts and have a “short fuse.”
• Stress-related dissociation: The individual might feel “out of body” or become detached from their surroundings when they become stressed.

Treatment Options for Borderline Personality Disorder

The most effective treatment for borderline personality disorder is psychotherapy. Various psychotherapies applicable to BPD include cognitive-behavioral therapy (CBT), which is structured and goal-oriented. It can help individuals adopt healthier thought patterns [*].

Another option is dialectical behavior therapy (DBT), which equips individuals with life skills for managing symptoms. These skills might include grounding exercises, reciting affirmations, and cognitive restructuring. Regarding its efficacy, DBT is most effective for women with BPD who show parasuicidal behaviors [*]. In men, DBT has been shown to reduce symptoms such as self-harm, aggression, and depression.

Occasionally, experts might recommend group therapy to help individuals interact with others more positively. In line with this, they might employ mentalization-based therapy (MBT), which improves a person’s ability to interpret thoughts and feelings.

Sometimes, a psychiatrist will prescribe medications to manage symptoms like anxiety and depression. These medications might include selective serotonin reuptake inhibitors (SSRIs) to address depression symptoms or antipsychotics to manage paranoia and hallucinations [*].

What is Bipolar Disorder?

Bipolar disorder, once known as manic depression, is a mental health condition characterized by mood swings [*]. These mood swings can last anywhere between a few hours and several months.

There are different types and severities of bipolar disorder, including Bipolar I (manic episodes), Bipolar II (no manic episodes), and cyclothymic disorder (mild depression and hypomania).

Depending on your bipolar type, you might experience two kinds of episodes:

• Manic episodes: These episodes manifest as prolonged, elevated, or irritable moods and can significantly affect your emotions, thoughts, energy levels, and talkativeness. People in manic states might act recklessly or develop psychotic symptoms, such as delusions and hallucinations. People with Bipolar I are more likely to experience mania.
• Depressive episodes: These episodes involve low moods and can manifest in other symptoms like exhaustion, changes in appetite, and feelings of worthlessness. People with Bipolar II are more likely to experience depressive episodes.

Individuals with cyclothymic disorder are in a state of chronic instability. They might experience both manic and depressive episodes.

Causes of Bipolar Disorder

As with BPD, there is no singular cause of bipolar disorder, though risk factors can affect a person’s likelihood of developing it.

For example, there is a strong genetic component to bipolar disorder. A parent with bipolar disorder is likely to pass it down to a child—but this isn’t guaranteed.

Neurological changes, such as differences in brain structure, can increase the likelihood of developing bipolar disorder. Environmental factors like trauma and stress can also trigger manic or depressive episodes.

Symptoms of Bipolar Disorder

Bipolar I and II may manifest differently, and changing moods don’t always occur predictably. Some signs of manic episodes include the following:

• Excessive happiness or excitement (euthymia)
• Rapid speech and racing thoughts
• Recklessness and risk-taking behavior
• Increased impulsive behavior and poor judgment
• Psychosis, such as delusions or hallucinations
• Sudden mood swings

On the other hand, symptoms of depressive episodes include the following:

• Low energy and constant fatigue
• Sleep problems
• Overwhelming sadness and stress
• Uncontrollable crying and meltdowns
• Difficulty focusing and making decisions
• Changes in appetite
• Thoughts of death or suicide

Treatment Options for Bipolar Disorder

While bipolar disorder isn’t technically “curable,” there are healthy ways to manage symptoms. Most experts recommend a combination of psychotherapy and medications. Therapy types might include:

• Psychoeducation, wherein individuals learn more about the condition
• Interpersonal and social rhythm therapy (IPSRT), wherein individuals address biological and social concerns to stabilize their mood
• Family-focused therapy, wherein families undergo communication improvement training

A psychiatrist might also prescribe the following medications:

• Mood stabilizers
• Antidepressants
• Antipsychotics

Borderline Personality Disorder vs. Bipolar Disorder

While borderline personality disorder and bipolar disorder often have similar or overlapping symptoms, they are separate diagnoses [*].

For example, BPD manifests in abrupt and spontaneous mood swings and behaviors, whereas mood changes in people with bipolar disorder last significantly longer.

Triggers may also differ, as people with BPD are often highly reactive to external triggers, such as negative interactions with other people. By comparison, bipolar mood swings aren’t necessarily a result of external triggers.

Another area in which BPD and bipolar differ is the sense of self. Bipolar disorder doesn’t often cause identity instability, whereas BPD often manifests in an unstable and distorted self-image. Someone with BPD may develop their sense of self depending on what’s happening around them and who they associate with.

Impulsive and risky behaviors can occur in both disorders, especially when a person is experiencing a manic episode. However, in BPD, impulsivity is a more chronic problem and happens most frequently when a person is triggered.

Can You Have Both BPD and Bipolar Disorder?

It’s possible to have a dual diagnosis of both BPD and bipolar disorder. Research suggests that 10% to 20% of people with bipolar disorder also meet the criteria of borderline personality disorder [*].

When a person has both conditions, they may display symptoms unique to each condition. For example, they might have manic episodes while experiencing day-to-day emotional changes.

It’s more common that bipolar disorder is diagnosed first, as symptoms often change and can mask BPD symptoms.

Coping Strategies and Support

While managing BPD or bipolar disorder can be challenging and require lots of time and effort, there are evidence-based strategies that you can consider. Self-care plays a huge role in how someone manages their daily symptoms. Developing a simple, stable routine involving quality sleep, regular exercise, balanced nutrition, and fulfilling activities can improve depressive symptoms.

If you notice your symptoms are becoming disruptive to your daily life or even interfering with your safety, it may be time to seek professional help. Start with your general physician, who can refer you to the appropriate mental health professional.

Connecting with people can make the healing journey more enriching. Reach out to family members or join support groups where like-minded members can share valuable insights and experiences.

The Bottom Line

Living with borderline personality disorder or bipolar disorder is not easy, especially when you receive a dual diagnosis. However, with the right support, access to professional help, and healthy lifestyle adjustments, you can make either condition more manageable.

If someone in your family is diagnosed with BPD or bipolar disorder, our DBT worksheets and CBT worksheets can provide support alongside therapy.

FAQs About BPD and Bipolar

Can BPD be mistaken for bipolar?

Yes, BPD can be mistaken for bipolar, especially during the early stages of diagnosis. Symptoms may not be clearly defined or may change significantly over time. These symptoms, such as mood instability, impulsivity, and depression, are shared among both disorders, which can make them confusing to define.

Which condition is more severe?

Neither condition is more inherently severe than the other. How severe the symptoms are will depend on each person’s individual experience and access to support.

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