Despite the fact that BPD and bipolar disorder are vastly different psychiatric conditions with very different causes as well as treatments the two are very often confused and even misdiagnosed by mental health professionals.
Bipolar disorder is a hereditary Axis one mood disorder which affects approximately 2% of the population and is treated primarily with medication, specifically mood stabilizers and sometimes adjuvant antidepressants.
BPD (borderline personality disorder) is a very complex Axis two personality disorder which is now believed to affect upwards of 6% of the population and is normally treated with a combination of long-term therapy and medication. It is usually accompanied by a number of co morbid conditions including depression, anxiety, and various forms substance abuse.
However despite the differences there is a significant overlap in symptoms between these two disorders. As a result BPD and bipolar disorder are often misdiagnosed as each other. Some people diagnosed with BPD actually have bipolar; and the reverse is also true.
In both disorders the following symptoms can exist:
- Identity disturbance (more a symptom of bpd but can also occur in the bipolar disorder)
- Intense or unstable relationships
- Impulsive behavior
- Mood swings
- Anger or irritability
- Depression
In bipolar disorder many of these symptoms such as impulsiveness, irritability, and unstable relationships are brought on by mania or hypomania. With BPD these symptoms tend to be brought on by situations such as fears of abandonment, perceived criticism, or stressful interactions with others.
The mood swings which are the hallmark symptom of bipolar disorder are usually fixed, brought on by biochemical changes in the body, and generally occur at regular intervals. In borderline personality disorder these moods swings from "sadness to anger to euthymia" are unpredictable, situational, and reactive. They also are much more frequent and can occur multiple times in a single day.
With regard to impulsivity and impulsive behavior (spending, sex, substance abuse, reckless driving, etc.) in bipolar disorder it tends to be episodic and generally occurs during periods of mania. While with bpd impulsive behavior is much more commonplace and tends to be an inherent part of the actual disorder.
The most important reason that the correct diagnosis be given is that the disorders have two very different treatment approaches. Patients diagnosed with bipolar disorder will normally respond to a mood stabilizing drug such as Lithium, Tegretol or Depakote and possibly the addition of an antidepressant. Psychotherapy for bipolar disorder is considered an adjuvant treatment. With bpd the opposite tends to be the case. Talk therapy, specifically dialectical behavior therapy, is the primary treatment, while medications can be used to treat some of the anxious and/or depressive symptoms.
Again the key in distinguishing the two disorders lies in the nature of the mood cycling. With bipolar disorder the swings in mood are less frequent and occur at fixed intervals regardless of life events. With borderline personality the mood swings are much more frequent and are directly related to events and specific situations.
Take an online assessment for borderline personality disorder.
Take an online assessment for bipolar disorder.
Source material: psychiatric times; Marianne Goodman, MD; psychology today
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