Disclaimer: I am not a mental health professional and all of this information is what I have learned from personal experience and reading information from actual professionals on the internet. I will link to good resources and my sources below. Please bring up your concerns with your health professional if you disagree with your diagnosis and/or treatment.
Bpd stands for borderline personality disorder (also known as emotionally unstable personality disorder) and is a pervasive way of feeling, behaving and relating to others. It shares many symptoms with bipolar, a mood disorder, however is also very different in many ways.
To be diagnosed with borderline personality disorder you must meet 5 or the 9 criteria:
- Frantic efforts to avoid real or imagined abandonment
- Unstable and intense interpersonal relationships, characterized by alternating between extreme idealization and devaluation
- Unstable self image and sense of self
- Impulsivity in two areas which are self damaging (e.g. alcohol or drug abuse)
- Recurrent suicidal behaviours or self harm
- Affective (emotion) instability and marked reactivity of mood lasting a few hours or rarely a few days
- Chronic feelings of emptiness
- Inappropriate or hard to control anger
- Transient stress related severe dissociation or paranoid ideation
To be diagnosed with bipolar affective disorder type 1, you must meet the criteria for a manic or mixed episode (lasting a minimum of one week) and a depressive episode (lasting a minimum of two weeks). Often episodes last much longer, lasting months at a time without medication. To be diagnosed with bipolar affective disorder type 2, you must meet the criteria for a hypomanic episode (lasting a minimum of 4 days) and a depressive episode (lasting a minimum of two weeks). Hypomania is a less severe form of mania, where psychosis isn’t present. Mania interferes with persons life much more and stops them from functioning day to day. Mania is characterized as a elated (‘high’) or irritable mood while someone with depression has a low mood. In mixed episodes people meet the criteria for both manic/ hypomanic and depressed episodes at once.
Like with any condition, someone with bipolar or borderline personality disorder can present differently to someone with the same diagnosis. Everyone is different. There are many overlaps which mean making the correct diagnosis is tricky and takes time.
To explain the similarities I will go through the criteria for bpd and link to how this can be seen or not seen in someone with bipolar.
- When patients with bipolar become depressed they may withdraw from others but they could also become dependent and ‘needy’ and less assertive as their self esteem drops and they believe in their own abilities less. This may cause them to fear abandonment from the people/ person they have become dependent on. It is unlikely, however, that they would go to “frantic” efforts to avoid this abandonment unlike bpd patients.
- Relationships with people who have bipolar may be unstable and intense. When that person is manic they may idealise a person because their mood is elated then hate the person when they become angry or paranoid. When depressed, again they may withdraw or hold other people at a higher value than themselves.
- Episodes can cause a person with bipolar to have a very changeable sense of self. When manic they may love themselves and when depressed they may hate themselves. Unlike bpd, however this view will continue all through the episode, lasting weeks to months.
- When manic or hypomanic, someone with bipolar will likely become impulsive and not think about the damage they are doing to themselves. They may drink a lot or go on shopping sprees. When this person is depressed, however, they are not impulsive at all. They may still do similar behaviours, like drinking, but will do this as a way to self medicate and may become addicted to the way it helps them feel ‘better’. They will often neglect themselves and not care about the consequences of hurting themselves in this way.
- In mixed state or depressed episodes, a person with bipolar may self harm or try to commit suicide. This is unlikely to happen in manic episodes but may occur unintentionally through risky and delusional behaviours.
- A person with bipolar may have a very unstable affect when manic presenting as very grandiose then suddenly aggressive. They may ‘overreact’ to situations in such a heightened state of arousal. In depressive episodes people with bipolar may feel extremely numb and emotionless or overly sensitive and tearful. They may also become irritable easily. In a mixed state this is even more confusing, with crying one minute and laughter the next,
- Again, feeling numb or empty might be a key symptom in someone’s depression but is unlikely to be present when they are manic or stable.
- Anger/ irritation can be present in mania/ hypomania, mixed episodes and depression. It is often difficult to manage and can seem to be over nothing.
- Transient severe dissociation is unlikely to occur solely because of bipolar however paranoid ideation and psychosis can happen at either extreme of mania or depression.
As you see there are so many similarities between these disorders. A main difference is that bipolar affective disorder is episodic, meaning the symptoms last weeks to months then subside. While borderline personality disorder is continuous throughout someone’s adult life. With bpd emotions are very intense and change depending on external and internal factors. They don’t last very long, unlike in bipolar where an episode of similar emotions (eg sadness in depression) can last for months at a time. When stable between episodes, someone with bipolar won’t be emotional, impulsive or won’t self harm, unless they have another condition like bpd.
Why does diagnosis even matter?
Some of you will read this post and wonder why psychiatrists should even bother diagnosing people if the symptoms are so similar. There are many answers and one key one is treatment. The treatment for bipolar and bpd differs greatly. While talking therapies help both, bipolar is primarily treated with medication (often a mix of mood stabilisers and antipsychotics) while the best treatment for bpd is DBT (dialectical behavioural therapy). Another reason why diagnosis matters is when finding support groups and self help books which are designed for your actual condition with the right symptoms. To a point diagnosis isn’t everything and can be wrong but the right diagnosis can save and improve lives and can help people reach out and recieve the right support.
- Kati Morton video on bipolar vs borderline personality disorder: https://www.youtube.com/watch?v=rfQTf8NA73s
- Diagnosis guide for bipolar disorder: https://www.healthline.com/health/bipolar-disorder/bipolar-diagnosis-guide
- Information from the DSM, criteria for borderline personality disorder https://behavenet.com/diagnostic-criteria-30183-borderline-personality-disorder
Resources for bipolar
Resources for borderline personality disorder