What is the difference between borderline personality disorder and bipolar?

Ms. Julie A. Fast
Mental Health
Bipolar is an episodic mood disorder. When a person is not a mood swing such as mania or depression, the symptoms are not present.
BPD is a pervasive illness that is considered a part of a person’s personality. It is not episodic.
Definition of BPD
People with BPD often feel misunderstood, alone, empty and hopeless. They're typically full of self-hate and self-loathing. They may be fully aware that their behavior is destructive, but feel unable to change it. Poor impulse control may lead to problems with gambling, driving or even the law. They may find that many areas of their lives are affected, including social relationships, work or school. Those with the illness often show strong changes in moods, but these often seem calculated as they can be turned off and on. (Mayo Clinic, 2011)
Sheila:  “I feel that I’m reeled in by my husband's charm and then punched in the face (not literally, but definitely emotionally). His charisma is often so amazing. No one believed me it was happening, people would say he was a great guy, but it seems he only saved it for me behind closed doors."
And yet, those with the illness are in great pain and are not simply acting out. It’s a true illness.
How is Bipolar Different?
Bipolar mood swings sit on top of a person and are not part of their personality. The mania, depression and anxiety start and end at a specific time. It’s a very serious illness and like BPD can cause great disruption in family, work and financial relationships, but it does come and go.
Bipolar is treated with medications such and a strong management plan. The treatment outcome for BPD is complicated as the drugs on the market address only some of the symptoms such as depression and anxiety, but there is no specific drug for the illness.
What is Dialectical Behavioral Therapy? (DBT)
Many of those with BPD have had great success with DBP. There are many books on the topic of DBT as well as therapists and centers that specialize in the therapy. DBT is for family members as well.
Can a Person Have a Bipolar and BPD Diagnosis?
Yes! If you or your loved one has both, make sure you work with a health care professional who understands how they interact. There is hope for the treatment of both illnesses.
John Preston, PsyD

Borderline Personality Disorder (BPD) and Bipolar Disorder have two things in common: significant emotional instability and poor impulse control (e.g. poor judgment and making rapid decisions that often cause the person great harm; inability to control ones emotions). Beyond this, the two are quite different.

Bipolar disorder is a genetically-transmitted biologically-based mood disorder. It has two forms: Bipolar I (those diagnosed have both major depressive episodes and episodes of mania) and Bipolar II (major depression and episodes of hypomania).

Manic episodes include the following symptoms: hyperactivity or agitation, racing thoughts, rapid, pressured speech, decreased need for sleep, psychotic symptoms, such as delusions or hallucinations (psychosis occurs in 70% of manic episodes), very impaired impulse control and poor judgment. There are 2 types of mania: euphoric mania (grandiosity, up-beat, euphoric)…delusions: “I am the smartest person in the world) and dysphoric mania (severe depression, marked irritability, and suicidal ideas and impulses). Hypomania is a mild version of mania: upbeat mood, decreased need for sleep, out-going, but no psychotic symptoms.

Bipolar episodes can be ignited by major life stresses, sleep deprivation and/or substance abuse. They also can arise spontaneously (appear to come out of the blue

BPD does not have spontaneous mood changes. Rather people suffering from this disorder are very sensitive, especially to interpersonal rejections or fears of abandonment. Periods of depression, extreme anxiety, and anger can be sparked by what to others may be seen as small stressors (e.g. someone does not return their phone call). BPD does not have these classic manic symptoms: decreased need for sleep, extreme grandiosity, rapid thoughts, and pressured speech. People with BPD always have a history of very chaotic interpersonal relationships and intense emotional instability.

Bipolar disorder can be successfully treated with psychiatric medications (mood stabilizers), although this treatment is often very challenging. People with BPD are sometimes treated with antidepressants (that target irritability and impulsivity); however the outcome of such treatments is usually marginal. The treatment for BPD is psychotherapy.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.