Borderline personality disorder vs. bipolar disorder: What’s the difference? Can you have both?

Borderline personality disorder vs. bipolar disorder causes | Prevalence | Symptoms | Diagnosis | Treatments | Risk factors | Prevention | When to see a doctor | FAQs | Resources

Borderline personality disorder (BPD) is a personality disorder that causes people to have unstable moods, behaviors, and relationships. Bipolar disorder is a mood disorder that causes mood swings and changes in energy levels. These two conditions have similarities that can make it difficult to tell them apart. Let’s take a look at the key differences between borderline personality disorder and bipolar disorder to better understand them and how they affect people.  

Causes

Borderline personality disorder

Borderline personality disorder is a mental illness that causes people to have varying moods, behaviors, self-image, and impulse control. Doctors and researchers don’t fully understand what causes BPD, but it’s thought to be a combination of a family history of the disorder, environmental factors like traumatic life events (abuse, neglect, or abandonment, especially during childhood), differences in brain structure, and an imbalance of brain chemicals. This imbalance can lead to abnormal levels of chemical messengers called neurotransmitters, which send signals between brain cells.   

Bipolar disorder

Bipolar disorder is a mood disorder that causes people to shift between manic phases (an overly excited and elevated mood) and depressive phases (feelings of sadness and hopelessness). Just like with BPD, doctors and researchers don’t fully understand what causes someone to develop bipolar disorder. Instead, it’s believed to be caused by many different factors. There is a lot of research that suggests that people with bipolar disorder have physical changes in their brains that affect how they behave. For example, having higher or lower levels of neurotransmitters in the brain causes a chemical imbalance and ultimately contributes to the symptoms of bipolar disorder. Having a family history of bipolar disorder may also contribute to someone getting it later in life, but it does not mean that they will develop it for sure.   

Prevalence

Borderline personality disorder

According to the National Alliance on Mental Illness, about 1.4% of adults in the United States experience BPD. This means that about 1 in 16 Americans will have the disorder at some point in their lives. Borderline personality disorder is also considered to be the most common personality disorder in clinical settings. About 14% of the global population is thought to have the disorder according to studies done by the World Health Organization.   

Bipolar disorder

Bipolar disorder is more common than BPD. It’s estimated that about 2.8% of American adults over the age of 18 have bipolar disorder and that 4.4% of U.S. adults will experience the disorder at some point in their lives. Around the world, about 46 million people have bipolar disorder. One survey of 11 countries found that the lifetime prevalence of bipolar disorder was 2.4%. The U.S. had a 1% prevalence of bipolar type I, which was notably higher than many other countries in this survey. Of all the mood disorders, bipolar disorder causes the most people to experience “severe impairment.”  

Symptoms

Borderline personality disorder

Someone with BPD will experience a distinct set of symptoms that can make daily life more stressful and difficult to manage. The most common symptoms are emotions that shift very quickly, having a fear of abandonment, having a shifting self-image, impulsive behavior, engaging in self-destructive behaviors, feelings of emptiness, anger, and dissociation. People with this disorder will often have unstable relationships with people in their lives, and they may have additional mental health conditions, such as depression. 

Shifting emotions are usually triggered by external events, such as rejection or failure. Anger is a common emotion that everyone experiences, but BPD is characterized by intense and inappropriate anger. People with BPD may also have trouble controlling their impulses and struggle with gambling, overspending, substance abuse, and binge eating. Self-image can be unstable, where someone with BPD has trouble defining an identity, and they may feel disconnected from their thoughts and memories. 

Bipolar disorder

Bipolar disorder can make daily life hard to manage because it causes periods of intense emotions. There are three types of bipolar disorder:

• Bipolar I disorder: This type of bipolar disorder is characterized by episodes of mania that can last seven days or longer and depressive episodes that last at least two weeks. People in a manic episode can often experience increased energy, a decreased need for sleep, hyperactivity, hypersexuality, exaggerated self-confidence, talkativeness, poor decision making, racing thoughts, and distractibility.When they switch to being in a depressive episode, they may feel empty, lonely, hopeless, fatigued, depressed, and they may have trouble concentrating, lose interest in activities they previously enjoyed, and experience changes in their sleeping patterns and appetite.
• Bipolar II disorder: This type of bipolar disorder is less intense than type I. People will have depressive episodes and hypomanic episodes, but they won’t be as severe as type I. Hypomanic episodes are less severe than manic episodes, last a shorter amount of time, and don’t cause major problems in daily functioning.
• Cyclothymic disorder: Someone with this milder type of bipolar disorder will have had periods of hypomania and depressive symptoms for at least two years, but the symptoms are less severe than bipolar I or II disorder.

Diagnosis

Borderline personality disorder

Borderline personality disorder must be diagnosed by a psychiatrist, psychologist, clinical social worker, or other trained mental health professional. Before giving a diagnosis, the trained professional will need to do a thorough medical exam that includes a complete discussion of the symptoms someone is having as well as their medical history and family history. They may also give their patient a questionnaire to make diagnosing the disorder easier. 

Borderline personality disorder often occurs at the same time as other mental disorders like depression, anxiety, and eating disorders, so it can be difficult to separate the condition from these others. Mental health professionals will be able to tell what kind of mental disorder someone has based on their symptoms and medical history, which is why it’s so important to tell your doctor about every symptom you’re experiencing.    

Bipolar disorder

Just like with BPD, bipolar disorder must be diagnosed by a trained psychiatrist, psychologist, clinical social worker, or another mental health provider. They will ask about the patient’s symptoms, family history, and medical history and may do a complete physical exam and run certain lab tests to rule out underlying diseases that may be causing someone’s symptoms. Sometimes they’ll have their patient fill out a mental health questionnaire.  

Doctors use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to help determine what specific type of bipolar disorder someone has: bipolar I disorder, bipolar II disorder, or cyclothymic disorder.   

Treatments

Borderline personality disorder

The most effective treatments for BPD are medications and psychotherapy. Here’s how each of them works: 

• Psychotherapy: Talk therapy is another name for psychotherapy, and it’s the preferred treatment for BPD. It’s used to help patients learn to manage their emotions, reduce their impulsiveness, and improve their interpersonal relationships. Effective types of psychotherapy include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), mentalization-based therapy, and schema-focused therapy.  
• Medications: The Food and Drug Administration (FDA) hasn’t approved any one specific medication to treat BPD, but medications like antidepressants, mood stabilizers, and antipsychotics can be helpful for treating its symptoms. These medications may be used along with psychotherapy, but there isn’t one single drug that can cure the disorder.   

Bipolar disorder

Psychotherapy and medications are often used in combination to treat bipolar disorder. Cognitive behavioral therapy is one of the most popular treatment options because it helps patients change their negative thinking and behaviors. Other forms of psychotherapy can also be helpful.

Mood stabilizers like lithium and anticonvulsants are commonly used to treat bipolar disorder because they treat both manic and depressive symptoms. Other medications like second-generation antipsychotics have also been used to help treat symptoms associated with bipolar disorder. Certain antidepressants may be used to treat bipolar depression, but they must be used carefully because they can sometimes worsen the condition. Overall, these medications tend to work very well when they’re combined with something like cognitive behavioral therapy. 

For people with severe mania or depression who have not responded to psychotherapy or medication, a treatment called electroconvulsive therapy (ECT) may be needed. This therapy transmits short electrical impulses to the brain to change brain chemistry and is done when the patient is under anesthesia.   

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Risk factors

Borderline personality disorder 

Some people have a higher risk of getting BPD than others. People with a family history of the disorder are more likely to get it. Although 75% of people diagnosed with BPD are women, recent research shows that men are equally as likely to get the disorder, so being female is not a risk factor. Finally, research suggests that environmental factors like abuse and abandonment can contribute to someone developing BPD.  

Bipolar disorder

The top risk factors for bipolar disorder are environmental and genetic. People who have a family history of bipolar disorder have a higher risk of getting it at some point in their life. People who have experienced traumatic childhood events like childhood abuse or traumatic events later in life like the loss of a loved one also have an increased risk of becoming bipolar. Having a history of substance abuse may also increase your risk of developing bipolar disorder later in life.  

Prevention

Borderline personality disorder

Borderline personality disorder can’t be prevented, but there are some things that can be done to reduce the severity of symptoms. Following the treatment plan your doctor gives you is the best way to do this. This might mean taking certain medications and engaging in some form of psychotherapy. 

Bipolar disorder

There’s no way to prevent bipolar disorder, but it can be successfully managed with the right treatment plan. A treatment plan for bipolar disorder will likely include psychotherapy, medication, avoiding alcohol and drugs, and in rare cases, electroconvulsive therapy. 

When to see a doctor for borderline personality disorder or bipolar disorder

Having occasional mood swings and feelings of sadness or depression is a normal part of life, but if you begin to have these symptoms or any of the symptoms of BPD or bipolar disorder on a regular basis, then it may be time to see a doctor. Because the symptoms of BPD and bipolar disorder overlap with other mental illnesses like anxiety, it’s important that a mental health professional checks out your symptoms to make an accurate diagnosis. 

Borderline personality disorder and bipolar disorder that go untreated can make life really hard. Psychiatrists and psychologists are trained to help people with these disorders have a higher quality of life, so it’s always best to seek medical advice if you think you have one of these disorders.  

In addition, people with bipolar disorder or BPD who are having suicidal thoughts or behaviors should seek immediate medical attention and go to the emergency room. Not seeking help could result in self-harm or the harm of another. 

Frequently asked questions about borderline personality disorder and bipolar disorder

What’s the best way to support someone with bipolar disorder?

Supporting someone with bipolar disorder can be difficult because it’s hard to know what kind of support they need. According to the Depression and Bipolar Support Alliance, some of the best ways to support someone with the disorder are:

• Ask the person what kind of support they need. 
• Don’t ask the person to “snap out” of an emotional state they may be experiencing. 
• Educate yourself about bipolar disorder to better understand what the person is going through.
• Encourage the person to seek treatment.
• Try to offer as much unconditional love as you can. 

Is there a cure for bipolar disorder?

There is currently no cure for bipolar disorder, but the right treatment plan, including therapy, medications, and lifestyle changes, can make living with the disorder more manageable. Talking with your doctor is the best way to find a treatment plan that will work best for you. 

Can you have borderline personality disorder and bipolar disorder at the same time?

It is possible to have borderline personality disorder and bipolar disorder at the same time. About 20% of people who have bipolar disorder will also have borderline personality disorder and vice versa. People who have both of these disorders usually have more extreme symptoms like depression and suicidal ideation and are more likely to be hospitalized.

Resources

• Bipolar disorder, National Institute of Mental Health
• Borderline personality disorder, National Alliance on Mental Health
• Frequency of borderline personality disorder among psychiatric outpatients in Shanghai, Journal of Personality Disorders
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5), American Psychiatric Association
• Helping someone living with depression or bipolar, Depression and Bipolar Support Alliance
• Borderpolar: Patients with borderline personality disorder and bipolar disorder, Psychiatric Times