Bipolar vs. BPD: How to Tell the Difference
The two mental health conditions are sometimes confused—but treatment depends on which diagnosis a person actually has.
When it comes to successfully treating a mental health disorder, it’s important that you have the correct diagnosis—which is easier said than done. As if struggling with symptoms isn’t hard enough, in some cases, these symptoms may overlap with other conditions, making it tough to nail down the right diagnosis.
While bipolar disorder and borderline personality disorder (BPD) might sound similar at first, aside from a few symptoms the two have in common—impulsivity, promiscuity, and rage—the conditions are actually very different, Kathleen Cairns, PsyD, a clinical psychologist in Connecticut, tells Health.
So what are the symptoms of bipolar disorder?
The symptoms and their severity can vary person to person, but the most common symptoms of bipolar disorder include mania and depression.
In order to be diagnosed with bipolar disorder, a person has to have at least one manic or hypomanic episode, according to the National Alliance on Mental Health (NAMI). Hypomania isn’t as severe as mania—it doesn’t include psychotic episodes.
According to NAMI, suicide is “an ever-present danger” in people with bipolar disorder because they may become suicidal during a manic state.
People with bipolar disorder will swing from a manic state to a depressed state. During a depression, some people have trouble sleeping while others sleep more than usual.
If properly treated, the periods of wellness in between manic and depressive states can last for months or even years, says Ken Duckworth, MD, medical director for NAMI.
How is bipolar disorder treated?
Once properly diagnosed, bipolar disorder can be extremely well-managed, Cairns says. “You probably know someone who’s bipolar and you don’t even know it,” she says of treatment success.
Bipolar disorder is usually treated with a combination of medications (including mood stabilizers and antidepressants) and talk therapy. Following a regular sleep routine is also crucial, Cairns says. Once a sleep cycle is thrown off schedule, it can trigger symptoms and lead to a depressive or manic state, she says—which can make traveling across time zones risky for people with bipolar disorder.
Like many health conditions—physical and mental—having a support team is also important. People with bipolar disorder who successfully manage their condition often count on friends, family, a significant other, a psychologist, and a psychiatrist, Cairns says.
Bipolar vs. BPD
People with borderline personality disorder have difficulty regulating emotion. That results in a host of severe symptoms, including feelings of real or imagined abandonment and efforts to avoid abandonment, unstable personal relationships, distorted self-image, self-harming behaviors, chronic feelings of boredom or emptiness, and no sense of self.
It’s a particularly painful and challenging diagnosis, Cairns says, “because there is no stability. And without a sense of self, you’re just empty and lost.”
In addition to emptiness, having unstable relationships is a defining factor of BPD. People with the diagnosis often latch on to others—friends or romantic partners—very quickly and full-force, Cairns says. And then things turn.
“One day, everything is fine. Your partner [with BPD] is loving and kind, and the next day, it’s awful, and you don’t know what hit you,” she says. “No one really knows what triggered it. It could be because you looked at him or her funny, or you looked at someone else, or you wanted to go somewhere without that person. They perceive abandonment where there is none and then there is a huge rage.”
Compared to bipolar disorder, the mood changes in BPD are shorter and tend to happen every day, says Dr. Duckworth.
Borderline personality disorder treatment
Unlike with bipolar disorder, treatment for borderline personality disorder is often unsuccessful, Cairns says.
Cognitive behavioral therapy and dialectical behavior therapy can help. But frequently, she says, people with borderline personality disorder won’t stay in therapy because of their inability to have stable relationships. “I’ve seen my fair share of these patients. They idealize me, and then they devalue me and leave.”
It’s important for a person with BPD to understand the diagnosis and learn that they can be with someone but not merge with them; this understanding can help foster success in managing the condition, Cairns says. (She recommends Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder by Paul Mason and Randi Kreger as a helpful place to start.)
There is no one medication designed to treat the core symptoms of borderline personality disorder, according to NAMI. But medications for certain symptoms, like depression and anxiety, could help make a person with BPD feel better. They could also increase a person’s ability to participate in therapy.
If you or someone you know is thinking about suicide, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter