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.

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When it comes to successfully treating a mental health disorder, it is important to have the correct diagnosis. Unfortunately, symptoms of different conditions can overlap, making it tough to find the right diagnosis.

Bipolar disorder and borderline personality disorder (BPD) may sound similar at first and share a few symptoms like impulsivity, promiscuity, and rage. However, the two conditions are very different, Kathleen Cairns, PsyD, a clinical psychologist at Life Goes On Psychotherapy Center in Connecticut, told Health.

What Is Bipolar Disorder?

The most common symptoms of bipolar disorder include high and low moods, also known as mania and depression. These moods are more extreme than the mood changes most people experience; they can affect how well people with bipolar disorder can live their life. Periods of mania or depression vary in length but often last days or weeks.

To be diagnosed with bipolar disorder, a person must have at least one manic or hypomanic episode, according to the National Alliance on Mental Health (NAMI). Hypomania is a less severe form of mania—it does not include psychotic episodes. However, both types of mania are associated with higher energy and impulsive behavior. According to NAMI, suicide is "an ever-present danger" in people with bipolar disorder because they may become suicidal during a manic state.

On the other extreme of the mood scale, people with bipolar disorder can swing from a manic state to a depressed state. During a depression, some people have trouble sleeping while others sleep more than usual. They may feel overwhelmed by making decisions and become obsessed with negative thoughts.

If properly treated, the periods of wellness in between manic and depressive states can last for months or even years, said Ken Duckworth, MD, chief medical officer for NAMI.

How Is Bipolar Disorder Treated?

Once properly diagnosed, bipolar disorder can be extremely well-managed. "You probably know someone who's bipolar and you don't even know it," Cairn said regarding 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 said. Once a sleep cycle is thrown off schedule, it can trigger symptoms and lead to a depressive or manic state—which can make traveling across time zones risky for people with bipolar disorder.

Like many health conditions, 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 said.

What Are the Symptoms of BPD?

Borderline personality disorder is also a mental condition that affects mood. According to NAMI, BPD can cause people to have difficulty regulating their emotions—they feel these emotions more strongly and these emotions can change suddenly. This can cause feelings of abandonment, 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 said, "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 in full force, Cairns said. Then, their attitude can change quickly.

"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," Cairns said. "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."

Diagnosing Bipolar Disorder vs BPD

Though both conditions involve mood swings, the length of mood changes can vary. Compared to bipolar disorder, the mood changes in BPD are shorter and tend to happen every day, Dr. Duckworth said. Mood changes in BPD can range from a few hours to a few days. Meanwhile, episodes of mania or depression can last several days to weeks.

The emotions felt during mood swings are also different. People with BPD do not generally have manic episodes. They vary from feeling loving and secure in their relationship to depressed, angry, or lonely. However, both people with BPD and people with bipolar disorder can be at risk for self-harm and impulsive behaviors.

How Is Borderline Personality Disorder Treated?

Unlike with bipolar disorder, treatment for borderline personality disorder is often unsuccessful, Cairns said.

Cognitive behavioral therapy and dialectical behavior therapy can help. But frequently, people with borderline personality disorder have difficulty staying 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 is 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 said. (She recommended reading 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).

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