Borderline Personality Disorder (BPD) vs. Bipolar Disorder: Comparing These Two Commonly Misdiagnosed Conditions
Key takeaways:
Bipolar disorder and borderline personality disorder (BPD) are frequently misdiagnosed as one another due to some overlapping symptoms.
These disorders differ in their symptoms, causes, and treatments.
Misdiagnosis of BPD with bipolar disorder, and vice versa, can affect a person’s recovery.
Borderline personality disorder (BPD) and bipolar disorder are two mental health conditions that involve mood changes. The conditions are similar in some ways but differ in their symptoms, causes, and treatment options. Understanding these differences can help you get an accurate diagnosis and the best treatment plan.
What is borderline personality disorder?
BPD is a personality disorder that involves difficulty regulating one’s emotions. This emotional dysregulation can impact your behaviors and relationships. People with BPD may have difficulty functioning in many areas of their lives because of their symptoms.
Symptoms of BPD include:
Intense mood swings
Difficulty controlling one’s anger
Fear of being abandoned by others
Unstable interpersonal relationships
Brief periods of stress-related paranoia or loss of touch with reality
Feelings of being disconnected from one’s self or others
Unstable sense of self and self-image
Chronic feelings of emptiness
Impulsive and self-destructive behavior
Suicidal threats or attempts or self-harming behavior
To receive a BPD diagnosis, you must experience at least five of these symptoms on a regular basis. In addition, these symptoms must start during adolescence or early adulthood.
What is bipolar disorder?
Bipolar disorder leads to changes in your mood, energy, and activity level. These changes can make it challenging to function in many areas of your life.
People with bipolar disorder may experience manic, hypomanic, and depressive episodes.
A manic episode leads to a significantly elevated mood that lasts at least 7 days in a row. Other signs of a manic episode include:
Excessive euphoria or irritability
Increased energy and activity
Less need for sleep
Excessive talking
Racing thoughts
Overinflated self-esteem
Distractibility
Impulsivity
A hypomanic episode usually involves less intense symptoms than a manic episode. Symptoms must last at least 4 days in a row to be considered hypomania.
Some people with bipolar disorder experience mixed episodes. A mixed episode involves a combination of manic and depressive symptoms.
There are three different types of bipolar disorder:
Bipolar 1: People with bipolar 1 experience manic episodes. They may or may not experience depressive episodes as well.
Bipolar 2: People with bipolar 2 experience both depressive and hypomanic episodes.
Cyclothymic disorder: This form of bipolar disorder involves frequent but less extreme shifts between hypomanic and depressive symptoms. Typically these symptoms don’t meet the criteria for a full depressive or hypomanic episode.
Quiz: Am I Bipolar?
How do BPD and bipolar disorder compare to each other?
BPD and bipolar disorder are distinct disorders. Bipolar disorder is a mood disorder, while BPD is a personality disorder. They differ in their symptoms, causes, and treatment approaches. The following table outlines these similarities and differences.
Borderline personality disorder | Bipolar disorder | |
Symptoms | • It involves changes in mood, impulsive urges, and risk-taking behaviors. | • It involves changes in mood, impulsive urges, and risk-taking behaviors. |
Causes | • BPD is believed to be caused by a combination of genetic, biological, and environmental factors. | • Bipolar is believed to be caused by a combination of genetic, biological, and environmental factors. |
Treatment | • Treatment for BPD is centered on therapy. | • Treatment for bipolar disorder often involves a combination of therapy and medication. |
What factors can lead to misdiagnosis of BPD or bipolar?
BPD and bipolar disorder are often misdiagnosed. Keep in mind that someone can have both BPD and bipolar disorder. But there are several factors that contribute to misdiagnosis.
Overlapping symptoms
Both disorders involve mood instability. This can make it challenging for providers to make an accurate diagnosis. It may take time for a provider to determine whether you experience bipolar mood episodes or mood shifts due to BPD.
Stigma
There is still significant stigma around mental health, especially when it comes to bipolar disorder and BPD. People with these conditions are sometimes labeled as “problematic,” “difficult,” or “dramatic.”
Stigma leads to shame, which may prevent people from seeking help or being honest about what they experience. This can interfere with getting an accurate diagnosis.
Gender bias
Rates of BPD are equal among males and females. But females are more likely to be diagnosed with BPD than males. BPD has been stereotyped as a feminine illness, which may lead to providers over-diagnosing BPD in women and underdiagnosing it in men.
Having an accurate diagnosis is important. If you feel like your healthcare provider may be wrong about your diagnosis, consider getting a second opinion. It may also help to track your moods and symptoms and share that information with your healthcare provider.
The bottom line
Bipolar disorder and BPD are distinct mental health conditions. They both share some overlapping symptoms, including mood instability. But the way that the symptoms present is different. Because of their similarities, however, misdiagnosis is common.
Understanding the differences between the two conditions is important, since an accurate diagnosis is necessary to develop a treatment plan. If you think you may have been misdiagnosed, consider getting a second opinion.
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References
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Substance Abuse and Mental Health Services Administration. (2016). Table 3.8: DSM-IV to DSM-5 hypomania criteria comparison. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
