Borderline Personality Disorder vs. Bipolar Disorder

By Paula Holmes LCSW

Differentiating between varying mental health conditions can be challenging, especially when there are overlapping symptoms. For example, people tend to confuse conditions like borderline personality disorder and bipolar disorder because some of their symptoms can be similar. However, these two disorders are unique diagnoses that differ in several important ways. Learning about the differences between borderline personality disorder and bipolar disorder can help you think about ways to manage symptoms and their underlying causes. 

What Is the Difference Between a Mood Disorder and a Personality Disorder?

Mood disorders and personality disorders are two different categories of mental health diagnoses. Personality disorders are long-standing patterns of thoughts, feelings and behaviors that result in challenges with self-esteem, emotional regulation and relationships with others. Often, personality disorders lead people to have misperceptions about the intent of others or the way others think of them.

Mood disorders are a type of mental health condition that primarily impacts mood and emotion regulation. People who have mood disorders may not struggle with interpersonal relationships or misperceptions in the same way that people with personality disorders often do. Mood disorders are often managed with medications that help with the brain’s neurotransmitters, but personality disorders are not able to be treated with medications.

What Is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a condition that impacts self-image and relationships with others. BPD makes it difficult to develop and maintain healthy relationships due to fears of being abandoned. These fears of abandonment can make people with BPD feel desperate and highly anxious, which can cause them to feel agitated or make attempts to keep others in their lives. Sometimes, people with borderline personality disorder become severely depressed or feel unsafe toward themselves, especially if they feel like people do not care about them or do not meet their needs effectively. 

People with borderline personality disorder may feel easily slighted or mistreated by others, and they may dwell on these experiences. Because low self-esteem is often part of BPD, these problems in relationships can result in major distress. Impulsive acts and self-harm are not uncommon for people struggling with borderline personality disorder, and feelings of emptiness make these behaviors even riskier. 

Symptoms of BPD

Borderline personality disorder impacts people in a variety of ways relating to self-perception, emotional reactions and relationships with others. There are nine common symptoms of BPD. People must have five or more of these symptoms to be diagnosed with borderline personality disorder:

• Efforts to avoid abandonment (real or imagined)
• Patterns of unstable and intense relationships with others; excessively adoring a person at some times but devaluing them at other times
• Difficulty maintaining a sense of self and having an unstable self-image
• Impulsive, self-damaging behaviors in at least two of these ways: spending, sexual behaviors, substance abuse, driving unsafely and binge eating
• Ongoing suicidal feelings, behavior or threats; self-harm behaviors
• Unstable moods lasting several hours or more
• Ongoing feelings of emptiness
• Chronic challenges with anger, outbursts, physical fights and temper issues
• Stress-related paranoia and severe dissociative symptoms

What Is Bipolar Disorder?

Bipolar disorder is a type of mood disorder that can impact a person’s functioning in a variety of ways. Genetics plays a significant role in bipolar disorder, and people with this diagnosis often have a relative who also has it. There are several types of bipolar disorder and related conditions. The main factor for bipolar disorder is the way a person’s mood shifts from one end of the spectrum to the other — specifically, from depression to mania. 

During the depressive phase of bipolar, a person’s energy is low, and they may feel suicidal, severely depressed and hopeless. It may be difficult to get out of bed or function in any way. Self-care is often neglected, and tasks such as eating, showering or getting dressed are difficult. The manic phase of bipolar disorder is the opposite. Bipolar mania can mean high energy, little need for sleep, feeling on top of the world and engaging in extreme behaviors such as overspending, substance abuse or increased or risky sexual activity. Other symptoms can include irritability or being argumentative, excessive talking and racing thoughts. 

Symptoms of Bipolar Disorder

Bipolar disorder symptoms vary depending on what phase a person is in, the severity of the condition and the type of bipolar it is. There are manic and depression symptoms that can emerge, and some of the symptoms may apply while others do not. 

Symptoms of mania include:

• A period of elevated or irritable mood with greater amounts of activity or energy lasting a minimum of one week
• Inflated self-esteem or grandiose feelings
• Less need for sleep than usual
• Excessively talkative or pressured, rapid speech
• Racing thoughts
• Easily distracted
• Driven to accomplish certain tasks (socially, sexually, or at school or work)
• Excessive risk-taking (risky sexual behaviors, overspending, substance abuse or making dangerous choices)
• Disruption of work, school or social life to the point of needing hospitalization for safety of self or others (particularly if psychosis is present)
• Symptoms are not caused by substance use

Symptoms of depression include:

• Depressed mood most of the day (feeling sad, empty, hopeless, tearful or irritable)
• Loss of interest or enjoyment in life and activities
• Major weight loss or weight gain (change of 5% of body weight)
• Insomnia or oversleeping
• Being fidgety or moving more slowly than usual (that is noticeable by others)
• Exhaustion and fatigue
• Feeling worthless or excessively guilty without cause
• Problems with thinking, concentration or decision-making
• Thoughts of death, suicidal ideation or wishing to be dead
• Disruption in daily life (school, work or social life)
• Symptoms are not caused by substance use

Difference Between Bipolar and Borderline Personality Disorder

Bipolar and borderline personality disorder are different in their origins. Bipolar is a mood disorder that is influenced by genetics and brain chemistry. Borderline personality disorder stems from defense mechanisms that are brought on by challenging or invalidating early life experiences and perceptions rather than biology. 

Bipolar disorder can be managed with medications and psychotherapy. Borderline personality disorder is not treatable with medications, but it can be helped with treatments such as dialectical behavioral therapy. Bipolar disorder is more related to mood changes, while borderline personality disorder is more related to interpersonal relationships and a fear of abandonment and emptiness. 

Similarities Between Bipolar and Borderline Personality Disorder

Borderline personality and bipolar disorder are sometimes confused because of overlapping symptoms between the two diagnoses. Mood changes, feelings of hopelessness and impulsivity are common experiences for people with either condition. Both BPD and bipolar disorder can take a while to diagnose, as both have symptoms that might look more like depression or anxiety. 

Other common symptoms of bipolar and borderline personality disorder can include substance abuse. While not all people with BPD or bipolar disorder abuse drugs and alcohol, it can be a risk factor given the strong emotions and the urge to reduce their intensity. Intense anger can also be a commonality for these disorders. People with bipolar disorder or BPD can learn to manage overwhelming feelings to increase their quality of life, experience greater inner peace and improve relationships. 

Diagnosis and Treatment of BPD and Bipolar Disorder

Mental health providers can assess and diagnose bipolar and borderline personality disorders. Through questionnaires and assessments, trained providers can also determine the best course of treatment and help you find ways to manage symptoms. It is important to be as open and honest with your providers as you can, as it helps ensure you receive a form of treatment that will help you feel better. 

Psychiatrists and other medication managers may offer prescriptions to manage symptoms that interfere with your daily life. For bipolar disorder, medications are commonly prescribed to help regulate mood. Medications may also be prescribed for people with BPD if there are co-occurring conditions. Therapists may also ask you to track symptoms over time and work on lifestyle changes to make the most of your treatment and learn coping strategies. Therapy modalities like dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) can be helpful in managing emotions and learning new ways to cope with thoughts and feelings. 

If you’re wondering whether you have symptoms of BPD or bipolar disorder, or you’re struggling with other difficulties and could use some assistance, Nobu can help. The free-to-use Nobu app offers a variety of ways to support your mental health and overall well-being, including journaling tools, mindfulness training, guided yoga sessions and much more. For an additional fee, you can even connect with a licensed mental health professional to receive confidential telehealth treatment and therapy. Sign up for Nobu and download the app today, available for free on Apple and Android devices.