Borderline personality disorder vs. bipolar disorder — what’s the difference? What are the symptoms? What options are available for treatment? It can all be confusing — and even a bit overwhelming when you first start to look at these two disorders. Even though there are several similar symptoms between them, there are some distinct differences to be aware of and understand.
At a very high level, borderline personality disorder (BPD) is a type of mood disorder that causes a cycle of varying behaviors, mood changes, and self-image concerns. Bipolar disorder is more common than BPD, and it causes changes in energy, mood, thoughts, and activity levels. These shifts can last anywhere from a number of days, up to months at a time.
In this article, we’ll dive into these two mental health conditions further so you can better understand the differences and similarities.
What Are the Symptoms of Borderline Personality Disorder?
The overarching symptoms of borderline personality disorder include unpredictable behaviors, moods, and a distorted self-image. Symptoms such as these often result in difficulty maintaining relationships and a tendency for impulsivity.
There’s a long list of BPD vs. bipolar symptoms that are pretty similar, so it’s important to understand the ones that are unique to BPD. It’s equally important to keep in mind that not everyone with BPD will have the same symptoms, or even the same severity of symptoms, at any given time.
Symptoms of BPD can include some or all of the following:
- An inclination to view things as black and white — either life is all good, or it’s all bad
- Self-harming behaviors like burning, cutting, or overdosing or abusing drugs or alcohol
- Uncertainty about your place in the world
- A frequent change in values
- A pattern of emotional instability
- Frequently changing your interests
- A changing pattern within close relationships — swinging from being very close and filled with love, to feeling distant and experiencing hate and anger
- Fast-changing opinions about others
- Difficulty trusting — often because of an irrational fear about people’s intentions
- An unstable or distorted self-image
- Often, recurring thoughts of suicide or self-harm
- An attempt to avoid abandonment (whether it be real or perceived) by ceasing communication with someone else first
- An intrinsic, deep fear of being alone
- Impulsive behavior — like unsafe sex, reckless driving, drug misuse, inappropriate spending sprees
- Chronic, regular feelings of emptiness or self worthlessness
- Extreme episodes of anger, anxiety, or depression
- A feeling of disassociation — having a sense of being cut off from your own body, feeling unreal, or seeing yourself from outside your body
What Are the Symptoms of Bipolar Disorder?
The symptoms of bipolar disorder can also vary. So, you might be wondering how to know if you are bipolar. The disorder is largely defined as one that has fluctuating periods of mania (where you feel extreme highs) and depression (where your mood can shift to deep lows). Not everyone will experience depression, however, and the type of bipolar diagnosis (bipolar I or bipolar II) can impact the type and severity of episodes.
- To be diagnosed with bipolar I, only manic episodes need to be experienced.
- To be diagnosed with bipolar II, depressive episodes can be present, and a less intense mania, known as hypomania, is often experienced.
There are a few significant differences between bipolar vs. borderline personality disorder. First, bipolar disorder mood swings aren’t triggered by interpersonal conflict. In bipolar relationships, this is a common occurrence that can be challenging for a partner to experience. Another difference is that while BPD episodes can last minutes to hours, bipolar mood swings (either high or low) can last for several days to even a few weeks or months. They usually include noticeable changes in energy levels, sleep, and how you talk and think.
Other symptoms can depend on whether a mood change is a manic or depressive episode.
During a manic episode, manic symptoms of bipolar disorder can include:
- Racing thoughts
- Extreme moods — angry, happy, or irritated
- Intense sense of optimism or an amplified sense of self confidence
- Talking very fast, and a lot
- Increased mental energy
- Increased physical energy
- Making very big plans or having grandiose ideas
- Showing poor judgement
- Risk taking
- Feeling like you need (and getting) less sleep, but not always feeling exhausted as a result
- Being very impulsive and reckless about spending money, sex, substance abuse, etc.
During a depressive episode, depressive symptoms of bipolar disorder can include:
- Long-lasting sadness
- A severe and noticeable drop in energy
- Worry (founded or not)
- Anxiety (founded or not)
- Having less energy
- Being less active
- Change in appetite patterns
- Feelings of hopelessness
- Loss of interest in activities you once loved
- Suicidal thoughts
- Change in sleep habits
- Constant fatigue
- Feelings of guilt
With all of these symptoms, you may be wondering how to identify bipolar disorder from depression as well. Learn more about the key differences between bipolar disorder vs depression.
“Bipolar disorder, literally meaning, ‘two poles,’ incorporates both mania and depression. Mania, described as a rush of energy, typically lasts for several days. Depression, described as an all-encompassing feeling of dread, can last several weeks as part of bipolar disorder or act as a stand alone diagnosis and always be present to a certain degree.”Talkspace therapist Meaghan Rice, PsyD, LPC
Treatment Options for Borderline Personality Disorder vs. Bipolar Disorder
Finding the right, effective treatment plan for borderline personality vs bipolar disorder often takes both patience and time.
For BPD, medication isn’t the go-to treatment. Unfortunately, the U.S. Food and Drug Administration (FDA) has yet to approve any drugs to treat borderline personality disorder and the benefits of trialed medications are largely unclear. However, there are a number of options to help manage some of the symptoms those with BPD might be experiencing.
For bipolar disorder, typically a combination of lifestyle recommendations, medications, and therapy from a licensed mental health provider is a suggested form of treatment.
Treatment for borderline personality disorder
BPD can be treated using therapy and some types of medications for specific symptoms, like anxiety and depression. Psychotherapy is commonly suggested. Many people find that group therapy or one-on-one talk therapy is particularly effective. Generally, there are two forms of therapy often suggested for treating BPD.
- Cognitive behavioral therapy (CBT) — CBT is often helpful in helping someone recognize behaviors and beliefs that create their perception of the world. It can also help change some of those behaviors and beliefs.
Many people credit CBT with helping them learn how to manage their anxiety and reduce some of the mood-related symptoms (like anxiety and an inclination for self-harm) that are associated with BPD.
- Dialectical behavior therapy (DBT) — DBT is a form of therapy designed specifically for people who have a borderline personality disorder. The concept includes a focus on acceptance and being aware of your existing emotional state and the environment you’re in at any given moment. Like cognitive behavioral therapy, dialectical behavior therapy can help those with BPD overcome an urge for self-harm and improve relationships while controlling emotions.
“The focus of both a CBT and a DBT approach in working with individuals who struggle with Borderline PD, is on their relationship with others. We spend a lot of time challenging the dysfunctional beliefs and perspectives that often lead to a push and/or pull dynamic with others. Rejecting others prematurely out of fear that they reject us first is problematic in that it can lead to isolation.”Talkspace therapist Meaghan Rice, PsyD, LPC
Treatment for bipolar disorder
Treatment for bipolar disorder often includes a combination of medication, therapy and specific lifestyle changes.
- Psychotherapy — The right form of therapy (like CBT) can help you learn how to manage bipolar disorder. Therapy has also proven effective in helping treat other symptoms associated with bipolar disorder like substance abuse, stress, and anxiety.
- Medication — Certain mood stabilizers can be beneficial during both manic and depressive episodes. Antipsychotics, anticonvulsants, and others might be options.
- Self-management — Learning to recognize the behaviors and early signs of the highs and lows associated with bipolar disorder is critical. It can help you better manage bouts of mania or depression. If you feel yourself starting to exhibit either side of the disorder, you should reach out to your healthcare provider or therapist as soon as possible. Together, you can discuss the best possible path forward, whether it be a change in medication, therapy, or both.
- Additional approaches — Self-care is critical for everyone. Eating and sleeping well, and taking care of yourself physically and exercising can help enhance aspects of your mental health and well-being.
“Bipolar disorder typically responds well to a combination of all different types of modalities. It requires each individual to explore what works best for them, but making sure to include modalities specific to depression as well as specific to mania. For example, we can therapeutically challenge beliefs and perspectives that lead to depression in the same way that we can use medications to decrease the levels of intensity of mania.”Talkspace therapist Meaghan Rice, PsyD, LPC
How to Get Help for BPD or Bipolar Disorder
Getting help so you can understand borderline personality disorder vs. bipolar disorder is possible. You can reach out to friends and family for support, and find a licensed therapist who can treat either disorder. Your healthcare provider and therapist can help you feel better and live the fullest life possible.
- Bipolar disorder | NAMI: National Alliance on Mental Illness. Nami.org. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder/Overview. Published 2017. Accessed August 15, 2021.
- Do I have borderline or bipolar? Mental health America. https://screening.mhanational.org/content/do-i-have-borderline-or-bipolar/. Published 2020. Accessed August 15, 2021.
- Sanches M. The Limits between Bipolar Disorder and Borderline Personality Disorder: A Review of the Evidence. Diseases. 2019;7(3):49. https://doi.org/10.3390/diseases7030049. Published 2019. Accessed August 15, 2021.