Borderline personality disorder, typically abbreviated BPD, and bipolar disorder are often confused.
Both disorders can involve rapid mood shifts and intense, difficult-to-deal-with emotions that impact daily functioning. Both are typically managed using a combination of psychotherapy and medication. However, they feature different diagnostic criteria, etiologies (or origins), and treatment approaches.
What is Borderline Personality Disorder (BPD)?
Borderline personality disorder is in the diagnostic category of cluster B personality disorders. A core feature of BPD is significant abandonment anxiety, which can result in sometimes pre-emptive, frantic efforts to subvert real or perceived abandonment.
A common behavior seen in BPD is “splitting,” where individuals tend to view others in relationships as “all good” initially, and then shift to complete devaluation the moment abandonment anxiety is provoked or trust is called into question.
This all-or-nothing pattern can be understood as a defense mechanism that serves a protective role by simplifying reality in a way that offers relief from intense anxiety or internal conflict. However, by shifting between these extremes, relationships can sometimes become quite turbulent or end prematurely.
As a secondary impact of this sensitivity to abandonment, people with BPD often struggle to sustain healthy relationships and to feel secure within them.
Some other common features of BPD include intense, volatile emotions that can shift rapidly, an unstable sense of identity, and depressive symptoms like a chronic sense of emptiness and suicidal ideation. As a result of these challenges, BPD, like many personality disorders, features high comorbidity (often co-occurs) with other disorders.
Where Does it Come From?
It’s worth noting that some dialogue among clinicians seems to be moving in the direction of classifying BPD as the result of developmental trauma or CPTSD (complex post-traumatic stress disorder). In this view, the central fear of abandonment contained within BPD, which gives rise to its emotional and relationship issues, is seen as emerging from attachment wounds sustained during childhood, rather than a disorder of the personality.
While CPTSD has yet to be adopted by the DSM, the formal publication of mental disorders recognized by the American Psychiatric Association (APA), some of its features do appear to be contained within subtypes of PTSD. And CPTSD does feature in the latest edition of the World Health Organization’s International Classification of Diseases (ICD-11).
Literature on the precise etiology of BPD is complex. BPD likely originates from the interaction of many factors, where trauma may play a role. It remains somewhat unclear whether BPD represents a separate category from CPTSD. There may be significant overlap between the two diagnoses, while also occupying distinct areas. This writer, for one, reserves a level of curiosity and non-judgment towards the many perspectives and conceptualizations of BPD that exist.
What’s the Treatment?
Typically, treatments for BPD include DBT, or dialectical behavior therapy, which can help people build skills to deal with intense emotions, as well as medication to target specific issues impacting functioning. Various trauma-informed approaches can also be valuable, especially when childhood trauma or abandonment is foundational to an individual’s presentation.
What is Bipolar Disorder?
Bipolar disorder, by contrast, is a mood disorder. The core feature of bipolar disorder is a rapidly fluctuating mood that oscillates between two (hence the prefix ‘bi’), opposite poles (‘polar’). These two opposite states are called depressive and manic episodes.
A depressive episode looks similar to clinical depression and features the same characteristic low energy, low self-esteem, lack of motivation, suicidal ideation, insomnia/hypersomnia, etc.
However, with bipolar disorder, these depressive episodes can shift suddenly into manic episodes, which can be understood as the opposite of depressive states. In manic episodes, people experience exceptionally high energy, high self-esteem, racing thoughts, impulsiveness, and irritability.
Unfortunately, while manic states might seem like an improvement over depressed states, mania can be difficult to deal with, as it can lead to risky, unsafe behavior that often results in outcomes that are not consistent with an individual’s typical values. Hospitalization, unfortunately, is not uncommon when manic individuals engage in dangerous or self-injurious behavior.
Where Does it Come From?
The precise cause of bipolar disorder is unknown and is understood to involve a combination of genetic, biological, and environmental influences. Bipolar disorder is known to run in families and has a highly heritable, genetic component. While certain biomarkers in the brain have been identified, there is no known single brain-based cause for bipolar disorder.
What’s the Treatment?
Treatment for bipolar disorder often involves medication to help reduce the severity and impact of mood swings. Mood stabilizers appear to serve this purpose, while antipsychotics can be helpful for manic episodes or if an individual experiences psychosis. Antidepressants may also be used. Psychotherapy, broadly, is beneficial. Approaches like cognitive behavioral therapy (CBT), for example, can help people address negative thought patterns that may be contributing to mood swings.
BPD vs. Bipolar: In Summary
To summarize, while both borderline personality disorder and bipolar disorder contain some symptom overlap in terms of intense emotions, mood swings, and depressive features, they each occupy distinct categories with different core issues.
It can be helpful to think of BPD as instability in relationships and the self-concept, and bipolar as instability in mood.
Both BPD and bipolar respond well to medication and psychotherapy, though their specific treatment approaches are different.
Treatment for BPD often involves supplying individuals with coping skills for managing intense emotions, addressing attachment trauma, and attending to patterns that may reinforce disconnection and instability in interpersonal relationships.
Treatment for bipolar disorder, by contrast, involves a heavier emphasis on managing mood, equipping clients with medication and relevant skills to navigate mood swings.
This blog contains the views of Alex Thomson and is intended as educational content. It is not a replacement for therapy or formalized diagnostic assessment. Read full Disclaimer.
Alex Thomson is a licensed associate professional counselor in the state of Georgia and a certified trauma professional. He provides counseling services through Exhale Counseling Services in Acworth.
