How to Tell the Difference Between Borderline Personality Disorder and Bipolar Disorder
Bipolar disorder and borderline personality disorder have some symptoms in common, but are two very different diseases. It’s important to understand the difference between borderline personality disorder and bipolar disorder, in order to help yourself or someone you love get the right treatment. Each of these two mental disorders is often misdiagnosed as the other, because the difference between borderline personality disorder and bipolar disorder, in terms of symptoms, can be so subtle.
Bipolar disorder causes its victims to cycle through mania, a mental state characterized by feelings of invulnerability, euphoria, and impulsivity, often followed by periods of severe depression marked by anxiety, aggression, irritability, suicide attempts or self-harming episodes. The person is able to function normally in between mood cycles.
The difference between borderline personality disorder and bipolar disorder becomes hard to discern when we consider that borderline personality disorder also causes symptoms similar to those found in both phases of the bipolar mood cycle. The biggest difference between borderline personality disorder and bipolar disorder is that the person with bipolar disorder does and says destructive, risky or hurtful things because of a chemical imbalance in the brain; with medication, or between episodes, the bipolar person’s symptoms disappear.
You can more easily understand the difference between borderline personality disorder and bipolar disorder when you consider that symptoms in a person with BPD are chronic; the person does destructive, risky or hurtful things to avoid rejection or perceived rejection and stave off possible emotional pain. While a person with borderline personality disorder might have mood swings, there’s a big difference between borderline personality disorder and bipolar disorder mood swings, namely, that BPD mood swings occur much more rapidly, often every few minutes or hours. For the most part, bipolar disorder mood changes occur every few months or years, with periods of normalcy in between.
Another key difference between borderline personality disorder and bipolar disorder is that people with BPD have mood swings and lash out in response to events, or perceived events, going on in their lives – especially when they feel the threat of abandonment. This doesn’t happen with people suffering bipolar disorder because their mood changes are due to changes in the brain.
13 Comments
Root Branch
Can’t you have both? Or have untreated bipolar turn into borderline?
Rick Anderson
I’m NOT a mental health professional, as a layman, I suppose its possible to have both afflictions, but I suspect it is extremely rare.
As far as untreated bipolar turning into borderline, NO, that is NOT possible. Bipolar is a physiological problem that occurs in the brain, chemical imbalances are behind it and can be treated by re-balancing the brain chemicals. Borderline is a maladaption of learned behavior, although there is some evidence it might be inherited and there might be a difference in brain structure that might account for a propensity to become afflicted more so than the general population, but that is NOT proven. The counter argument is that a parent with Borderline would create the exact environment for the child to maladapt and suffer borderline themselves, and that might be behind the hereditary correlation.
Rick Anderson
For years I thought my ex wife was bi-polar, the few people outside our marriage that caught glimpses of her behavior when she let her mask slip, or the few that I confided in and described my ex wife’s behavior behind closed doors, would suggest she must be bi-polar as well.
We were all wrong and I suspect the higher profile of bi-polar disease in the media and culture is the reason behind amateur diagnosis based off some glimpses of behavior all fall into a popular disease that has become a household name.
The key difference in the afflictions, that I was able to exclude Bi-Polar Disorder and kept searching until I found Borderline Personality Disorder. (Please note, my ex-wife refused to even acknowledge she ever had problem and refused to cooperate with any of my attempts to get help, so I had to diagnose her myself. During the separation, I was able to get my wife into a marriage counselor that was qualified to also diagnosis her, and the counselor did conclude the same that I did.)
Bi-Polar Disorder the mood swings are cyclical and it takes days to gradually shift from one mood extreme to another.
My ex-wife would suffer instantaneous mood swings so drastic and dark, it was like she was a whole different person (a.k.a. identity disturbances). The instantaneous mood swings definitely are NOT bi-polar.
I can go on and on about the cycles of my ex-wife’s behavior, I think if you compare the cycles, the details of BiPolar’s cycle would NOT fit a Borderline’s and vice-a-versa; the only similarity is that sometimes in Borderline you can find a cycle in the symptoms. The Borderline cycles, if there are even cycles are NOT regular or evenly spaced, there is NOT corresponding highs to the lows. In my ex’s case, there was almost never highs, just coming up to even and calm (normal) was her high. There certainly was highs in the courtship, which is learned behavior, NOT driven by a cycle.
Bon Dobbs
Rick,
I was thinking on not approving your comments here because they are each filled with misinformation. Your statement:
“Bipolar is a physiological problem that occurs in the brain, chemical imbalances are behind it and can be treated by re-balancing the brain chemicals. Borderline is a maladaption of learned behavior, although there is some evidence it might be inherited and there might be a difference in brain structure that might account for a propensity to become afflicted more so than the general population, but that is NOT proven.”
is just not accurate in light of most recent research. Even in 1993, when DBT was first created, Marsha Linehan posited a biosocial model. More recently, researchers at Mt. Sinai have shown that these brain differences are real and proposed a cause of BPD is due to differences in neuropeptides. Here is a quote:
For several years, there has been an ongoing discussion about whether impulsive aggression or affective dysregulation is at the core of the disorder. While these factors are important in borderline personality disorder, it is the exquisite interpersonal sensitivity that frequently triggers both dysregulated affect and impulsive behaviors, which suggests that this sensitivity perhaps rests at the core of the disorder and may in turn drive impulsivity and dysregulated affect. Consistent with this conceptualization, Gunderson (2) suggests that disturbances in the interpersonal realm may serve as a potential endophenotype for identifying genetic vulnerabilities in borderline personality disorder, but little research has been done on the neurobiological substrates of the interpersonal sensitivity of the disorder.
It is noteworthy that many symptoms in the interpersonal domain of borderline personality disorder are actually
manifestations of intrapersonal difficulties (e.g., difficulty being alone and misperception of the intentions of
others as malevolent), and this dimension could perhaps be reconceptualized as “intrapersonal dysfunction.” We
suggest that an internal feeling of well-being, stability, and self-regulation in borderline personality disorder is tenuous
and may rely heavily on a sense of interpersonal contact and connectedness. This vulnerability may be related
to an underlying dysregulation of neuropeptides. The critical role of neuropeptides, including the opioids, oxytocin,
and vasopressin, in the regulation of affiliative behaviors as well as a sense of well-being suggests that these systems
may be implicated in borderline personality disorder and are therefore potentially promising targets for treatment.
…
The interpersonal dysfunction typically seen in this patient
group can be conceptualized within one of several
paradigms: 1) as distinct from neurobiology and conceptualized
purely in psychological or developmental terms;
2) as an emergent phenomenon stemming from the interpersonal
consequences of impulsive aggression and/
or affective instability; and 3) as a problem arising from
neurobiological vulnerabilities that lead to interpersonal
sensitivity, partially distinguishable from those implicated
in impulsive aggression and affective instability and manifest
most robustly in the interpersonal domain.
In the first model, neurobiological factors are conceptualized
as relatively nonspecific and less important, with
interpersonal disturbances developing in the context of
dysfunctional attachment interactions. Specific stressors
include neglect, abuse, and other trauma as well as repeated
experiences of feeling invalidated. In such a model, neurobiological
factors may be considered in terms of a “black
box”—that is, nonspecific mechanisms. We will argue that
the neurobiological underpinnings related to the interpersonal
dysfunction may be explicable in established neurobiological
systems related to affiliation and affect regulation
that shape the trajectory of interpersonal development
in the context of the specific interpersonal environment.
In the second, interpersonal dysfunction emerges as a
consequence of the more fundamental disturbances of
affect regulation and impulse dyscontrol (4, 22–25). Thus,
individuals with borderline personality disorder are less
able to modulate their emotions in the context of interpersonal
relationships, so their well-being is experienced
as dependent on the availability of important others. They
are more likely to become disappointed, feel abandoned,
or become enraged in their key relationships. Because
they have a low threshold for impulsive behaviors, these
emotions are translated into action, including outwardly
aggressive or self-destructive behaviors that disrupt these
relationships. While these dynamics may indeed contribute
to much of the relational turmoil of borderline personality
disorder, they do not easily account for the feelings
of inner deadness or panicky aloneness these individuals
feel when they are separated from the important figures in
their life, the repeated self-injurious behaviors when their
relationships are disrupted, and their reliance on others to
maintain a stable sense of self-esteem.
In the third paradigm, there are specific neurobiological
systems (35), including neuropeptides such as the opioids
and oxytocin, that are implicated in affiliative and interpersonal
behaviors. Dysregulation of these peptides may specifically
contribute to the disturbed affiliative behaviors by
intensifying the stress of separation, rendering the maintenance
of self-esteem and a feeling of well-being more problematic,
and diminishing the capacity to trust and respond
appropriately to others, thus driving self-destructive behaviors
that may provide relief from pain. In conjunction with
neurological substrates already implicated in the impulsive
aggression and affective dysregulation of borderline personality
disorder, these dysregulations may more directly
affect the capacity to maintain interpersonal relationships.
Considering these alternative paradigms, we propose
a model of borderline personality disorder that incorporates
vulnerability or dysregulation of the opioid system.
We posit low basal opioid levels in this disorder, with a
compensatory supersensitivity of m-opioid receptors such
that transient increases in opioids following painful stimuli
lead to heightened responses (21, 36). Low basal opioid
levels are reflected clinically in a sense of “inner deadness,”
chronic dysphoria, and lack of a sense of well-being,
all characteristics of borderline personality disorder,
while stimulation of the opioid system (e.g., nonsuicidal
self-injurious behavior) can result in heightened relief of
pain and restoration of a sense of well-being.
Rick Anderson
Your reply is very long and esoteric, it could confuse the average person looking at the article and comment for basic understanding. It was difficult for myself to read.
First things, first, a question was asked.
“Can’t you have both? Or have untreated bipolar turn into borderline?”
Is it possible for both to be co-morbid? How often/possible is it to occur?
I stated that they are two very different afflictions with seperate causes. I can’t imagine that one could progress into the other, is that correct?
Correct me if I’m wrong, the information in your reply does NOT prove that biosocial is the cause of Borderline, just that there is a strong link to be made.
I totally accept a more accurate way to state it would have been, there is strong evidence and the predominate work in the field has strongly linked the cause of Borderline Personality Disorder to a combination of Biology and Social Factors. Am I correct in understanding the point you’re trying to get across?
And one note, I kinda regret using the term learned behavior, for lack of better words, because I am a layman. But learned behaviour and maladaption are two very different things, aren’t they? I’m guessing learned behaviour is a bad term to use with Borderline, because it really isn’t at the root of any of the behaviour, no more so than learned behavior effects everyone.
Bon Dobbs
Considering that the disorders have 2 separate neural chemicals involved (if the study I cited is correct – and there are others that have shown this), you probably can have both, but I’m not a neuroscientist so I’m not sure if the chemicals are in opposition. The study cited was not intended to demonstrate the biosocial model – that’s a model that was originally put forth in 1993 when DBT was created and at the time the biological factors were “yet unknown”. The study was intended to demonstrate that in the past few years researchers have found many biological and neural factors related to BPD.
In my experience, you certainly can have BPD and PTSD (my wife does) and BPD only (like my daughter). The PTSD causes maladpative behavior that can look like BPD, but the behaviors are those that were functional when the abuse was suffered but no longer functional in a given situation. It is threat-awareness behavior that can be difficult for the loved ones to endure, yet are also deeply conditioned. My daughter is very emotionally sensitive. This makes her a loyal friend and empathetic to those around her. It can also make her quite angry with what she sees as unjust. She’s always been emotionally sensitive and it seems to have been in-born – not learned – as I have another one (her twin sister) who is not as sensitive emotionally.
The point I was making is that the idea that BPD is a personality disorder and learned behavior seems to do 3 things that are dangerous to them and to the idea of supporting those we love. Firstly, it blames the parents for poor, invalidating and neglectful/abusive parenting. Believe me, as parents of a child with BPDish traits I’ve heard more than enough of that. I have TWINS. They have had the same parenting. One is one way. One is another. Secondly, it sends the message to the person with BPD that their issues are entirely behavioral and therefore in their complete control. With enough will power or self-awareness, they can change their behavior. In other words it blames the victim. BPD is a very painful way to go through life and to treat it as a “person behaving badly” disorder diminishes the emotional pain of the person with the disorder. Thirdly, it sets up a situation that is abuser/victim situation in which the family members and spouses (or more likely ex spouses) are the victim of this behaving badly person. That is, she could change if she really wanted to, or if I set boundaries and if she doesn’t then she deserved getting left.
Rick Anderson
But BPD is a Personality Disorder, it is right in the name, it is still in the latest DSM as such, is it NOT?
Are you saying the latest evidence is pointing to it NOT being a Personality Disorder?
I don’t disagree that treatment requires validating experiences.
Non-BPD’s suffer PTSD from their relationships with BPD’s as well, do they NOT?
Bon Dobbs
Yes, personality is still in the latest version of the DSM. There are camps in the APA. One camp believes it is a personality disorder, one camp doesn’t. The politics of what to call it are huge. I sat in on a discussion of the DSM before it was published and there are many different factors for leaving it as a personality disorder. Part of that has to do with funding and part has to do with philosophical stances and part has to do with insurance payments. If research shows that it is a neurological disorder, they will likely change it. The ICD-10 changed the term to Emotionally Unstable Personality Disorder. The DBT folks would probably like for it to be renamed Emotional Regulation Disorder (or Emotional Dysregulation Disorder) because they believe the primary core driver of the disorder is emotional dysregulation, which, as you noted is not moods – it is emotions which can be very labile. Others (including the mentalization people) feel it is an attachment disorder. Still others, like the study I cited, believe it is related to u-opioid issues in the brain – like Parkinson’s is related to l-dopa or clinical depression is related to serotonin.
“An Opioid Deficit in Borderline Personality Disorder: Self-Cutting, Substance Abuse, and Social Dysfunction.” The American Journal of Psychiatry, 167(8), pp. 882–885
“Dysregulation of regional endogenous opioid function in borderline personality disorder”. Prossin AR1, Love TM, Koeppe RA, Zubieta JK, Silk KR.Am J Psychiatry. 2010 Aug;167(8):925-33. doi: 10.1176/appi.ajp.2010.09091348. Epub 2010 May 3.
What I am saying is that non-BPD’s “PTSD” from experience with borderline behavior (although not in ALL cases, obviously) doesn’t rise to the level of PTSD like my wife experiences. She was repeatedly raped as a child. While I don’t want to dismiss the emotional abuse that non-BPD’s suffer (and physical as well), I think the best way to address that is by skills acquisition, which is what I did and why I wrote my book. The only path to empowerment IMO is through knowledge and the acquisition of agility – in the case of being in relationship with a person with severe emotional dysregulation, like both my wife and daughter, is to learn new skills. Also, if indeed the disorder is the result of an opioid deficit (couple with over-active receptors in the brain), then the person with BPD would be in almost constant brain-driven pain and have a desperate need for a sense of well being. Personally, I think that sounds awful.
Some people believe alcoholism is a disease, some do not. If you believe it is a disease, like they do in the book “Alcoholics Anonymous” (a manifestation of an “allergy” which triggers a phenomenon of craving), then to call it a “personality disorder” (or just behave better – i.e. don’t drink) would not be either helpful or effective. Would it?
Rick Anderson
I was going to bring up the correlation of BPD with childhood abuse and tramau.
Keeping in mind correlation does NOT necessarily mean causation.
But is that NOT an example of maladaption?
NOT to dismiss the other research. The fact is, as I understand it, since human beings brains are underdeveloped at birth, and continue to devlope as they mature (even seen young adulosence is the most critical time for brain development), that environment and stimuli does change the brain and can create patterns/structure in the brain that can create dysfunction the rest of their life. Can that create an opioid deficiency, I don’t know, but I have seen that argument as too why abuse or trauma in childhood can produce problems that can be found in the biology of the brain.
But it seems to be, you’re saying youself the jury is still out on whether BPD is nature or nurture, or a combination of both. That is my layman understanding, there is still much, much more to learn about this affliction.
Bon Dobbs
The thing is what you’re saying doesn’t matter. I don’t have to point to a cause. What I was originally responding to was your idea that BPD is a personality disorder and is all learned behavior (your words). The clinical research does not bear that out. There is a biological component and possibly genetic component to BPD as well – that’s what the research is indicating. The “it’s a personality disorder” response is very invalidating to the parents of these adult children with BPD. And invalidating to the sufferers themselves. I’ve met hundreds of parents of BPD sufferers. I know many of them have completely normal children about the same age of the person with BPD. I know that many of the children with BPD have not suffered horrible abuse. You think the parents don’t feel some level of guilt already that their child has a debilitating disorder? That there’s not a whole group of people that blame the parents? It’s difficult enough to cope with the disorder and find effective treatment without all of that. You’re an ex-spouse of a person with BPD. Have you thought of what it feels like to be a parent of someone with BPD? Did you know that both autism or schizophrenia were once thought to be caused by “refrigerator mothers”? http://en.wikipedia.org/wiki/Refrigerator_mother_theory I wonder how that felt to the parents of people with those issues?
As for the causes, yes, the jury is out. It will likely be out forever. If you go to wikipedia and look at bipolar disorder there are various causes of that too.
Rick Anderson
The thing is what you’re saying doesn’t matter. I don’t have to learn about BPD, I am ex spouse of someone with BPD. BPD is out of my life and I have every right to walk away.
My ex wife’s mother has shown every sign of being afflicted with BPD as badly as she was. I have considered what it was like for her father to have a wife like that. He did NOT stop the mother from aflicting all sorts of trauma on the whole family. I have had some success at stopping my ex-wife at afflicting that trauma on my children, mostly by being a human shield and spending most of family life as a hostage negotiator and father.
My children have NOT shown any symptoms of BPD, but have shown some signs of interpersonal relationship problems, reflective of their only model for a loving relationship they have known is constant conflict and instability. I am working with my children to get them past that, and understand the dysfunction they have witnessed and how it will effect them, how to recognize and avoid the pitfalls of falling into a high conflict relationship. Something my parents never did for me, because of their own high conflict, bullying family they ran themselves. Nor my father-in-law who grew up in an abusive family. Sorry, you may NOT see it that way, but just as important as children with BPD are children that without BPD that may suffer effects the rest of their lives. I think about Children before I think about parents, and parents should be thinking about children before themselves.
What your saying about parents is the same any parent goes through with children in crisis, whether they bear any responsibility or non at all. Of course parents care and support for parents is important as well. To imply personality disorders, maladaption and learned behaviour can only be the fault of the parents is ridiculous, I never said that, yet you try to put those words in my mouth, aren’t you?
While your attitude is benificial in avoiding the stigmatism of parents, you’re NOT communicating it properly. I certainly hope you do NOT believe that there is benefit in subverting the academic discussion of the science, to avoid hurting the feelings of parents is good science. Yet, that seems to be the point you’re trying to get across?
Bon Dobbs
What I was saying is that your characterization of the disorder is not correct or helpful. Having a scientific discussion could certainly be helpful. The point I am trying to get across is that there are a huge amount of suffering parents whose children have disorders and, in the case of BPD, many of them have been blamed for causing the disorder, which, based on the recent research, doesn’t seem to be the case. That’s a tragedy for a several reasons.
You have a single case on which to base your analysis – your ex-wife and your ex-wife’s family. I have hundreds of people with whom I’ve worked, been in support groups and been to training with (both DBT-FST and Mentalization training).
My original problem with what you were saying is that you were commenting on how BPD is a personality disorder and it’s “learned behavior” – which is exactly what I said in my last post. I find that approach a big problem on the Internet in general and with certain people specifically. Some people say that BPD is not even a disorder at all – that it is a “core trauma” attributed “to deficits in affection/touch/holding and emotional attunement, that derail a baby’s ability to maintain a nourishing bond of attachment with the birth mother.” That’s a quote from someone on the Internet who is just (IMHO) recycling the “refrigerator mother” argument from the 1950-60’s. It is a very unhelpful and ineffective way to approach the disorder and, based on research, flat-out wrong.
I can understand your desire to protect your children from trauma. I get that. I feel the same way about my kids. You say: “My children have NOT shown any symptoms of BPD, but have shown some signs of interpersonal relationship problems, reflective of their only model for a loving relationship they have known is constant conflict and instability. I am working with my children to get them past that, and understand the dysfunction they have witnessed and how it will effect them, how to recognize and avoid the pitfalls of falling into a high conflict relationship.” Firstly, my emotional twin showed signs of emotional lability very young and we intervened with DBT for children when she was 9. Secondly, how are you going about this? Do you think that using a method that is based on therapeutic success would be a good approach? Eventually, I did. At first, I didn’t. I didn’t want to change myself. I didn’t think that I needed to. I tried all kinds of t=other methods including those from popular books and none of them worked to achieve what I was trying to achieve.
I have 4 children. Only one of them is BPDish. My approach to my emotional daughter was through DBT. My approach to my wife with the disorder was through what I described in my book. It is an approach that was cobbled together from DBT-FST and conversations with other loved ones of people with BPD who tried these methods. It is what I found that worked for my daughter as well as my wife.
As for: “To imply personality disorders, maladaption and learned behaviour can only be the fault of the parents is ridiculous” – you might be surprised on what therapists say – like BPD treatment is “re-parenting”. There is a LOT of blaming the parents going on, in the therapeutic community, on the Internet and by “well intentioned bystanders”.
I don’t know what you’re doing to support your goal of protecting your children from the effects of BPD, but you can know what I’m doing by reading my book. It’s not what you might expect. I like to judge an approach by its effectiveness. I’ve seen my approach be effective in many spouses, parents and children of people with BPD.
My original intention in having this conversation was to counteract the idea that BPD is basically all behavioral – i.e. “a person behaving badly” – because in my experience and in the clinical research, that’s just not the case. Saying so just perpetuates too many ineffective ideas about BPD IMO.
Elizabeth R. (BPD)
Typical family members. Hey, I think you both have a point. The use of “NOT” probably doesn’t serve your purposes. And you both still have to deal with the fact that you were each attracted to a BPD woman with all of her dysfunction. Then you had kids with her!