BPD vs. Bipolar: Understanding the Key Differences. Can You Have Both?

Announcement

This article will help educate you on the distinct characteristics of BPD and Bipolar Disorder, clarify their differences, address the potential for coexistence, and guide those affected toward appropriate diagnosis and treatment.

Introduction

If you are struggling with symptoms of a mental health disorder, it can be a challenge to determine if it’s BPD or bipolar disorder and whether there’s another disorder co-occurring, like major depressive disorder or anxiety. Understanding the differences and whether or not you can have both makes it easier to get the right type of help.

Bipolar disorder represents an individual category of mental health disorders between schizophrenia-related disorders and psychotic and depressive disorders. Borderline personality disorder falls under the category of personality disorders.

There is a great deal of crossover between symptoms for both and a high risk of co-occurring mental health disorders or substance abuse problems. Without a proper diagnosis and the correct form of professional treatment, symptoms can increase the risk of drug or alcohol addiction and interfere with daily life.

	BPD	Bipolar Disorder
Symptoms	– Problems with self-image – Impulsivity – Interpersonal relationship issues – Fear of abandonment	– Manic episodes – Depressive episodes
Causes	– Genetics – Childhood abuse	– Genetics – Stress – Substance abuse
Common misdiagnosis	– Depression – Bipolar disorder – Anxiety disorder	– Depressive disorder – Anxiety disorder – Panic disorder – PTSD
Treatment	– Therapy	– Therapy – Medication

Difference Between BPD and Bipolar

BPD

With borderline personality disorder or BPD, signs of the disorder usually start by the time a client reaches early adulthood. The pattern of instability reaches:

• Relationships
• Self-image
• Impulsive behavior
• And other contexts

People with BPD usually struggle with five or more of the following nine criteria:

1. People go to great lengths to avoid real or imagined abandonment.
2. People often have unstable interpersonal relationships because they go through extreme feelings of being devalued or idealizing the other person.
3. People don’t have a good sense of self when they struggle with borderline personality disorder, and they don’t really know what their self-image is.
4. People are often impulsive and have at least two self-damaging areas like binge eating, substance abuse, reckless driving habits, spending, unsafe sex, or shopping.
5. Clients can struggle with chronic feelings of complete emptiness.
6. Clients might have frequent displays of anger problems like an inability to control their temper or get into physical fights.
7. People usually have effective instability because of their moods, with things like intense irritability or anxiety that spring up every once in a while for just a few hours.
8. People can struggle with stress-related paranoia.
9. People might have recurrent suicidal or self-mutilating thoughts and behaviors.

Bipolar Disorder

Is BPD and bipolar the same? No, they are two very different mental health disorders, although there can be comorbidity where individuals experience both disorders simultaneously.

With bipolar disorder, individuals experience extreme mood swings, usually manic or depressive episodes that can last for several weeks or months at a time. These episodes can be characterized as extremely hyperactive or extremely depressive.

Bipolar disorder can come in a few versions:

• Bipolar I
• Bipolar II
• Cyclothymic

Bipolar I is characterized as manic depression, where individuals struggle with at least one manic episode. Bipolar II is characterized as slightly less severe but with significant swings between manic and depressive episodes.

Symptoms of manic or depressive episodes are usually so severe that they can disrupt work, school, family life, and personal relationships.

BPD or Bipolar Diagnosis: Prevalence

• A borderline personality disorder affects around 2.7% of the population. However, it has a higher occurrence among psychiatric inpatients (20%), individuals getting help at mental health clinics (10%), and in Primary Care settings (6%).
• Roughly 1.5% of the population experiences a 12-month prevalence of bipolar I disorder. It seems to affect men and women at the same rate.

BPD and Bipolar Onset

When do symptoms manifest for bipolar vs. BPD?

BPD

One difference between BPD and bipolar disorder is that borderline personality disorder is an adult-onset disorder, which means that it usually doesn’t present symptoms until adulthood. However, symptoms can sometimes manifest in younger adolescents.

In some cases, the severity of symptoms diminishes as individuals reach their 30s or 40s, but it’s not uncommon to have remissions every few years.

Impulsive symptoms remit quickly, but the other affective symptoms remit at a much slower pace, so when individuals who are older adults start to experience symptoms of their condition coming back, it’ll most likely be the impulsive symptoms before the other symptoms.

• One difference between BPD vs. bipolar disorder is that BPD is equally common in men and women, but women are more likely to seek treatment for it.
• Men tend to externalize their behaviors while women internalize them.

Bipolar Disorder

Bipolar disorder tends to manifest between the ages of 20 and 30, although it can appear later in life. For women, the symptoms typically start around the age of 21, whereas for men, it usually starts around the age of 23.

• More than 90% of people who experience a single manic episode will struggle with ongoing mood episodes.
• Around 60% of people who experience a manic episode struggle with a major depressive episode immediately after.
• People who experience four or more mood cycles of any kind in the span of 12 months struggle more with a diagnosis and treatment because of what is called “rapid cycling.”
• Women with bipolar disorder are more likely to experience depressive episodes compared to men, especially during hormonal changes.

Co-occurring Disorders: can you be bipolar and have BPD?

Several diagnoses for other mental health disorders commonly occur alongside borderline personality disorder. This leads people to ask, “Is BPD and bipolar the same?” and “Can you be bipolar and have BPD?”

BPD Co-occurring disorders

Yes, you can be bipolar and have borderline personality disorder.

Borderline personality disorder frequently co-occurs with depression, bipolar disorder, and other personality disorders.

Depression and Bipolar Episodes

One of the most common co-occurring disorders alongside borderline personality disorder is depression. However, some clients with bipolar disorder who are going through a depressive episode can be commonly misdiagnosed as having borderline personality disorder and depression simultaneously.

Separation Anxiety Disorder

Separation anxiety disorder and borderline personality disorder can often co-occur as their symptoms are very similar. Problems with self-direction, identity, and impulsivity are the central components of BPD, while the issues of abandonment anxiety and interpersonal relationships are often associated with separation anxiety disorder.

Bipolar Co-occurring Disorders

As mentioned, you can be bipolar and have BPD, but other coexisting mental health disorders are common in people with bipolar disorder. There is often an overlap between borderline personality disorder impulsivity and mood changes and those of bipolar disorder.

Anxiety Disorders

The most common mental health disorders to present alongside bipolar disorder are anxiety disorders.

Substance Abuse

It’s also common for people who struggle with bipolar disorder to self-medicate when they don’t get proper treatment, and this leads to problems with substance abuse disorders or alcoholism.
Without proper treatment for co-occurring disorders, attempts to self-medicate or manage symptoms of one disorder can interfere with the management of another.

Diagnosing Bipolar vs. BPD

With BPD vs. bipolar, you have different diagnostic criteria.

Borderline Personality Disorder Diagnostic Criteria

A pattern of instability in relationships, problems with self-identity or self-image, and impulsivity characterizes a borderline personality disorder.

Abandonment

Those with borderline personality disorder will make frantic attempts to avoid any form of real or imagined abandonment.

If you are struggling with BPD, you might always be afraid that someone in your life will reject you, whether it’s a friend, family member, or partner. And that fear can cause significant changes in how you behave, how you view yourself, and what you think.

Any change in your environment can exacerbate these feelings.

• If you are, for example, meeting a close friend for lunch and they are a few minutes late, it might cause profound panic or fury where you are immediately afraid that they have abandoned you and that they are a bad person because of this.
• If you are meeting with someone for an hour-long appointment and they tell you that the appointment is coming to an end, you might experience intense and sudden despair with feelings that you are somehow being abandoned or rejected by that other person.

Unstable relationships

These fears of abandonment can influence the intense and unstable relationships you have. Someone struggling with BPD might idealize an intimate partner but quickly start sharing intimate details and trying to spend as much time together as possible, all to switch on a dime and suddenly feel like that other person doesn’t care enough about you and doesn’t give you enough of their time and is not worth it.

It’s not uncommon for people with BPD to have sudden shifts in how they view other people, either as really good or really bad.

Self-image

People with borderline personality disorder struggle to figure out their self-image. They might experience dramatic shifts, like someone who is on the war path to seek vengeance for any wrongdoing of the past and then immediately into a helpless and needy individual begging for attention.

Some individuals feel like they don’t have any identity at all because of these dramatic shifts, problems with meaningful relationships, and lack of support.

Other features

Several other features of borderline personality disorder include:

• Impulsivity usually involves reckless spending, driving, unsafe sex, substance abuse, or binge eating.
• Recurrent suicidal thoughts or behaviors, as well as self-mutilating Behavior, usually precipitate perceived rejection or separation.
• Significant mood changes and reactions like periods of anger episodes, anxiety, or irritability that last a few hours.
• Chronic feelings of loneliness or emptiness.
• Intense and inappropriate anger and an inability to control things like verbal outbursts, expressions of anger, extreme sarcasm, or bitterness.

Bipolar Disorder Diagnostic Criteria

Bipolar disorder impacts 3% of adults, with 83% of those diagnoses considered severe. Individuals with bipolar disorder experience recurring mood swings, usually a single manic episode followed by a depressive episode, the symptoms of which can continue for several days, weeks, or even months.

Manic Episodes

If you are experiencing a manic episode, you might feel elevated and spontaneously engage in extensive conversations with complete strangers while walking down the street or shopping for groceries.

But that persistently elevated mood can also quickly shift into irritability. It’s not uncommon to experience a decreased need for sleep where you only sleep a little bit, and yet you feel rested and spontaneous, speaking loudly or rapidly during the day and behaving in a theatrical way with dramatic gestures and even singing or dancing.

The hyperactive nature of a manic episode might cause you to engage in multiple projects, all of which are overlapping, and yet you’ll find that you don’t get any of those projects completed because your elevated energy levels also impede focus.

During these phases, you might deal with inflated self-esteem, and even though you don’t necessarily have experience or talent in a given field, you might decide that you will want to speak in public, publish a novel, make a documentary, or something else equally grandiose.

Depressive Episodes

But just as rapidly, you might find yourself switching into a depressive episode where you feel hopeless and even tearful all day, every day. You’ll suddenly find no interest or pleasure in any activity.

Whereas during a manic episode, you may have needed very little sleep, during a depressive episode, you might struggle with hypersomnia or insomnia. It’s not uncommon to be exhausted and yet agitated all day, feeling restless but fatigued concurrently.

Getting tasks done might seem equally impossible during a depressive episode because of your inability to concentrate or make decisions. Symptoms can include changes to appetite and significant weight gain or loss, as well as unending feelings of worthlessness or guilt sometimes about things like loss of appetite or an inability to make decisions.

BPD vs. Bipolar Disorder Risks and Causes

BPD and Bipolar disorder share some crossover where risks and causes are concerned.

BPD

With BPD and bipolar disorder, there are some environmental and genetic risks and causes that can influence whether you have either condition.

Environmental

Borderline personality disorder commonly occurs in people who were subject to emotional neglect or abuse in childhood. A history of sexual abuse in childhood, in particular, has the highest risk factor for borderline personality disorder.

Genetic

Individuals can also struggle with borderline personality disorder if they have a family history of BPD. BPD is five times more likely in people who have a first-degree relative who has been diagnosed.

Physiological

Individuals who have a family history of other mental health disorders are more likely to develop borderline personality disorder. This can include a history:

• Bipolar disorder
• Depression
• Antisocial personality disorder
• Anxiety disorder
• Substance abuse

Bipolar Disorder

Similarly, there are environmental and genetic risks and causes for the development of bipolar disorder, too.

Environmental

Exposure to family conflict or emotional trauma in childhood can increase your risk of developing bipolar disorder. Experiencing traumatic life events or life stress can also increase the risk of relapse, particularly a relapse in depressive episodes for people who have a diagnosis.

Genetic

While there is still a great deal of research on both BPD and bipolar causes, most research points to a strong genetic risk factor. Individuals who have a family member with bipolar disorder are more likely to develop it themselves, much the same as with BPD.

The Importance of a Correct Diagnosis for BPD vs. Bipolar Disorder

If you believe that you or someone close to you is struggling with symptoms of BPD or bipolar disorder, it’s important that you speak with a mental health professional and possibly a few mental health professionals. Several consultations can help you compare the diagnosis you receive and ensure that what you are told is correct.

A misdiagnosis can lead to significant hiccups when it comes to getting the right treatment and controlling your symptoms.

Misdiagnosis for BPD

There is a significant crossover between BPD and bipolar disorder. It is possible to have a diagnosis for both.

However, borderline personality disorder is one of the most commonly misdiagnosed disorders, with nearly 40% of people with BPD originally misdiagnosed as having bipolar disorder.

There are several reasons why this happens:

1. First, there are similar symptoms with regard to impulsivity, emotions, and suicidal ideations so mental health professionals might accidentally provide a misdiagnosis.
2. Second, because symptoms of borderline personality disorder usually manifest later in life, when younger adolescents or teenagers show symptoms, they might be misdiagnosed as having bipolar disorder because that can typically manifest at a younger age.
3. Third, there is a lot of crossover and a higher risk that individuals actually have a diagnosis for both conditions.

Misdiagnosis for Bipolar Disorder

Many people, especially women, who struggle with bipolar disorder are misdiagnosed as having major depressive disorder because they seek treatment during a depressive episode where symptoms are very similar.

It’s equally common for symptoms of PTSD, panic disorder, or anxiety disorders to be misconstrued as bipolar disorder.

In fact, just as is the case with BPD, nearly 40% of people with bipolar disorder are originally misdiagnosed.

Why?

1. First, symptoms of a depressive episode are more likely to be brought to the attention of a mental health professional or primary care physician. When individuals reach out for help with depressive symptoms it’s not uncommon to be misdiagnosed as having depression. Without following up during a manic episode, it can be difficult to receive the right diagnosis. However, many people don’t get help for a manic episode because they may not view it as particularly disruptive or problematic compared to a depressive episode.
2. Second, many symptoms are very similar to anxiety disorders, panic disorders, PTSD, or bipolar disorders.
3. Third, it’s common for people to have comorbidities where they struggle with several mental health disorders like bipolar disorder and anxiety disorder or bipolar disorder and BPD

For this reason, it is imperative to seek a professional diagnosis and proper treatment for bipolar vs. BPD, depression, PTSD, or anxiety disorders.

Getting Treatment for BPD and Bipolar Disorder

Whether you have BPD or bipolar disorder, it’s important that you find treatment. Bipolar disorder, for example, is not something you can cure or fix but rather something you must learn to control and manage.

With the right diagnosis, you can start two forms of treatment for bipolar disorder: therapy and medication.

• Therapy often involves cognitive behavioral therapy, where you can learn long-term coping strategies to help you manage symptoms of depressive or manic episodes.
• You’ll also likely start family therapy where everyone close to you can learn how to help you or avoid exacerbating your symptoms.
• Your therapy will likely include individual psychotherapy, where you can learn to regulate stress and identify signs and symptoms of an upcoming manic or depressive episode.
• Medication like mood stabilizers, anticonvulsant medications, or second-generation antipsychotics can help you manage the acute symptoms of a depressive or manic episode, depending on your circumstances.

It is essential that you work with a mental health professional so that you can monitor the medication you are being prescribed for things like bipolar disorder and regularly review the effectiveness of your medication with someone who can help you recognize efficacy or make changes where necessary.

For bipolar disorder, you’ll likely receive several forms of therapy as the basis of your treatment.

• Cognitive behavioral therapy can be essential to your treatment plan, teaching you ways to change your automatic thoughts and control things like impulsivity and fears of abandonment.
• Anger management can help address the issues of uncontrollable anger and outbursts.
• Dialectical behavioral therapy can encourage you to not only take action to control symptoms but also learn to accept your emotions as they are.
• Individual therapy can help you navigate your thoughts and feelings, things that may have contributed to certain symptoms, and trigger management moving forward.

Without proper care, a correct diagnosis, and professional treatment, symptoms of BPD and bipolar disorder can continue to interfere with relationships, work responsibilities, self-image, and overall achievement and life satisfaction.

Summing Up

There is more than one difference between BPD and bipolar disorder. Is BPD and bipolar the same? No. Can you be bipolar and have BPD at the same time? Yes. Whether you have BPD or bipolar disorder, both, or other co-occurring mental health disorders, it is imperative that you speak with a mental health professional to undergo a consultation, receive a diagnosis, and start treatment to manage your symptoms.