Bipolar vs. Borderline Personality Disorder

Instructor: Karin Gonzalez

Karin has taught middle and high school Health and has a master's degree in social work.

In this lesson, you will learn the definition and symptoms of bipolar disorder and borderline personality disorder and understand the similarities and differences of the two. Following the lesson will be a brief quiz to test your knowledge.

What is Bipolar Disorder?

'Bipolar' is a word often thrown around by people unfamiliar with what it actually means. If someone is really happy but then suddenly erupts into an angry outburst, a friend might accuse them of being 'bipolar.' Sometimes people refer to a person who is bipolar as having two personalities. Both of these assumptions are oversimplified or wrong representations of this serious psychiatric illness.

Bipolar disorder (BP), also known as manic depression, involves alternating states of elation and high energy (mania) with depression. Bipolar disorder is often caused by a chemical imbalance in the brain or stressful and traumatic environmental factors. It's important to note that everyone has highs and lows in their mood, but this does not mean that they have bipolar disorder. Someone would be diagnosed with BP if their mania and depression were significant and negatively impacting areas of their life.

Let's look at Susan's BP.

Susan couldn't sleep well, so she got up at 4 a.m. to start household chores. Despite her lack of sleep, she felt happy and highly energetic. In fact, she sang while cleaning. She also thought of many ideas for inventions to improve the vacuum, iron, and her son's high chair. Susan went so far as to draw up sketches of what these inventions would entail. Then she woke her husband at 7 a.m. to tell him all about her plans to be an inventor and make them a lot of money.

Susan accomplished a lot during her manic state. She thought she was the best stay-at-home mom in the world and frequently posted pictures and updated her status on Facebook, highlighting the successes of her day.

A few days later, Susan felt depressed and struggled to get out of bed. She ate every bit of junk food in her pantry and put her son in front of the TV all day so she could lie in bed and sulk. She felt hopeless as a mom and even considered if her son and husband would be better off without her. Susan felt frustrated that she went from being so productive a few days ago to being so lazy and lethargic.

Susan is a perfect example of someone with BP. Feelings of elation, like being on top of the world, are soon followed by feelings of hopelessness and depression, or vice versa.

How does bipolar disorder relate to borderline personality disorder (BPD)? Let's first look at what BPD entails.

What is Borderline Personality Disorder?

Personality disorders can form when genetics and/or negative life events (i.e. abuse, trauma, etc.) accumulate to a point that they affect a person's personality. Borderline personality disorder (BPD) is characterized by a pattern of unstable relationships with others, deep-seated fears of abandonment, impulsivity, an unstable sense of self, feelings of emptiness, intense (often 'out-of-left-field') anger outbursts, and paranoid thoughts. Paranoid thoughts in BPD center around a fear of being abandoned or hurt in interpersonal relationships. For instance, people with BPD have unreasonable thoughts that others are maliciously trying to hurt or leave them.

One of the biggest indicators to therapists that a client has BPD is if the client first has an idealized view of the therapist, and then, like a light switch, hates and loathes the therapist. This is one of the biggest reasons that individuals with BPD are often difficult to treat. They may enter therapy willingly and with an open-minded, but then with a small trigger, become accusatory, or even abusive, to the person who is trying to treat and help them. According to the American Psychological Association, 70 percent of people with BPD drop out of treatment.

Now, let's consider Amy's situation.

As a child, Amy was sexually and physically abused by her father, which her mother knew about. When the Department of Children and Families discovered what was happening, they took Amy out of the home.

Amy now experiences BPD as an adult. She is not able to have a stable romantic relationship or maintain healthy friendships. She will quickly fall in love but then become fearful that her partner will abandon her, or paranoid that they have ulterior motives, and she will instigate yelling matches and fights. Amy often feels empty and depressed and has impulsive, uncontrollable outbursts of anger.

Amy is a textbook example of someone with BPD. But what does borderline personality disorder have to do with bipolar disorder?

Similarities Between Bipolar and Borderline Personality Disorders

These two disorders are often confused because they have similar symptoms. BPD is often underdiagnosed. The National Alliance on Mental Health reports that about 1.6 percent of Americans have BPD, but some theorize that the percentage could actually be higher, up to nearly 6 percent, due to misdiagnosis. For instance, BPD is often mistaken for bipolar disorder or post-traumatic stress disorder.

Let's take a look at some of the similarities between BP and BPD:

Mood Swings. The quick turn in both BP and BPD from elation and idealization to depression and anger is the primary symptom that confuses therapists when making a diagnosis. The fluctuation of moods and tendency of these moods to change like a light switch in both disorders can give them a similar outward appearance.

Reckless behavior. Individuals with BPD or experiencing a BP manic episode often engage in reckless and careless behaviors, such as driving too fast or spending money they don't have on things they don't need. They may engage in high-risk activities such as popping wheelies on a motorcycle.

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