How to Tell the Difference Between BPD vs Bipolar Disorder

Living with Borderline Personality Disorder (BPD) or Bipolar Disorder proves challenging for many people. Both struggle to manage their emotions and maintain personal relationships. Many also face professional difficulties and suffer from additional mental health concerns, such as depression. However, BPD and Bipolar Disorder are often confused for each other, even when the person sees a mental health professional for help. Learning the differences between BPD vs Bipolar Disorder helps the individual the ability to ask the expert the right questions and obtain a more accurate diagnosis.

In this article, you’ll learn about:

• The similarities and differences between Bipolar Disorder and BPD
• How to seek treatment for each condition

BPD vs Bipolar Disorder

On the surface, BPD and Bipolar Disorder appear similar. After all, both conditions feature intense mood swings that appear outside of the person’s control. Likewise, both the person with BPD the person with Bipolar Disorder likely experience impulsiveness that often becomes destructive.

In fact, many people who have BPD initially think they have Bipolar Disorder. However, there are some key differences between the two conditions, making them distinct.

Keep in mind this article is not a diagnostic tool and cannot provide anyone with an actual diagnosis, nor is it intended to undermine professional opinions. If you suspect you have either of these conditions, you should seek the help of a counselor or psychiatrist. These professionals can perform scientifically-backed assessments to come to more precise conclusions.

BPD

The mood swings present in BPD present as sharp and significant, but they often dissipate within a relatively short period of time (in many cases, only a few hours). As such, the person with BPD might showcase a range of emotions throughout the day and snap quickly into deep emotional states. Some of the most common emotions experienced include:

• Emotional pain
• Emptiness
• Desperation
• Anger
• Loneliness

All of these emotions commonly occur in people without BPD as well. However, the person with BPD experiences them to such an extent that it often interferes with their lives. They may partake in impulsive or even dangerous behavior fueled by their deep emotions.

Some people with BPD have a pervasive fear of abandonment and may take measures to prevent themselves from being abandoned by friends, family members, and partners.

Here is the official criteria for a BPD diagnosis according to the official diagnostic handbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

7. Chronic feelings of emptiness.

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Bipolar Disorder

Bipolar Disorder also presents with severe mood swings featuring strong emotions and impulsive behavior. However, for a Bipolar Disorder diagnosis, a person must experience times of mania or hypomania. Both hypomania and mania consist of elevated euphoric states that lead to increased impulsivity and risk-taking behaviors. These periods must last for at least a few days, and they’re often followed by depression.

But Bipolar Disorder isn’t a singular diagnosis. In fact, there are 2 separate types: Bipolar I Disorder and Bipolar II Disorder.

Bipolar I Disorder

A person who has Bipolar I Disorder experiences manic episodes, and they may also experience hypomania (more on hypomania in the Bipolar II Disorder section) and depression. However,  the presence of depression and hypomania is not necessary for a diagnosis.

A manic episode is characterized by the following, according to the DSM-5:

Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).

B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:

1. Inflated self-esteem or grandiosity.

2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).

3. More talkative than usual or pressure to keep talking.

4. Flight of ideas or subjective experience that thoughts are racing.

5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.

6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).

7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition. Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis. Note: Criteria A–D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.

Bipolar II Disorder

Unlike Bipolar I, Bipolar II never reaches a full manic episode. Instead, it consists of alternating hypomanic and depressive periods.

Here is the diagnostic criteria, according to the DSM-5:

For a diagnosis of bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanic episode and the following criteria for a current or past major depressive episode:

Hypomanic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.

B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree:

1. Inflated self-esteem or grandiosity.

2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).

3. More talkative than usual or pressure to keep talking.

4. Flight of ideas or subjective experience that thoughts are racing.

5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.

6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.

7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition. Note: A full hypomanic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar diathesis.

Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2- week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to a medical condition.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)

4. Insomnia or hypersomnia nearly every day.

5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or another medical condition. Note: Criteria A–C constitute a major depressive episode.

The Differences Between BPD vs Bipolar

As you can see, telling the difference between BPD vs Bipolar Disorder might seem a little complicated at first. However, when considering whether someone has BPD or Bipolar Disorder, taking into account the length of time emotional episodes last helps determine which diagnosis is correct. Both types of Bipolar Disorder require the symptoms to last for a longer period of time. On the other hand, a person who suffers from BPD experience shorter emotional periods that change quickly, often within the same day.

Likewise, the Bipolar Disorders don’t list interpersonal interactions as diagnostic criteria, whereas BPD does. People with BPD often have unstable relationships with others and may go extensive measures to keep people in their lives. People with either type of Bipolar Disorder might struggle with relationships due to their symptoms as well, but this isn’t a criterion for diagnosis.

Finding Care for BPD and Bipolar Disorder

Now that you know the difference between BPD vs Bipolar Disorder, you need to know what type of treatment to seek out.

People with Bipolar Disorder and BPD both benefit from counseling and psychiatric treatment. Both benefit from undergoing cognitive-behavioral therapy (CBT) or dialectical behavioral therapy (DBT), both of which can be performed by licensed mental health therapists.

Psychiatrists can also provide their patients with further assessments and prescribe the proper medications.

No matter which type of treatment you pursue, knowing the difference between BPD vs Bipolar Disorder can help you ask the right questions from the professional you see. As you seek out care, remember that these conditions don’t define you, and they’re just one part of the wonderful, complex person you are.