BPD vs. Bipolar Disorder: What Is the Difference?

Borderline personality disorder (BPD) and bipolar disorder share many similar symptoms, the most evident being unstable moods and impulsive actions. As a result, they’re often confused and those suffering the life-altering symptoms of one or the other are often misdiagnosed and then treated for the wrong disorder.

Because borderline personality disorder is an emotional disorder and bipolar disorder is classified as a mood disorder, the methods of treatment vary. Bipolar disorder typically responds well to antidepressant medication, while borderline personality disorder is effectively treated with evidence-based therapies like dialectical behavior therapy (DBT). In an article published by the U.S. National Library of Medicine, Joel Paris, M.D., writes, “Treatment studies have failed to show that mood stabilizers have anywhere near the same efficacy in BPD as they do in bipolar disorder.”

Errors in Diagnosis

The correct diagnosis, therefore, is of the utmost importance in order to experience recovery from the symptoms of borderline personality disorder or bipolar disorder. Yet the disorders continue to be mistaken for each other. However, “there may be more to this than a simple confusion,” says Randi Kreger, author of Stop Walking on Eggshells.

Kreger pinpoints a diagnostic tool, the Mood Disorder Questionnaire (MDQ), as being a potentially faulty tool in indicating BPD rather than bipolar disorder. This is based on the results of a study from Rhode Island Hospital in which it was discovered that when patients were screened based on the MDQ, they were four times as likely to be diagnosed with BPD than if they were diagnosed using the standards in the Diagnostic and Statistical Manual of Mental Disorders (DSM) alone.

Even the standards in the DSM have gone under the microscope and have been accused of being too vague. Changes in the way patients are diagnosed were made in the DSM-5, which was released at the American Psychiatric Association Annual Meeting in San Francisco in May 2013. Adding to the confusion is the fact that bipolar disorder and borderline personality disorder can be co-occurring. People diagnosed with borderline personality disorder can also be diagnosed with bipolar disorder, and vice versa.

Differing Mood Swings

There are differences a qualified clinician will look out for when determining the correct diagnosis. One of those is cycling through mood changes. While both those with BPD and those with bipolar disorder experience mood swings, those with BPD will cycle much more quickly, often several times a day.

Marsha Linehan, University of Washington professor of psychology and pioneer of dialectical behavior therapy (DBT), describes the cycling someone with BPD will experience: “You have fear going up and down, sadness going up and down, anger up and down, disgust up and down, and love up and down.”

Someone with bipolar disorder cycles through an episode much less quickly. Sometimes an episode’s cycle will last months or even years.

If you believe you have symptoms of either BPD or bipolar disorder, it’s vital to reach out to a trained mental health professional to receive the proper diagnosis and corresponding treatment. At Clearview Treatment Programs, our clinicians have experience with and expertise in treating both borderline personality disorder and bipolar disorder at our Women’s Treatment Center, our Dual Diagnosis Treatment Center, and our outpatient treatment centers.