Bipolar Disorder vs. BPD: Symptoms, Causes, Treatment

Key Takeaways

• Bipolar disorder involves mood changes lasting days or weeks, while BPD mood changes happen in hours.
• Bipolar disorder often has a genetic link, and BPD is linked to childhood trauma.
• Medications are the primary treatment for bipolar disorder, while therapy is often used for BPD.

Borderline personality disorder (BPD) has been controversial since it was first recognized in the “Diagnostic and Statistical Manual of Mental Disorders” in 1980. One controversy that still has not been resolved is whether or not BPD is related to bipolar disorder since they have many similar symptoms.

Both conditions are characterized by mood instability and impulsivity, but there are also important distinctions. Bipolar disorder involves dramatic shifts in mood and activity levels, whereas BPD is marked by emotional dysregulation.

Learn more about the differences between bipolar disorder and BPD. If you are experiencing symptoms of a mental health condition, talk to a healthcare provider to receive a diagnosis and treatment.

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Symptoms

Mood instability and impulsive behavior are frequently experienced both by people with bipolar disorder and by people with BPD.

Bipolar disorder is associated with mood shifts from depression to mania or hypomania. Mania is characterized by elation, a decreased need for sleep, and increased activity. Hypomania is similar to mania but less severe.

BPD is also associated with mood changes, sometimes called emotional dysregulation or affective instability. People with BPD frequently change from feeling fine to extremely distressed in minutes.

Bipolar Disorder

• Extreme shifts in mood

• Mood episodes lasting a week or more

• Restlessness

• Racing thoughts

• Increased energy and activity levels

• Reduced need for sleep

• Grandiosity

• Reckless, risky behaviors

• Impulsivity

• Psychosis during severe manic episodes

BPD

• Rapid changes in mood

• Mood episodes lasting hours or days

• Emotional dysregulation

• Fear of abandonment

• Unstable self-image

• Intense, unstable relationships

• Anger issues

• Feelings of worthlessness

• Paranoid thinking

• Impulsivity

• Self-harm or suicidal behaviors

Causes

Research suggests that while bipolar disorder and BPD may co-occur, they appear to be separate conditions with different causes. While researchers do not fully understand the exact causes of each condition, it is believed that several factors play a part in increasing a person’s susceptibility to developing each condition.

Bipolar Disorder

• Genetics: Bipolar disorder is believed to have a strong genetic link. It is one of the most heritable mental health conditions.
• Trauma and stress: Childhood trauma and stressful events may also be linked to bipolar disorder.
• Brain differences: Some studies suggest that brain structure and chemistry differences may also contribute to bipolar disorder, although more research is needed to understand this link better.

Borderline Personality Disorder

• Abuse and trauma: BPD is strongly associated with childhood abuse and trauma. Factors such as poor maternal attachment, parental substance use, and physical, emotional, and sexual abuse are associated with BPD.
• Brain differences: People with BPD may have differences in areas of the brain associated with emotional control. 
• Genetics: Research also suggests that the condition may have a genetic link. BPD tends to run in families, meaning having a close relative with the condition may increase the risk that a person will also have it.

Are Bipolar Disorder and BPD Related?

Although it is not yet clear-cut, research has not found a strong relationship between BPD and bipolar disorder. There is some evidence that people with BPD are diagnosed with bipolar disorder at higher rates than individuals with other personality disorders.

Diagnosis

When making a diagnosis, healthcare providers will look at several different factors to help distinguish between bipolar disorder and BPD. Some significant components separate the two.

• Quality: While the disorders are both characterized by mood changes, the quality of the mood changes can be very different. People with bipolar disorder tend to experience mania and depression, while people with BPD experience intense emotional pain and feelings of emptiness, desperation, anger, hopelessness, and loneliness.
• Time: In BPD, mood changes are often more short-lived. They may last for only a few hours at a time. In contrast, mood changes in bipolar disorder tend to last for days or even weeks.
• Cause: Mood shifts in BPD usually react to an environmental stressor, such as an argument with a loved one, whereas mood shifts in bipolar disorder may occur out of the blue.
• Degree: The mood shifts typical of BPD rarely involve elation. Usually, the shift is from feeling upset to feeling OK, not from feeling bad to feeling a high or elevated mood, which is more typical of bipolar disorder.

Treatment

Because bipolar disorder and borderline personality disorder are distinct conditions, it is essential to treat each disorder individually for the best chance of symptom relief.

Bipolar Disorder

Medication is the primary treatment for bipolar disorder, although psychotherapy can also be helpful. Mood stabilizers can help balance moods and minimize the risk of experiencing extreme highs and extreme lows.

Lithium was the first medication that was developed for the treatment of bipolar disorder. It is still commonly used today as a first-line treatment.

Types of medications that are often prescribed to treat bipolar disorder are antipsychotics and anti-convulsants, which may include:

• Abilify (apripiprazole)
• Depakote (divalproex sodium)
• Haldol (haloperidol)
• Lamictal (lamotrigine)
• Topamax (topiramate)

Borderline Personality Disorder

BPD was previously regarded as challenging to treat, but more recent evidence indicates that treatments can be very effective. It is most often treated with psychotherapy, but medications may also be prescribed to help manage specific symptoms.

Dialectical behavior therapy (DBT) is a form of psychotherapy that was specifically created to treat borderline personality disorder. This approach is a form of cognitive behavioral therapy (CBT) that teaches people stress management, emotional regulation, and relationship skills.

Other therapies that can also be helpful include CBT, mentalization-based treatment (MBT), and group therapy. Medications sometimes prescribed to treat BPD symptoms include antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers.

Prevention

Unfortunately, it is not possible to prevent bipolar disorder or borderline personality disorder. The exact causes of each condition are not known, and both are believed to be affected by genetics to some degree. However, there are things you can do that will help you prevent serious outcomes associated with your condition.

Bipolar Disorder

There is no way to prevent bipolar disorder. However, early detection and treatment can help improve outcomes. Watch for warning signs and learn more about the condition so you can be on the lookout for early symptoms. If you have been diagnosed with bipolar disorder, some things can help reduce the risk and severity of having mood episodes:

• Adhere to your treatment plan
• Avoid drugs and alcohol
• Avoid triggers
• Eat a balanced diet
• Find ways to manage stress
• Get enough sleep
• Stick to a consistent schedule

Borderline Personality Disorder

There is no surefire way to prevent borderline personality disorder. Some steps can lead to better outcomes, such as:

• Avoiding drugs and alcohol
• Minimizing stress
• Utilizing relaxation strategies
• Seeking treatment at the first sign of symptoms

Summary

Bipolar disorder and borderline personality disorder share some common symptoms, but they are distinct conditions. They do sometimes co-occur, so future research on the genetic and biological causes of BPD and bipolar disorder may reveal some undiscovered relationships between the two conditions.

The exact causes of the two conditions are not clear, but genetics is strongly linked to bipolar disorder, while trauma is strongly connected to borderline personality disorder. Both conditions have different treatments, so getting an accurate diagnosis is essential.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Kristalyn Salters-Pedneault, PhD

 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.

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