Bipolar Disorder vs. Borderline Personality Disorder: Key Differences and What You Need to Know

This content has been updated from the previous article published on October 2, 2023.

Mental health awareness has expanded significantly over the years, leading to a broader understanding of various conditions. While there are strides made in erasing the stigma around it, nuances and complexities in conditions often create confusion. A recurring point of discussion, for instance, is the distinction between borderline personality disorder (BPD) and bipolar disorder.

Bipolar Disorder vs. BPD: What’s the Difference?

Both conditions involve difficulty in self-managing emotional regulation and mood fluctuations. Yet, their root causes, manifestations, and treatments can be vastly different. Understanding these distinctions is crucial for accurate diagnosis and treatment. As highlighted by this study , the expansion of the bipolar disorder spectrum may highlight some similarities between both conditions, but there remains a lack of consensus as to whether these two disorders fall on the same spectrum.

Recent research underscores that while bipolar disorder and borderline personality disorder can present overlapping mood symptoms, they remain clinically distinct entities. Accurate differentiation is essential in order to develop individualized treatment plans.

Here are some common characteristics of BPD vs. Bipolar Disorder:

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Symptoms of Borderline Personality Disorder vs. Bipolar Disorder

The world of mental health can be burdensome to navigate, especially when it comes to distinguishing symptoms. We’ll explain the distinct symptoms and behaviors associated with both BPD and bipolar disorder, so you have the foundational knowledge to differentiate between the two.

Borderline Personality Disorder Diagnostic Criteria:

There are ten different personality disorders grouped into clusters A, B and C. Borderline personality disorder is in cluster B along with three others: antisocial personality disorder, narcissistic and histrionic. There are nine criteria, and in order for someone to be diagnosed, they must meet five.

  • Fear of abandonment

  • Intense and unstable relationships

  • Identity disturbance, unstable self-image

  • Impulsive behaviors

  • Self-harming tendencies

  • Mood swings lasting a few hours to a few days

  • Persistent feelings of emptiness

  • Explosive anger

  • Paranoid thoughts

People with BPD may also exhibit impulsive behaviors such as excessive spending, binge eating, or substance use. Borderline personality disorder commonly co‑occurs with other conditions, including substance use disorder and binge eating disorder .

Learn more about the signs and symptoms of borderline personality disorder .

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Bipolar Disorder Diagnostic Criteria:

  • Distinct episodes of depression lasting two weeks or more

  • Manic episodes lasting a week or more

  • Feelings of worthlessness during depressive phases

  • Euphoria or agitation during manic phases

  • Reduced need for sleep in states of mania

  • Racing thoughts

Explore the types of bipolar disorder and understand myths and facts about bipolar disorder .

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Causes of Bipolar Disorder and BPD

Genetic Predisposition

Both disorders have roots in genetics, brain structure, and function, but their triggers and progression pathways vary. The likelihood of developing both borderline personality disorder and bipolar disorder can be influenced by one’s genetic makeup. Some studies have shown that individuals with a close family member diagnosed have a heightened risk of developing the disorder. Although no specific genes have been directly linked to each condition, heredity can play a role in susceptibility.

Childhood Trauma

Family history and childhood experiences can play an important role in shaping our mental health. Individuals living with BPD often report histories of physical, emotional, or sexual abuse during their formative years. Such traumatic experiences can lead to unstable self-image, intense emotional responses, and difficulties in building and maintaining relationships; common symptoms of BPD.

Stressful Life Events

Similarly, stressful life events, such as the loss of a loved one, divorce, or other major life changes, can impact mental health. These stresses can act as triggers for the onset or relapse of bipolar disorder. Coping with these situations can be especially challenging for those predisposed to the disorder, leading to the emergence or intensification of symptoms.

Brain Structure

Mental health starts in the brain, and recent neuroimaging studies suggest that people with BPD might have structural and functional differences in certain areas of the brain responsible for emotion regulation and impulse control. These anomalies may lead to heightened emotional responses and impulsivity seen in BPD patients.

Brain structure and functionality can differ in individuals with Bipolar Disorder as well. While these differences don’t directly cause the disorder, they can contribute to symptom severity and manifestation. Anomalies in certain brain regions may disrupt mood regulation, leading to the manic and depressive episodes typical of the disorder.

Neurotransmitters and Hormones

Neurotransmitters are the brain chemicals responsible for communication between nerve cells and are important for mood regulation. Imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine often lead to mood disturbances. In bipolar disorder, these imbalances can result in extreme mood swings, from euphoric highs to devastating lows.

Hormonal changes can also influence the onset or exacerbation of bipolar disorder. For example, abnormalities in thyroid function can amplify mood disturbances.

References

  1. O’Connell, K. S., & Coombes, B. J. (2021). Genetic contributions to bipolar disorder: current status and future directions. Psychological medicine, 51(13), 2156–2167. https://doi.org/10.1017/S0033291721001252

  2. Perrotta G. (2024). Neuroanatomical and functional correlates in borderline personality disorder: A narrative review. Ibrain, 11(1), 19–31. https://doi.org/10.1002/ibra.12190

  3. Sanches M. (2019). The Limits between Bipolar Disorder and Borderline Personality Disorder: A Review of the Evidence. Diseases (Basel, Switzerland), 7(3), 49. https://doi.org/10.3390/diseases7030049 

  4. Walters, J. T., Soloff, P. H., & Runeson, B. (2004). Bipolar disorder—borderline personality: A distinct diagnostic entity? Indian Journal of Psychiatry, 46(3), 200-208.

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LifeStance Health

LifeStance is a mental healthcare company focused on providing evidence-based, medically driven treatment services for children, adolescents, and adults.

Reviewed By

Valerie Christian, PhD
Valerie Christian is a licensed Psychologist who earned her Ph.D. from the California School of Professional Psychology in 1997. She completed her post-doctoral fellowship at Scripps Clinic: Division of Mental Health. Dr. Christian has experience in the treatment of childhood abuse and trauma. Having completed a pre-doctoral internship with San Diego Court Child Protective Services' Child Sexual Abuse Treatment Program, she is well versed at treating complex and difficult cases. Dr. Christian also has expertise in treating children, adolescents, teens, and adults who suffer from chronic illness. She was the Lead Psychologist on a research study conducted by Sharp Hospital and UCSF on the impact of familial support in the treatment of psychological issues associated with living with diabetes. In addition, Dr. Christian works with individuals suffering with obesity. She helps these patients cope and adjust to the psychological, behavioral, and cognitive changes that occur as they prepare for bariatric surgery, during recovery, and in the months following surgery. Dr. Christian utilizes a variety of treatment modalities tailored to her patients' individual needs. She creates a safe and supportive atmosphere allowing her patients to learn, grow, and heal.

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