The differences between bipolar disorder and borderline personality disorder may be difficult to identify at first because of the significant overlap in symptoms. But the diagnostic criteria are different for each of these conditions.
Bipolar disorder and borderline personality disorder may mimic some aspects of each other but stand as separate mental health diagnoses.
Overall definition and classification
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) lists bipolar disorder under the Bipolar and Related Disorders section, while borderline personality disorder appears under Personality Disorders. This categorization implies there are core differences between the two conditions.
Bipolar disorder is characterized by episodic changes in mood, ability to concentrate, self-perception, and energy levels. These changes may be mild or intense and typically occur without an apparent reason or external influence.
Moods in bipolar disorder vary between mania, hypomania, and depression. Mania is a state of elevated mood with a tendency to feel invincible and energetic and act impulsively. Hypomania is a milder form of mania.
Borderline personality disorder involves pervasive mood changes but not necessarily between mania and depression. Changes may involve going from feeling sad to angry, irritable, or joyful, and they’re closely related to experiences or interpersonal exchanges.
Changes in the perceptions of self and others, intense fear of abandonment, instability of personal goals and affects, and impulsivity are also common symptoms of borderline personality disorder.
Types and symptoms
According to DSM-5-TR, borderline personality disorder involves a persistent and long standing pattern of instability that affects self-image, emotions and mood, relationships, and functionality.
Experts recognize only one type of borderline personality disorder, while the DSM-5 lists three main types of bipolar disorder and four related disorders.
For borderline personality disorder, symptoms must be evident across different situations and over time for a healthcare professional to reach a diagnosis. Not everyone experiences the same symptoms or with the same intensity, though.
At least five of the nine formal symptoms of borderline personality symptoms are needed to establish a diagnosis:
- intense anxiety and frantic actions to prevent abandonment
- frequent changes in opinion and affect toward other people, going from idealization to devaluation
- a changing sense of self that may lead to self-sabotage
- low impulse control, especially with activities that may involve some degree of self-harm, including substance use, overspending, unhealthy eating habits, and unsafe sexual behaviors
- physical self-harm thoughts and behavior, including mutilation and suicide threats and attempts
- high mood reactivity leading to emotional instability, including anxiety, irritability, and a sense of discontent with life in general
- persistent feelings of emptiness
- challenges with anger management with frequent anger outbursts that may involve physical fights
- temporary stress-related ideas of persecution (paranoia) or feelings of being detached or disconnected from self, others, and the world in general
On the other hand, bipolar disorder is classified into different types depending on prevalent symptoms and other characteristics. The three most common bipolar disorder presentations are:
- Bipolar I disorder:
- intense and recurrent symptoms, some of which may lead to hospitalization
- at least one episode of mania is required for diagnosis
- manic episodes last at least 7 days and may involve symptoms of psychosis
- episodes of depression may occur but aren’t a criterion for diagnosis
- Bipolar II disorder:
- symptoms may be impairing and more pervasive but could be less intense than in bipolar I disorder
- at least one episode of hypomania is required for diagnosis
- hypomania symptoms are present for at least 4 days
- at least one episode of depression is required for diagnosis
- no manic episodes
- depression symptoms last for at least 2 weeks
- symptoms of psychosis are unlikely
- Cyclothymic disorder:
- mild symptoms of hypomania for at least 2 years or 1 year for children and teens
- symptoms cause a disruption in typical functioning and a higher-than-usual level of distress but don’t qualify for bipolar I or II disorders
- symptoms aren’t intense or severe enough to provide a diagnosis of mania, hypomania, or depression
| Symptom | Bipolar disorder | Borderline personality disorder |
|---|---|---|
| Psychosis (hallucinations, delusions) | Likely in bipolar I disorder | Not part of the diagnostic criteria |
| Mood changes | Formal symptom; episodic and moderate to severe, without an evident cause | Formal symptom; long-lasting and related to situations (real or perceived) |
| Mania | Required for bipolar I disorder | Not part of the diagnostic criteria |
| Hypomania | Possible in bipolar I disorder, required for bipolar II disorder | Not part of the diagnostic criteria |
| Depression | Required for bipolar II disorder | Not part of the diagnostic criteria |
| Low mood (including sadness, emptiness, hopelessness) | Very likely during episodes of depression | Likely |
| Anger outbursts | Not part of the diagnostic criteria | Formal symptom |
| Self-harm behavior (including suicidal thoughts and attempts) | Formal symptom | Formal symptom |
| Fear of abandonment | Not part of the diagnostic criteria | Formal symptom |
| Low impulse control and potentially unsafe behavior | Only during episodes of mania and hypomania | Formal symptom |
- adverse early experiences and trauma
- family history of mental health conditions
- past or current experience with substance use disorder
Both conditions may also involve a degree of irritability, difficulty concentrating, and rapid switching between thoughts or ideas.
The most common overlapping symptoms may be:
- mood changes
- self-harm or death ideation
- impulsivity that may lead to unsafe behaviors
- relationship challenges
Yes, it’s possible that some overlapping symptoms may lead to misdiagnoses, particularly mood changes and impulsivity.
Some
However, changes in mood in both conditions have different presentations, intensities, and triggers.
While people with bipolar disorder experience mood episodes that go for at least 4 to 15 days, borderline personality disorder involves short-lived constant mood shifts. These changes are also commonly triggered by negative thoughts, relationship friction, and other internal and external influences.
In the case of bipolar disorder, mood changes do not necessarily correspond to something in particular.
These differences, together with other differential factors, can help a healthcare professional reach an accurate diagnosis.
Both conditions require ongoing treatment but respond to different approaches.
Healthcare professionals usually treat bipolar disorder with a combination of long-term psychotherapy and medication. Symptoms of borderline personality are typically managed with psychotherapy and do not require medications unless you have co-occurring conditions like depression and anxiety.
Yes, bipolar disorder and borderline personality disorder often co-occur.
According to a
Bipolar disorder and borderline personality disorder are two distinct mental health diagnoses. However, some symptoms, like mood changes, may have similar presentations. It’s also possible to have both conditions at the same time.