BPD vs. bipolar disorder: What makes them similar, and how are they different?

Despite being different disorders, bipolar disorder and borderline personality disorder have so many symptomatic similarities that they can often be mistaken for one another. That being said, the functioning and root causes, and therefore the treatment, of each disorder are quite different, which makes it very important to discern one from the other in order to make treatment effective.

What Is BPD? Understanding Borderline Personality Disorder

Borderline personality disorder (BPD) is characterized by a diffuse sense of self along with a deep fear of abandonment, often to the point of impairing functioning and impacting relationships. Individuals with BPD struggle with knowing who they are, and because of that instability, have a difficult time regulating their emotions. This can result in frequent impulsivity and emotional outbursts, as well as internal issues like low self-esteem.

Symptoms and Causes of BPD

Though bipolar disorder and BPD can look similar in terms of symptoms, there are some key differences. One of the main things that set BPD apart from bipolar disorder is that BPD symptoms occur at a consistently, while bipolar symptoms are episodic.

Common symptoms of borderline personality disorder include:

  • Efforts to avoid real or perceived abandonment (i.e. “I’ll harm myself if you leave”)
  • Unstable relationships across multiple areas such as work, family, social groups
  • Idealizing people until they “fall from grace;” no in-between in perception
  • Void sense of self/self-image
  • Impulsivity 
  • Mood swings within short time periods (prone to self-harm)
  • Feelings of emptiness 
  • Intense anger
  • Issues with emotional regulation
  • Emotionally relying on others to regulate them and make them feel safe
  • Paranoia

Two of the most common causes tied to BPD are trauma (childhood, sexual, etc.) and having close relatives with BPD. In fact, BPD is five times more common among first-degree biological relatives. Other influential components are environmental factors and one’s brain structure and function.

Comparing BPD and Bipolar Disorder: What Are the Differences?

Again, one of the main differences between bipolar disorder and BPD is the episodic nature of bipolar disorder symptoms. Bipolar disorder symptoms aren’t always happening or present—they often intensify and decrease in distinct waves. 

Bipolar disorder involves manic or major depressive phases that last around one to two weeks. These phases are a noticeable departure from their baseline functioning, and they seem very different from an individual’s normal state. 

However, for someone with BPD, they experience symptoms consistently instead of episodically—their symptoms are consistent and largely unchanging, at least without treatment.

Similarities in Symptoms: BPD vs. Bipolar Disorder

The external symptoms of bipolar disorder and BPD are very similar, which makes them difficult to differentiate. This is why diagnostic clarity is extremely important when addressing either disorder.

Most noticeably, both BPD and bipolar disorder can cause mood swings. For BPD, moods may change quickly, jumping from anger to joy to sadness within a few hours sometimes. With bipolar disorder, these mood swings are more spread out, but also more intense. They usually last a few days at least, with individuals acting noticeably differently—either feeling intense and debilitating sadness or the high-energy spurts that accompany manic episodes.

The risky, impulsive behaviors that characterize disorders can look very similar, fitting with both the standard symptoms of BPD and the manic states caused by bipolar disorder. Flip-flopping on relationships can also happen during manic episodes, similar to the pattern of idealization/falling from grace that people with BPD have in relation to their partners.

People with bipolar disorder can experience certain amounts of paranoia, but it appears more like psychosis or delusion than paranoia tied to BPD.

A subtle difference that can be spotted in the symptoms of the two disorders can be the intensity: Bipolar symptoms can tend to be more intense since they are episodic.

If you have been diagnosed with bipolar disorder or BPD and you feel like your treatment isn’t working, inquire with your provider about your treatment plan and/or diagnosis, or consider getting a second opinion on your diagnosis.An accurate diagnosis is essential to finding the appropriate treatment. 

Living With BPD or Bipolar: Coping Strategies

Despite their symptomatic similarities, the roots of BPD and bipolar disorder are quite different, and therefore need different treatment and coping mechanisms to be managed effectively.

Tools for coping with BPD include:

  • Dialectical behavior therapy (DBT): DBT is a therapeutic approach that was specifically created to treat BPD, though it works for other conditions. It helps with emotional regulation, distress tolerance, and self-awareness as well as emotional awareness through mindfulness.
  • Distress tolerance: An important part of managing BPD, distress tolerance skills help with emotional regulation skills by improving one’s ability to deal with emotional distress, something that can occur with BPD frequently.
  • Social skills: Since people with BPD struggle to maintain relationships with others, social skills can help them learn how to interact with and communicate with those close to them in a healthy and productive way.
  • Trauma-focused therapy: As BPD can be caused by trauma, this kind of therapy works to get at the root of the issue in order to help one understand where their BPD comes from and how it works, as well as heal old wounds that are exacerbating their BPD symptoms. Understanding their BPD, and by extension a part of themselves, allows them to manage their symptoms much more effectively
  • Mindfulness: Mindfulness is an important part of managing BPD symptoms, as it allows

Treatment for bipolar disorder is more about stabilizing rhythms of life to reduce the frequency and risk of manic and/or depressive episodes. Helpful coping strategies for bipolar disorder are:

  • Maintaining low stress: Lowering stress levels can help reduce mood swings and the overall frequency/intensity of bipolar symptoms.
  • Outdoor time/time in the sun: Being outdoors and getting some sunshine can have a positive influence on one’s circadian rhythm, which is a key part of managing bipolar disorder.
  • A healthy sleep schedule: A consistent sleep schedule is important to maintaining an ideal circadian rhythm.
  • Taking prescribed medication: Medication is a key component to managing bipolar disorder, so it’s important to take them regularly.
  • Maintaining a regular eating schedule: Again, maintaining one’s circadian rhythm is important—eating meals at regular times and intervals can help support this.
  • Social support from others: Mental and emotional support from close friends and family can help lower stress from managing bipolar disorder, and help one feel less alone as they deal with the effects of this disorder.

With bipolar disorder, it’s important to establish a healthy circadian rhythm to promote a healthy emotional and mental balance.

For both bipolar disorder and BPD, group therapy can be very helpful, as it brings a community together that is going through most of the same things. Both bipolar disorder and BPD are surrounded by strong stigma, which can make it hard to talk about one’s experiences and feel like they deserve help and support. In group therapy, people with either disorder can talk to others who know exactly how that feels and experience vulnerability without judgment.

Therapeutic Approaches for BPD

There are multiple therapy approaches that providers can use to treat BPD. Many providers will use different approaches depending on the client’s specific needs and experiences. Some common therapeutic approaches for treating BPD are:

Medication and Lifestyle Management for Bipolar Disorder

When receiving treatment for bipolar disorder, individuals will often be prescribed medication to use alongside talk therapy treatment in order to help mitigate their intense symptoms.Mood stabilizers are most commonly prescribed for bipolar disorder. Common types include:

  • Lithium
  • Lamotrigine
  • Depakote

Medication is an important part of managing bipolar disorder, but it does not take the place of talk therapy, nor does talk therapy do the job of medication. It’s very important to speak with a medical provider consistently about your medications, following their recommendations and getting regular blood tests while on medication. 

If you find that your medication is not making a positive impact on your symptoms, or you feel that it’s negatively impacting you, talk to your provider about adjusting your dosage or prescription, and always do so before making any adjustments yourself.

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Diagnosis and Treatment Options: BPD vs. Bipolar Disorder

The treatment processes for BPD and bipolar disorder are quite different from each other. 

Treatment for BPD is more therapy-oriented, as it often stems from trauma or childhood experiences. Medication can be helpful in managing symptoms, but it’s necessary to address the source of one’s BPD to effectively treat and heal from it. 

Bipolar disorder treatment also involves talk therapy, but medication is a much more integral part of treatment, as they are needed to stabilize one’s moods and reduce flare-ups.

With a long-term commitment to treatment, people can eventually recover or “heal from” BPD. However, bipolar disorder is a continual condition that needs to be consistently managed so that one’s symptoms no longer inhibit their functioning or hold them back in their daily life. 

In either case, professional help from a mental health provider is key to mitigating symptoms and managing the disorders in one’s day-to-day life.

Table of contents

What Is BPD? Understanding Borderline Personality Disorder

Comparing BPD and Bipolar Disorder: What Are the Differences?

Similarities in Symptoms: BPD vs. Bipolar Disorder

Living With BPD or Bipolar: Coping Strategies

Diagnosis and Treatment Options: BPD vs. Bipolar Disorder

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Kate Hanselman, PMHNP in New Haven, CT

Kate Hanselman, PMHNP-BC

Kate Hanselman is a board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC). She specializes in family conflict, transgender issues, grief, sexual orientation issues, trauma, PTSD, anxiety, behavioral issues, and women’s issues.

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Alexandra “Alex” Cromer is a Licensed Professional Counselor (LPC) who has 4 years of experience partnering with adults, families, adolescents, and couples seeking help with depression, anxiety, eating disorders, and trauma-related disorders.

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  • Skoglund, C., Tiger, A., Rück, C., Petrović, P., Asherson, P., Hellner, C., Mataix‐Cols, D., & Kuja‐Halkola, R. (2019). Familial risk and heritability of diagnosed borderline personality disorder: a register study of the Swedish population. Molecular Psychiatry, 26(3), 999–1008. https://doi.org/10.1038/s41380-019-0442-0

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