Borderline Personality Disorder (BPD): not to be confused with Bipolar Disorder

Borderline Personality Disorder (BPD): not to be confused with Bipolar Disorder

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Borderline Personality Disorder or BPD is a general pattern of instability in interpersonal relationships, self-image and affectivity.


  • 1 Differential diagnosis: BPD vs Bipolar Disorder
  • 2 Mood changes in BPD and Bipolar Disorder
  • 3 Differences in self-esteem between BPD and Bipolar Disorder

Differential Diagnosis: BPD vs. Bipolar Disorder

It has been determined that the Borderline personality disorder (TLP) and the Bipolar disorder on numerous occasions they are diagnosed together in the same person (between 8% and 18% of cases - Paris J. et al, Psychiatry 2007-), although we know that they are different clinical entities. A correct diagnosis guides the professional towards a more effective treatment, but it is likely that he is facing the difficult challenge of properly diagnosing these conditions, which share several clinical features.

The TLP It can present four main types of psychopathology: affective disturbance, impulsivity, cognitive problems, and intense, unstable relationships. What is most important in these cases is to find out if the patterns of affective instability, impulsivity and unstable relationships have been consistent over time. Therefore, obtaining a detailed medical history is crucial. In addition, the other characteristics we see in BPD, such as dissociation, paranoia and cognitive problems, often greatly affect the patient's environment and, in particular, their relationships. A person with BPD may have a history of rapid and sudden deterioration when their relationships change, such as the attempt to suicide after a breakup or severe mood swings when you leave your family. Generally, the more intense or significant the relationship, the greater the risk of chronic stress and mood dysregulation.

Mood swings in BPD and Bipolar Disorder

But many of these characteristics are observed in patients with Bipolar Disorder, such as dysphoria, hyperactivity, impulsivity, tendency to suicide, and psychotic symptoms. As a result, patients with BPD with this set of symptoms are often misdiagnosed with Bipolar Disorder, possibly also due to the efficacy of psychopharmacological treatments for such symptoms.

But in the TLP mood changes are generally short lived, last only a few hours and change with relative frequency. On the contrary, mood changes in the Bipolar disorder tend to last several days or even weeks or months. Another distinguishing feature is that mood changes in BPD are usually a reaction to an environmental stressor (such as an argument with a loved one or a frustration in the waiting room), while in a Bipolar Disorder you can produce mood changes for no reason.

Patients with BPD can quickly change from depression to anxiety and anger, but these mood swings rarely involve euphoria; More often, mood swings are about feeling annoying than feeling "good." Also, anxiety or irritability of BPD should not be confused with mania or hypomania of bipolar disorder, which usually involves expansive or elevated mood.

Differences in self-esteem between BPD and Bipolar Disorder

On a more existential level, patients with BPD patients, especially young people, often struggle with feelings of emptiness and lack of courage, difficulties of self-image and fear of abandonment. These symptoms are less common in Bipolar Disorder, where grandiosity and inflated self-esteem are common, especially during episodes of the state of manic mood. And while both conditions may include a history of chaotic relationships, a patient with BPD may describe relationship difficulties as the only primary source or their suffering, while the bipolar patient may see them as an unfortunate consequence of their behavior.

Accurate diagnosis of BPD and Bipolar Disorder can sometimes be difficult., but it is essential for proper treatment and optimal outcome. Remission rates in BPD can be as high as 85% in 10 years (Gunderson et al, Arco Gen Psychiatry 2011), in particular with effective psychotherapeutic treatments. However, Bipolar Disorder tends to become chronic and does not remit in adulthood.

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American Psychiatric Association Borderline personality disorder. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013: 663-666.

Gunderson, J. (2002). Borderline Personality Disorder: Clinical Guide. Barcelona: Ars Médica.

Johnson SL, Morriss R, Scott J, Paykel E, Kinderman P, Kolamunnage-Dona R, et al. Depressive and manic symptoms are not opposite poles in bipolar disorder. Acta Psychiatr Scand2011; 123: 206-10.

Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar spectrum disorder in the initiative of the global mental health survey. Arch Gen Psychiatry2011; 68: 241-51.