BPD and Bipolar Disorder are two mental health conditions that, often, get mistaken as being the same, what with them sounding very similar. There are, however, stark differences between the two conditions, and it is paramount that a correct diagnosis is reached to ensure that those struggling can receive the relevant support that they need to give them the best chance at recovery.
In order to help combat the idea that BPD and Bipolar Disorder are the same, I am dedicating todays post to detailing the two conditions. Hopefully it will prove an insightful read.
Borderline personality disorder (BPD), the most commonly recognised personality disorder, effects the way in which a person interacts with others. It tends to also have an impact upon the way someone struggling with the disorder feels about themselves, too, something which can make functioning in everyday life a struggle for them.
The symptoms of BPD can be grouped into 4 main areas:
1) Emotional instability – the psychological term for this is ‘affective dysregulation.’
2) Disturbed patterns of thinking or perception – cognitive distortions or perceptual distortions
3) Impulsive behaviour
4) Intense but unstable relationships with others.
In terms of the first symptom- “emotional instability” (affective dysregulation), an individual diagnosed with BPD might have difficulty managing their emotions, as they suffer with intense and highly variable moods, i.e., mood swings, as well as, sometimes, feelings of ongoing ’emptiness.’ Their feelings of intense emotions can last anywhere from a few hours to a few days and can change quickly (for example, from feeling very happy and confident to suddenly feeling very low and sad).
The second symptom often experienced by people living with BPD- disturbed patterns of thinking or perception (cognitive/perceptual distortion) can effect an individuals self-image. They might have feelings of uncertainty regarding how they sees themselves (i.e., they have a distorted self-image and/or sense of self). Furthermore, their interests and values might change quickly.
The emotional instability felt by someone with BPD, whereby they struggle to manage and, in some cases, even understand their emotions might, not just have an effect on their mood, but also on their behaviour, as the third group of symptoms suggests… People with BPD can behave in a manner that could only be described as ‘impulsive’ and/or ‘reckless’ by the average person without the illness. They might do things that could potentially harm themselves.
Examples of impulsive behaviour that someone with BPD might engage in include; binge eating, using drugs, drinking excessively, going on spending sprees, driving recklessly, gambling, self-harming, etc. They might also experience frequent feelings of wanting to commit suicide (suicide ideation).
The final group of symptoms associated with BPD- intense/unstable relationships with others- sees someone with BPD finding it difficult to maintain relationships with others. Their feelings for others can change quickly, and swing from extreme closeness to extreme dislike. For example, they might idealise someone one moment and then suddenly believe that the person doesn’t care enough or is cruel the next. These changing feelings can lead to a pattern of intense and unstable relationships developing with family, friends, and loved ones, something which can, unsurprisingly, cause lots of emotional pain. Furthermore, relationships can be further complicated as people with BPD often fear abandonment, yet inappropriate anger, impulsiveness and frequent mood swings may push others away, even though they want to have loving and lasting relationships. They might over compensate for their fear of abandonment by; plunging headfirst into relationships, for example, and/or ending them just as quickly).
Bipolar disorder is a mood disorder that causes changes in a person’s mood, energy, and ability to function. There are three main types of Bipolar Disorder; Bipolar I, Bipolar II, and Cyclothymic Disorder.
As a very basic overview, Bipolar I (1), also known as ‘manic depressive disorder’, involves manic episodes that last at least 7 days. During a manic episode in someone with bipolar disorder, elevated mood can manifest itself as either euphoria (feeling “high”) or as irritability.
Bipolar II (2) involves less severe episodes of mania known as hypomania. Unlike Bipolar I which can be accompanied by psychotic symptoms such as delusions and hallucinations, Bipolar II will never indicate such psychotic symptoms. It is not uncommon for BPD to be (frequently) misdiagnosed as Bipolar Disorder, Type 2. There are however differences, as I will outline below.
Cyclothymic Disorder involves chronic mood instability without extreme mood episodes. It is known as a mild form of bipolar disorder, whereby the emotional ups and downs between hypomania and depression that are experienced are not as extreme as those in bipolar I or II disorder. They’ll have periods of feeling low (though not lasting long enough or presenting severe enough to be diagnosed as clinical depression) followed by periods of extreme happiness and excitement (called hypomania) when they do not need much sleep and feel that they have a lot of energy. Mood swings will be fairly frequent – people will not go for longer than 2 months without experiencing low mood or an emotional high. In between these highs and lows though, people with Cyclothymia may feel pretty normal. Symptoms of Cyclothymia are therefore not severe enough for people experiencing them to be diagnosed with bipolar disorder.
All three types of bipolar disorder involve clear changes in mood, energy, and activity levels. These moods range from periods of extreme ‘up’s’, and periods of extreme ‘down’s.’ The up’s (mania/hypomania) see those struggling feeling uncharacteristically happy/joyful. They might feel as though they’re full of excess energy, and feel uncontrollably excited, like they can’t get their words out fast enough.
Having so much pent-up energy can lead to people feeling agitated and irritable as a result. They might feel unable to concentrate as their thoughts are racing and they have so many different ideas regarding new projects they want to start (and complete). In a manic episode, people might also feel overly confident, like they’re untouchable/can’t be harmed, like they can perform physical and mental tasks better than normal, and like they need less sleep than usual. Having such feelings however can lead to people taking risks with their safety. It can also cause people to say or do things that are ‘inappropriate’ and ‘out of character’.
Less severe manic periods are known as ‘hypomanic’ episodes.
For a mood episode to be classed as mania, it needs to last for a week or more. For hypomania, it needs to last for 4 days or more. But both manic and hypomanic episodes can last much longer than this. They can’t, however, last a shorter amount of time than this for it to be classified as a manic episode..
In contrast, the ‘down’s’ (depressive episodes) see those struggling going through sad/hopeless periods (known as depressive episodes). People might feel upset/tearful, and tired/sluggish. They might lose interest in the things which they used to enjoy, and suffer from low self-esteem and lack in confidence. Feelings of worthlessness might arise as a result. Additionally, people might feel agitated/tense which can, in turn, effect their daily habits, from their sleeping patterns (sleeping too much or not enough), eating patterns (again, eating too much or not enough), exercise routine (be less physically active), substance use (misusing drugs and/or alcohol), social interactions (acting withdrawn, avoiding contacting or responding to people, or avoiding social situations all together). It might see people struggling to get and/or stay asleep, or see them sleeping too much. In extreme cases, people might attempt to self-harm or attempt suicidal.
Some people find that depressive episodes can feel harder to deal with than manic or hypomanic episodes as, the contrast between one’s high and low moods may make their depression seem even deeper.
Like manic episodes, for ‘down days’ to be classed as depressive episodes, they must last at least a week, and they, often, last months.
One thing which ties them all together though is the fact that they are all characterised by changes in mood that are extreme (the ‘highs’ are overwhelmingly high and the ‘lows’ are overwhelmingly low). Whilst we all have down days from time to time, someone with bipolar disorder, on their down days, will find it effecting their ability to function ‘normally.’
Differences between BPD and Bipolar Disorder
The main difference between BPD and Bipolar is that, whilst BPD is a personality disorder, Bipolar is a mood disorder. And therefore, because one cannot change their personality, BPD tends to effect every part of someone who is diagnosed with the conditions life. Although the mood swings experienced by people with BPD themselves only last a few hours and rarely more than a few days, they occur very frequently and, in some cases, several times a day. Someone with BPD might go from feeling ‘normal’ to really low in a matter of seconds (I say really low and not elated too because, the mood shifts typical of BPD rarely involve elation. Usually, the shift is from feeling upset to feeling OK, what with negative feeling states being the predominant emotion of someone with BPD, not from feeling bad to feeling a high or elevated mood, which is more typical of bipolar disorder). Consequently, someone with BPD is likely to have an unstable mood all of the time, not just some of the time, as is the case with Bipolar Disorder which, as a mood disorder, is less ‘all-consuming.’ In between one’s ‘episodes’ of mania and depression (which typically last 4-7 days), people with Bipolar Disorder can lead a ‘normal’ life as their mood remains relatively stable.
Another major difference between BPD and Bipolar Disorder can be seen in the reasoning behind the mood fluctuations that occur in each disorder. Whereas mood shifts in BPD are usually in reaction to an environmental stressor, such as an argument with a loved one, mood shifts in bipolar disorder tend to occur out-of-the-blue/randomly.
If you are struggling with your mental health, perhaps you’re experiencing intense mood fluctuations, and/or you relate to any of the things which I have written about in this post, then help and support is out there, and you do deserve to access it.
The first point of call should be your GP, who will ask you about what you have been experiencing. They will then, based on what you are presenting with, be able to determine whether you meet the diagnostic criteria for either BPD or Bipolar Disorder. Your GP can also refer you on to third party organisations who can offer you further, more specialised help, such as therapy/counselling etc., if it is deemed necessary.
So, if you are struggling, then please utilise all the help and support that is out there, to ensure that you are not bound down by your feelings. Seek the support you deserve to seek, and live the life that you deserve to live.