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Bipolar Disorder and Borderline Personality Disorder both cause extreme mood swings and impulsive behavior. It's hardly surprising that people who are not mental health professionals sometimes confuse the two, but even clinicians may diagnose the wrong disorder — especially if they are using the Mood Disorder Questionnaire (MDQ).
While BP and BPD (oh no, even the abbreviations are similar!) have some noteworthy similarities, they also come with significant differences. To illustrate this, we'll take a look at both disorders individually and then examine the differences between the two.
Bipolar Disorder is a condition that goes by many names. Bipolar affective disorder, manic-depressive illness, and affective psychosis are all alternative terms that refer to Bipolar Disorder. This condition is characterized by extreme highs and lows, known as depressive and manic episodes.
Both these mood episodes temporarily "take over" the person, severely affecting their mood, energy and activity levels, and even their ability to successfully engage in day-to-day tasks. In some cases, mood episodes include characteristics of both mania and depression.
Symptoms of a manic episode include long periods of feeling happy or powerful, irritability, speaking fast, expressing seemingly unconnected thoughts, unusually high energy and activity levels, restlessness, lack of sleep and not feeling sleepy either, impulsive behavior, and risk-taking. In short, Bipolar people experiencing a manic episode will feel like they're ready to take over the world. Indeed, they may feel like they already have!
Depressive episodes represent the other side of the Bipolar coin. During this stage, sufferers may feel extremely low and hopeless, lose interest in activities they previously enjoyed, and may even contemplate or attempt suicide. Restlessness and irritability may come with depressive episodes as well, and BP people going through a depressive episode often have difficulty focusing, remembering, and making decisions during this stage. Their eating, sleeping and living patterns will change significantly. Mood episodes can last for weeks.
While the exact mechanism by which people develop Bipolar Disorder remains unclear, scientists do know there is a strong genetic component. Research also shows that there are physical differences in the brains of people with BP, and that environmental factors — such as abuse during childhood — play a significant role.
Bipolar Disorder comes in several sub-types, determined by the severity of the symptoms and the length of mood cycles. It is usually a life-long condition, but Bipolar Disorder can be managed well with medications and therapy. Lithium and anti-convulsants such as Carbamazepine are the go-to medications to treat Bipolar Disorder. These medications have a dramatically successful effect on BP patients.
Borderline Personality Disorder
The National Institute of Mental Health describes Borderline Personality Disorder (BPD) as a "a serious mental illness marked by unstable moods, behavior, and relationships". The disorder got its name because mental health professionals initially thought of its symptomatic picture as an atypical, or "borderline" presentation of other disorders.
People who have Borderline Personality Disorder typically have difficulty regulating their thoughts and feelings, display impulsive and reckless behavior, and find maintaining relationships with other people challenging. Some BPD sufferers have psychotic episodes, and the personality disorder also comes with a high-rate of co-existing diagnoses such as depression, anxiety disorders, and eating disorders.
- Extreme reactions to real or perceived abandonment. These may include panic, depression, rage, or frantic actions.
- Dysfunctional relationships with others. People with BPD may love you one minute, and hate you the next. If the BPD sufferer thinks you care for them, they are very likely to try to push you away.
- An unstable and unrealistic self-image, subject to constant change.
- Impulsive and high-risk behavior — spending sprees, substance abuse, dangerous sexual situations, and others.
- Recurring suicidal feelings, suicide attempts, self-harming, and other self-destructive behaviors.
- Extreme mood swings, lasting from hours to days.
- Feeling empty and bored.
- Intense anger problems.
- Dissociation (out-of-body experiences), paranoia, an inability to perceive reality.
Borderline Personality Disorder is still a little-understood illness, but environmental and genetic factors are both thought to contribute. In part because BPD is still not understood very well, treating this disorder is notoriously difficult. Therapy, including Cognitive Behavioral Therapy and Dialectical Behavior Therapy, is thought to be the best available treatment at the moment. No medications have been approved to treat BPD in the US.