There is a significant overlap, or co-occurrence, between bipolar disorder and borderline personality disorder (BPD). According to Dialogues in Clinical Neuroscience, “approximately ten percent of patients with BPD had bipolar I disorder, and another ten percent had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD.” This does not mean that there will always be comorbidity; rather, it leads to the discussion of how significant this percentage is in the understanding of these two distinct mental health conditions.
Bipolar Disorder and Borderline Personality Disorder
Due to the similar nuances in underlying causes and symptoms of bipolar disorder and BPD, it has become difficult to distinguish between them. Moreover, there have been cases of misdiagnosis, inadvertently seeing heightened symptoms of bipolar disorder and perceiving it as BPD. The focus here is on “missed” diagnoses: for those with BPD and bipolar disorder. This missed diagnosis or misdiagnosis can lead to lower quality of life and a lack of self-awareness.
The symptoms of bipolar disorder and BPD appear similar, but they are vastly different mental health conditions; in terms of diagnostic criteria, cause, and effect on everyday life.
Firstly bipolar disorder is a mood disorder, so the main impairment for an individual is mood regulation. Mood regulation occurs on a spectrum, and for those with bipolar disorder, the symptoms are largely polarized, hence the common medical term. The episodes categorized in the DSM-5 are manic episodes and depressive episodes.
Manic episode symptoms of bipolar disorder include the following:
- Feelings of euphoria and a heightened sense of personal significance
- Restlessness, racing thoughts, and fast speech
- Increased energy, activity, and task load
- Feeling no need for sleep
- Thinking of new ideas, rapidly moving from project to project
- Poor concentration and decision-making
- Impulsive, risky, or aggressive behaviors (e.g., drug use, risky sex, reckless spending, etc.)
- Sensational feelings that nothing is wrong in life or personally
Depressive episode symptoms of bipolar disorder include the following:
- Sadness, anxiousness, or emptiness
- Hopelessness, helplessness, and lack of optimism
- No interest in activities previously pleasurable and enjoyed
- Feeling sluggish, tired, sleeping too much or too little
- Inability to focus, make decisions, remember things, or concentrate
- Restless and irritable
- Feelings of shame, guilt, and worthlessness
These symptoms are experienced nearly every day during an episode for individuals diagnosed with bipolar disorder.
There are several types of bipolar disorder to include:
- Type I bipolar
- Type II bipolar
- Rapid cycling bipolar
- Mixed features bipolar
- Seasonal pattern bipolar
- Unspecified bipolar
About 20% of individuals with bipolar II receive a BPD diagnosis, and an estimated ten percent of those with bipolar I receive a BPD diagnosis.
Borderline Personality Disorder
There is only one type and one set of diagnostic criteria in the DSM-5 BPD. Different from bipolar disorder, BPD is a personality disorder that strongly impacts an individual’s sense of self and external relationships.
Someone with BPD has interests and values change based on their sense of identity. Furthermore, who inspires them one day could be someone they despise the next day. The turbulence in emotions and disagreeability within one’s foundation of identity are the key markers of BPD. When these symptoms are omnipresent, relationships are unstable day to day.
Other BPD symptoms can include:
- Extreme fear of abandonment
- Intolerance of being alone
- Inappropriate displays of anger
- Relapses in crises (e.g., substance misuse, self-harm, risky sexual relationships)
The Dual Diagnosis Effect
Given the similarities in some symptoms, BPD and bipolar disorder are often diagnosed one at a time to see the larger picture. Not all symptoms can be attributed to one of the two disorders because their causes are unique. Nevertheless, bipolar disorder and BPD symptoms can severely impact an individual.
The Impacts of Bipolar Disorder and BPD
In a study published by Multidisciplinary Digital Publishing Institute (MDPI), evidence was provided to reveal that the majority of bipolar patients dually diagnosed with borderline personality disorder were female (84.2%) and between 18 and 35 years. Furthermore, patients with bipolar disorder with a BPD dual diagnosis were reported to have longer, and higher-cost inpatient stays. Drug abuse and increased suicidal ideation/self-harm (SI/SH) risk were higher in patients with bipolar disorder dually diagnosed with BPD.
Later findings in the same study noted that electroconvulsive treatment, or ECT, was higher in “bipolar patients with comorbid BPD.” Overall the comorbidity of bipolar disorder and BPD has been associated with acute inpatient care, including more invasive treatments such as ECT, higher cost hospitalizations due to a more extended stay, and higher suicide risk.
While some wonder whether BPD is on a spectrum of bipolar disorder or wishes to conceptualize “border polar,” research moves forward towards alleviating the truth of the true relationship between borderline personality disorder and bipolar disorder.
To reduce harm, to reduce risk, and to give control back to those who are more than what they went through, what they are going through, and what they will continue to brave. The BP-BPD comorbid diagnosis is not a walk. It is a marathon, and with the right information, support, and strategies, it will never feel like a race.
Bipolar and borderline personality disorder are two mental health conditions that should be taken seriously, both dually diagnosed and individually experienced. If you or someone you know is at risk of self-harm, harming someone else, or having thoughts of suicide, do not hesitate to seek out immediate help and support. Here at Acera Health, we provide the proper support and care for those in need. With programs such as psychotherapy in our residential treatment facility, we can give you the focus and attention you need to see true results and progress. Call us at (949) 647-4090 today to hear more details about how we can help you find relieve from bipolar disorder and BPD symptoms.
Melody is a highly skilled proactive clinical administrator, with more than 17 years of experience serving the community in the behavioral health field.
Her clinical management career started in 2011 as a compliance manager and program director. In 2018, she became an executive as chief clinical officer (CCO). She is a seasoned licensed marriage & family therapist.