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Is There a Comorbidity Between Borderline Personality Disorder and Bipolar Disorder?

Is There a Comorbidity Between Borderline Personality Disorder and Bipolar Disorder?

People often wonder if someone can be diagnosed with both bipolar disorder and borderline personality disorder (BPD). The answer is yes. It’s surprisingly common for someone to be diagnosed with both. This is known as a co-occurring disorder, where two or more mental health disorders affect someone at the same time.

Sometimes this can make treatment more difficult. This is because both disorders must be equally treated for the greatest chance of recovery. Sometimes people are misdiagnosed, with one being mistaken for the other and vice versa. It’s why it’s so important to understand why these two disorders become co-occurring, who is most at risk, and how we can give those that struggle the best treatment possible.

Why Borderline Personality Disorder and Bipolar Disorder Often Co-occur

There are a lot of factors that determine if someone develops a mental health disorder or not. For both bipolar disorder and BPD, many of these factors are similar.

Genetics seem to have a role in the development of both disorders because they may be the result of faulty genes. So far, no singular gene is responsible. Because we inherit our genes from our family, we may also inherit mental health disorders as well. You are more at risk to develop a mental health disorder if a direct family member, such as parents and siblings, has one as well.

Sometimes people are born with brains with a different structure than an average person. We rely on a careful balance of chemicals and hormones for our brains to function. If there is a fault in our brain, or our brain is not structured optimally, this breaks down, and problems happen. This is why those that study bipolar disorder and BPD are taking internal maps of people’s brains to try and understand how these play a role in the development of these disorders. Right now, it’s not fully understood why some people have different brains than others, but it may be part of our genetics.

Our environment also plays a large role in the development of mental health disorders. Trauma, stress, substance abuse, and brain injury can all influence how someone’s brain functions. Sometimes the brain is fundamentally changed as the result of stress and trauma. Drugs and alcohol can change the chemistry in someone’s brain, altering the delicate balance within. Injury to the brain can damage sections responsible for how we control our moods or make decisions. All these are important to consider when assessing if someone is at risk for developing a mental health disorder.

How Borderline Personality Disorder and Bipolar Disorder Overlap

BPD and bipolar disorder share very similar symptoms. This can make it very hard to determine if someone has one or the other or if they have both. However, there are some subtle differences in how some symptoms manifest that help a doctor make an accurate diagnosis.

Both BPD and bipolar disorder affects how someone interacts with others, which influences how they build and maintain the relationships around them. When someone has either of these disorders, they often feel intense emotions or react to something in a more extreme way than average people. Both disorders cause impulsive actions that can be reckless or dangerous, such as unprotected sex or reckless driving. Someone with both disorders may sometimes feel depressed or even suicidal.

The difference between the two disorders is how distinct the shift in moods is. People with bipolar disorder shift dramatically from mania—high emotional moods marked with impulsive and reckless behavior—to hypomania—high moods but less severe than mania—and depressive episodes. How long these episodes last and what moods make them are different for each type of bipolar disorder. Bipolar I disorder most often overlaps with BPD because of the inclusion of intense manic episodes. Bipolar disorder is fundamentally a mood disorder that interferes with a person’s ability to regulate their emotions.

BPD, on the other hand, is a personality disorder. This means that BPD interferes with a person’s self-image and how they function with other people. BPD is marked by unstable or unpredictable behavior, which sometimes matches the symptoms of bipolar disorder. Those with BPD have difficulty maintaining healthy relationships due to fears of abandonment or the inability to regulate powerful emotions like anger. In some cases, a person with BPD may feel like they are outside of reality, known as dissociation.

Even though they are similar, it’s important to denote their distinctions, which is vital to both finding a diagnosis and treatment.

Getting a Diagnosis and Treatment

It’s possible to not only get a diagnosis for your mental health disorder but to find treatment as well. When getting treatment, remember that both disorders must be treated at the same time. One cannot be treated and then work on the other.

Luckily, many of the current treatments for bipolar disorder and BPD are very similar. Both make use of psychotherapy, also known as talk therapy, in treatment. Cognitive-behavioral therapy (CBT) is a specialized type of therapy that helps someone recognize harmful ideas and behavior and then change them. This can be used for both disorders, but it’s mainly used for bipolar disorder. On the other hand, there is dialectical behavior therapy (DBT), which has been especially useful in treating BPD. Both may be used, but each disorder has psychotherapy that helps treat them the best.

Medication is sometimes prescribed, but only when needed. BPD typically does not have medication prescribed to treat it unless it’s for a co-occurring mental health disorder, typically bipolar disorder. For that, they are typically given mood stabilizers and antidepressants to help manage their mood.

If you or someone you love is displaying signs of either of these disorders, it’s important to reach out for help right away. It’s never too late for help, and anyone can achieve recovery with the right support.

Sometimes someone can have what is known as a co-occurring mental health disorder. This is when someone has two or more mental health disorders simultaneously. This can make treatment tricky, as both disorders must be addressed to help someone achieve recovery. It may be difficult, but there is hope for those who struggle with these mental health disorders. At Acera Health in Costa Mesa, California, we help those with co-occurring mental health disorders find the best treatment and support they need to help them recover. Everyone deserves compassionate treatment, and that includes yourself and those you care about. If you or someone you love is struggling with a mental health disorder, call (949) 647-4090 today.

LMFT, Program Director at Acera Health | Edited & Medically Reviewed

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.


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