Bipolar Disorder and Borderline Personality Disorder: What you need to know

Cardinal Innovations Healthcare — May 7, 2019 — 4 min read

Bipolar disorder and Borderline Personality Disorder share some similarities that can make them easy to confuse, but the disorders also have a lot of important differences, including what causes them and how to treat individuals diagnosed with them.

Approximately 2.8 percent of U.S. adults ages 18 and older had a bipolar disorder diagnosis in the past year, according to the National Institute of Mental Health (NAMI). This disorder is slightly more common in males than females, with 2.9 percent of cases among males and 2.8 among females. About 4.4 percent of U.S. adults have experienced bipolar disorder at some point in their lives.

Meanwhile, 1.6 percent of the adult population in the United States is estimated to have Borderline Personality Disorder, but that number could be as high as 5.9 percent, according to the NAMI. This disorder is more prevalent in women with 75 percent of those diagnosed being female.

How are they defined?

Bipolar disorder, which has also been called manic depression, causes dramatic shifts in mood, energy and activity levels that can interfere with one’s ability to function throughout the day. These shifts in mood can last days, weeks or months and are more severe than the ups and downs experienced by everyone. Individuals with bipolar disorder often respond well to a combination of medication and therapy.

Borderline Personality Disorder also involves mood swings, but the changes entail an ongoing pattern of rapid shifts in mood, relationships, self-image and behavior. The shifts can happen from moment to moment and are frequently triggered by conflicts with others and an overly strong emotional response to an upsetting life event.

What are the symptoms?

Bipolar disorder involves alternating symptoms of depression and mania that can last for days or months. During a period of mania, one may seem excessively happy, angry and/or irritated and also have more physical and mental energy and activity than normal. Other symptoms during a manic episode include:
  • Racing thoughts and ideas
  • Talking more and faster
  • Making big plans
  • Risk taking
  • Impulsiveness (substance abuse, sex, spending, etc.)
  • Less sleep, but not feeling tired
During periods of depression, symptoms might include decreases in energy, sadness and reduced activity levels. Other symptoms during a depressive episode may include:
  • Restlessness and irritability
  • Problems concentrating and making decisions
  • Worry and anxiety
  • No interest in favorite activities
  • Feelings of guilt and hopelessness; suicidal thoughts
  • Changes in appetite or sleep patterns
Meanwhile, a person diagnosed with Borderline Personality Disorder has difficulty controlling their thoughts and managing feelings, and often has impulsive and reckless behavior. The most common symptoms of this disorder are:
  • Mood swings, often in response to stressful events or relationships
  • Low self-esteem, or self-image
  • Impulsiveness for example with spending or substance use
  • Problems managing unpleasant emotions such as anger
  • Paranoia
  • Self-harm or suicidal behavior
  • Feelings of emptiness or abandonment
  • History of unstable, intense relationships


The causes of bipolar disorder and Borderline Personality Disorder are not yet fully understood; however, scientists believe genetics, environmental factors and brain function may play a role in both.

For bipolar disorder, it is believed that genetics play a role, but are not the sole factor. A child’s chances of developing the disorder increase if their parent has the disorder, but they may never develop it. In studies of identical twins, one may have it while the other does not. Another factor that could trigger bipolar disorder is stress. A death in the family, an illness, a difficult relationship, divorce or financial problems can trigger a manic or depressive episode.

While brain scans cannot diagnose this disorder, research has uncovered subtle differences in the average size of some brain structures in individuals with bipolar disorder, according to NAMI.

Borderline Personality Disorder is five times more common with individuals who have a parent or other close relative with this disorder, according to NAMI. Traumatic events such as sexual abuse as a child or neglect by parents increase a child’s risk of developing Borderline Personality Disorder. Researchers believe the emotional regulation system in those with the disorder may be different than for those without it, according to NAMI.


Bipolar disorder treatment includes therapy, medication and self-management strategies. The therapy can involve cognitive behavioral therapy (CBT) or family-focused therapy. Medication that is frequently prescribed can include mood stabilizers, antipsychotic medications and antidepressants, though antidepressants should not be given alone, according to Dr. Tedra Anderson-Brown, Cardinal Innovations Healthcare’s Regional Medical Director. Self-management strategies can involve learning to recognize symptoms early and take action to address the episode.

Treatment for Borderline Personality Disorder involves therapy and medication. Therapy is often the first choice for treatment. The types of therapy frequently used include dialectical behavioral therapy (DBT), CBT and psychodynamic therapy. Medication for Borderline Personality Disorder often includes mood stabilizers, antidepressants and low-dose antipsychotic medication, which can help with disorganized thinking. Short-term hospitalization can be necessary for the safety of the individual.

“Some people require hospitalization, but other times people do not seek any care but they often overlook the social and occupational dysfunction that comes even with hypomania,” said Dr. Qionna Tinney, Associate Medical Director for Cardinal Innovations. “Safety/self-harm is a big issue with both disorders and so is self-medicating with substances.”
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