The 7 differences between Bipolar Disorder and Borderline Personality Disorder (BPD)

They may resemble each other in aspects such as emotional instability, but they should be differentiated.

The emotional element is one of the most important for the human being, since it allows us to value the implication for us of what happens around us and motivates different types of behavior.

Joy moves us to action and to the repetition of behaviors that have generated it, as does pleasure. Sadness leads us to avoid repeating situations. Fear causes us to avoid stimuli. Love and hate lead us to approach or move away from beings, stimuli or situations. Emotions are not immutable and change according to events. However, there are different disorders in which those who suffer from them undergo rapid changes in emotionality that they cannot control and that sooner or later make them suffer.

Perhaps the first one that comes to mind is Bipolar Disorder, but there are also others as well known as Borderline Personality Disorder. These disorders have symptoms that in some aspects make them very similar and sometimes they can even be confused. That is why in this article we are going to analyze the differences between Bipolar Disorder and Borderline Personality Disorder..

Bipolar Disorder

Bipolar disorder is, together with depression, one of the mood disorders, characterized by the presence of one or more manic or hypomanic episodes, which may be preceded or followed by a depressive episode.

In manic episodes, an expansive and an expansive and euphoric mood.Inflated self-esteem and feelings of grandiosity are frequent. Other symptoms that may and/or should be present are elevated energy level, decreased sleep, distractibility, failure to assess risk and engage in high-risk behaviors and flight of ideas.

In certain severe cases, hallucinations and delusions, verbosity and irritability/hostility may also be present. Symptoms usually last at least one week. Hypomanic episodes are similar but with a much lower intensity and duration (at least four days), with no alterations such as delirium.

As for the depressive episodes, they are experienced for at least two days.In the case of depressive episodes, a sad mood is experienced for at least two weeks, together with anhedonia and abulia, with frequent loss of motivation or the capacity to feel pleasure. Hopelessness and passivity, thoughts of suicide, and sleep and eating problems are also common.

There are two types of bipolar disorder, type 1 and type 2. In the first one it is essential that at least one manic or mixed episode has appeared, which may or may not be followed or preceded by a depressive episode. The second refers to people who experience one or more depressive episodes together with at least one hypomanic episode.

The Borderline Personality Disorder (BPD)

With regard to Borderline Personality Disorder, it is a personality disorder characterized by a pattern of behavior in which affective, emotional and relational instability prevails, together with a high level of impulsivity. a high level of impulsivityIt starts in adolescence as a result of the interaction between Biological aspects and the experiences and learning carried out by the subject.

Among the most characteristic symptoms are low self-esteem, permanent feelings of emptiness and worthlessness, high reactivity to events and interactions, extreme experience of emotions and idealization or devaluation of others in very categorical terms.high reactivity to events and interactions, extreme experience of emotions and idealization or devaluation of others in very categorical terms.

Also noteworthy is the presence of an atrocious panic of being abandoned, making frequent efforts to avoid it (even if it is not real). Suicidal thoughts are also frequent (and in many cases attempts to carry them out) or realization of self-injurious acts. There may appear alterations linked to dissociationsuch as depersonalization or derealization. In certain contexts they may be criticized for being irritable, it is speculated that this is due to a relative difficulty in recognizing and expressing their emotions, although little is known about this.

Characteristics in which they are similar

From the above descriptions and diagnostic criteria, we can find that Bipolar and Borderline Disorder have some obvious similarities. similarities. People suffering from both disorders manifest symptoms such as high impulsivity, irritability and a superficial pattern of relationships (at least at some times). The most important commonality is high emotional lability, changing rapidly from one emotional state to another.

In addition to the above, we are dealing with two of the disorders that have been most frequently linked to the realization and/or consummation of suicide attempts, with Bipolar Disorder being one of the most frequently linked (together with depression and addictions) and Borderline Personality Disorder being one of the most frequently linked (together with depression and addictions). the personality disorder most often linked to suicide.

Finally, we can find subjects who present both diagnoses, Borderline Personality Disorder and Bipolar Disorder. Although this clearly indicates that they are not considered the same, the truth is that many of the symptoms are very similar.

Differences between Bipolar Disorder and Borderline Personality Disorder.

The above points in common may lead one to think that both disorders are very similar and in some cases may even be confused. But despite the fact that Bipolar and Borderline Disorder have points in common and part of their symptomatology coincides, we are still facing diagnostic entities with several differences between them. Among the most significant differences are the following.

Presence or absence of euphoria.

In both Bipolar Disorder and Borderline Disorder we encounter rapid changes in very intense emotions.. However, while in bipolar disorder there are one or more manic or hypomanic episodes that are linked to an expansive and euphoric mood, in borderline disorder a depressive affective tone persists, with no euphoria appearing.

2. Stability of changes

While mood changes can be very rapid in Borderline or Borderline Personality Disorder, in the case of Bipolar Disorder they can be much more stable and long lasting. For example, someone with Borderline Disorder may have constant mood swings throughout a day, or even within one or a few hours. The person with bipolar disorder presents sudden changes, but in the form of episodes that tend to last longer.

However, it should be noted that people with bipolar disorder, known as "rapid cyclers," are rapid cyclers (with at least four changes of emotional polarity in a year) may present a greater lability than the average, although it will generally not be as marked as in the case of borderline disorder.

On the other hand, the level of impulsivity is stable and constant in patients with borderline disorder, while in bipolar disorder it appears only in the manic phase.

3. Reason for the mood change

Another of the differences can be found in what exactly triggers the change, while in the Bipolar Disorder we find that these changes are considered to be due to alterations and dysregulations of the cerebral neurotransmitters, those of the borderline disorder are often located outside, on psychosocial stress, interpersonal relationships and the experiences of those and the experiences that sufferers have. That is, someone with Bipolar Disorder may not be aware of exactly what has caused their changes, while the borderline may associate it with a much more specific discussion or discomfort.

4. Presence of asymptomatic periods

Borderline personality disorder, as the personality disorder that it is (its characteristics being therefore integrated into the subject's way of being), remains consistent over time. That is, there are no asymptomatic periods per se. On the other hand, in Bipolar Disorder, we find that between episodes there may be symptom-free periods more or less prolonged, although it is not uncommon that sometimes subclinical symptoms persist. And although it is not the most habitual thing they can not even get to repeat the episodes.

5. Level of self-esteem

Although the experience of both disorders in the long run usually leads to a decrease in self-esteem and self-concept, in Bipolar Disorder this will vary greatly depending on the type of episode the subject is having.

In manic phase usually appears an expansive state of mind in which sensations of grandiosity feelings of grandiosity stand outbeing the self-esteem very enlarged. In depressive phases the mood and self-esteem is usually very diminished. In asymptomatic periods this part of the self-concept may be at normative levels, although it may also be altered.

As far as Borderline Personality Disorder is concerned, as a rule sufferers tend to have a very low opinion of themselves, often feeling powerless and worthless. In a great majority of patients the prevailing feeling is that of feeling empty and panicking about being abandoned.

6. Relationship with others

We have seen above that in both disorders there may be the presence of superficial, shallow or unstable relationships. However, we can also observe differences.

The subject with Borderline Personality Disorder usually has feelings of emptiness, of having little value and an extreme panic of being abandoned. an extreme panic of being abandoned. It is frequent that they establish dependency relationships, needing to be understood, loved and valued. They also fight constantly, idealize others or devalue them.

However, the subject with bipolar disorder is attached to others in a normative way when he/she is in the asymptomatic phase, appearing superficiality especially in the manic phases, but but there is usually no emotional dependence on others (although it can occur in of others (although it can occur in depressive phases).

7. Treatment

Despite being a severe personality disorder, people with borderline personality disorder tend to benefit greatly from psychotherapy and various psychological techniques (many specifically oriented to this disorder). The treatment of Bipolar Disorder, on the other hand, tends to be more complicated and much more focused on pharmacotherapy. and much more focused on pharmacology, although different therapies such as interpersonal and social rhythms or different applications of cognitive-behavioral therapy have been generated.

Bibliographical references

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
• Santos, J.L. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J. ; de los Ríos, P. ; Izquierdo, S. ; Román, P. ; Hernangómez, L. ; Navas, E. ; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Psicología Clínica. Manual CEDE de Preparación PIR, 02. CEDE. Madrid.
• Working Group of the Clinical Practice Guideline on Bipolar Disorder (2012). Clinical Practice Guideline on Bipolar Disorder [Summary version]. Madrid. Quality Plan for the National Health System of the Ministry of Health, Social Services and Equality. University of Alcalá. Spanish Association of Neuropsychiatry. UAH/AEN No. 2012/1.