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

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

Joy moves us to action and to the repetition of behaviors that have generated it, as well as pleasure. Sadness leads us to avoid repeating situations. Fear generates that we avoid stimuli. Love and hate lead us to get closer or away from beings, stimuli or situations. Emotions are not immutable and they are changing based on events. However, there are different disorders in which those who suffer suffer rapid changes in emotionality that they can not 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 ways make them very similar and sometimes even get confused. That is why in this article we are going to analyze the differences between Bipolar Disorder and Personality Disorder .

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Bipolar disorder

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

In manic episodes it appears an expansive and euphoric mood , being frequent that appear inflated self-esteem and feelings of grandiosity. Other symptoms that may and / or should be present are the elevation of the energy level, the decrease in sleep, the distraction, the non-assessment of risks and the emission of high-risk behaviors and the flight of ideas.

In certain severe cases, hallucinations and delusions, verbiage, and irritability / hostility may also appear. The symptoms usually last at least a week. The hypomanic episodes are similar but with a much shorter intensity and duration (at least four days), there being no alterations such as delusions.

With regard to depressive episodes , a sad mood together with anhedonia and abulia is experienced for at least two weeks, often losing motivation or the ability to feel pleasure. It is also common for despair and passivity to appear, thoughts of suicide and sleep and feeding problems.

There are two types of Bipolar Disorder, type 1 and type 2. In the first, it is essential that at least one episode of a manic or mixed type 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 with at least one hypomanic.

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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, along with a high level of impulsivity , which begins in the period of adolescence as a result of the interaction between biological aspects and the experiences and learning made by the subject.

Among the most characteristic symptoms we find low self-esteem, permanent feelings of emptiness and having little value , high reactivity to events and interactions, extreme emotional experience and idealization or devaluation of others in very categorical terms.

It also highlights the presence of an atrocious panic to be abandoned, making frequent efforts to avoid it (although this is not real). Suicidal thoughts (and in many cases attempts to carry them out) or self-injurious acts are also frequent. They may appear alterations linked to dissociation , like depersonalization or derealization. In certain contexts they can be criticized for being irritable, it is speculated that due to a relative difficulty to recognize and express their emotions, although still little is known about it.

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Features in which they resemble

From the previous descriptions and diagnostic criteria, we can find that Bipolar and borderline disorder have some similarities obvious. People suffering from both disorders manifest symptoms such as high impulsivity, irritability and a superficial relationship pattern (at least in some moments).The most important coincidence is the high emotional lability, rapidly changing from one emotional state to another.

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

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

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Differences between Bipolar Disorder and Personality Disorder

The above points in common may suggest that both disorders are very similar and even in some cases could get confused. But despite the fact that Bipolar and Borderline Disorder have points in common and part of their symptomatology coincides, we do not stop being in front of diagnostic entities with diverse differences between them. Among the most significant differences we find the following.

1. Presence or absence of euphoria

Both in Bipolar Disorder and borderline disorder we find ourselves with 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 state of mind, in the borderline disorder an affective tonal of a depressive type persists, not appearing euphoria.

2. Stability of changes

Although the changes in the mood can be very fast in the Borderline Disorder or Personality Limit, in the case of Bipolar Disorder this can be quite stable and lasting. For example, someone with borderline disorder may have constant mood swings throughout a day, or even in a few hours. The subject with Bipolar Disorder presents sudden changes, but in the form of episodes that usually last longer.

Despite this, it must be taken into account that those people with Bipolar Disorder called fast 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, whereas in Bipolar Disorder it appears only in the manic phase.

• Related article: "Emotional lability: what is it and what are its symptoms?"

3. Reason for the change of mood

Another difference can be found in what exactly triggers the change, while in Bipolar Disorder we find that these changes are due to alterations and disregulations of brain neurotransmitters, those of the borderline disorder are often located outside , in psychosocial stress, interpersonal relationships and the experiences of those who suffer it. That is, someone with Bipolar Disorder may not be aware of exactly what 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 an alteration of the personality that it is (its characteristics being integrated into the subject's way of being), remains consistent over time. That is, there are no asymptomatic periods per se. By contrast in Bipolar Disorder we find that between episodes there may be periods free of symptoms more or less prolonged, although it is not uncommon that subclinical symptoms sometimes persist. And although it is not the most common 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 it will vary greatly depending on the type of episode that the subject is having.

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

With regard to the Limit Personality Disorder, as a general rule those who suffer from it often have a very bad opinion of themselves, often feeling helpless and worthless. In a large majority of patients the prevailing sensation is feeling empty and having panic to be abandoned.

6. Relationship with others

We have seen previously that in both disorders the presence of superficial, shallow or unstable relationships can occur. However, we can also observe differences.

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

However, the subject with bipolar disorder is bound to others normatively when he is in an asymptomatic phase, with superficiality appearing especially in the manic phases, but there is usually no emotional dependence of others (although it can occur in depressive phases).

7. Treatment

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

Bibliographic 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 .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Thief, A and Álvarez-Cienfuegos, L. (2012). Clinical psychology. CEDE Preparation Manual 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.

Understanding Bipolar Disorder (April 2024).