What is Borderline Personality Disorder… and How is it Different From Bipolar Disorder?

Borderline Personality Disorder

Intense emotions. Mood instability. Impulsivity. These are characteristic symptoms of borderline personality disorder… and bipolar disorder. Because they share some overlapping symptoms, these two psychiatric conditions are sometimes confused. Making things even murkier is the fact that they may be co-occurring, meaning a person can have both conditions simultaneously. Research in Dialogues in Clinical Neuroscience shows that approximately 1 in 5 people with borderline personality disorder (BPD) also has bipolar disorder (BD), and about 30% of those with BD were also diagnosed with BPD. But the two disorders are not the same. Here are the basics you need to know about each of them.

Intense emotions. Mood instability. Impulsivity. These are characteristic symptoms of borderline personality disorder…and of bipolar disorder. Because they share overlapping symptoms, these two conditions are sometimes confused. Click To Tweet


Borderline personality disorder (BPD) is a type of personality disorder that is associated with instability in moods, emotions, self-image, and relationships. Impulsivity and strong emotional reactions are also common in this condition, which affects an estimated 1.6% to 5.9% of the population. Women account for 75% of those diagnosed with BPD, but experts suggest that the disorder may be underdiagnosed in men. Males who report symptoms of BPD are more likely to be misdiagnosed with issues such as post-traumatic stress disorder (PTSD) or depression.


Bipolar disorder is a mood disorder characterized by significant changes in mood, energy, and activity levels that shift in a cyclical pattern. The highs are known as manic episodes while the lows are called depressive episodes. An estimated 6 million American men and women are affected by the condition, which is also seen in kids and teens.


Borderline personality disorder is associated with a wide variety of symptoms, including:

  • Distorted self-image: These individuals often have a poor sense of self.
  • Extreme emotional reactions: People with BPD can have inappropriate or exaggerated emotional responses to stressful situations, ranging from anger to deep sadness.
  • Dramatic mood swings: Moods can change rapidly and often.
  • Impulsivity: People with BPD may engage in risky behaviors, such as substance abuse, having unprotected sex, unsafe driving, and overspending.
  • Instability in relationships: These individuals have a tendency to see people as all good or all bad, viewing them as either an ally or an enemy. And this perception can change quickly.
  • Fear of rejection: Having a sense of dread that they will be abandoned is commonly seen, but extreme emotional reactions and mood swings tend to push others away. This can worsen symptoms.
  • Self-harm: People with BPD are at increased risk of suicide with almost 80% of sufferers making a suicide attempt at some point during their lifetime. Up to 10% of those with the condition die by suicide.
  • Co-occurring disorders: Other conditions seen in people with BPD include bipolar disorder, anxiety, depression, PTSD, eating disorders, and addictions. Co-existing conditions make it more challenging to diagnose BPD.


People with the condition typically experience a broad range of symptoms.

During manic episodes, symptoms may include:

  • Abnormally elevated mood, energy, and self-esteem: This can make a person feel superhuman as if they can accomplish anything.
  • Grandiose notions, ideas, or plans: A sudden flurry of new goals and an interest in undertaking a slew of new projects is common.
  • Racing thoughts: People say it’s like they can’t turn their minds off.
  • Risky behavior: Poor judgment can lead to extreme impulsiveness, such as hypersexuality, gambling, and more.
  • Delusions or hallucinations: Some people experience characteristics of psychosis.

During depressive episodes, symptoms may include:

  • Low mood: People may feel persistent sadness and negativity.
  • Loss of interest in usually pleasurable activities: Feeling no joy from the things you typically like doing is common.
  • Low self-worth: Feelings of helplessness and hopelessness may be present.
  • Decreased energy: Feeling fatigued or “slowed down” is a common complaint.
  • Suicidal thoughts: A 2019 study shows that 20%-60% of people with BD attempt suicide at least once in their lifetime.


Research points to a number of factors that may contribute to the development of BPD or BD, including:

  • Genetics: Having a close family member with BPD or BD may increase your risk.
  • Exposure to trauma: Exposure to traumatic events or experiencing childhood abuse, neglect, or abandonment appears to be common in people with borderline personality disorder or bipolar disorder.
  • Environmental factors: Toxins (such as toxic mold), infections like Lyme disease, substance abuse, and other toxins can negatively impact brain function and contribute to changes in personality and moods.


Brain SPECT imaging, which measures blood flow and activity, reveals abnormal brain activity in people with BPD and/or BD. On brain scans, borderline personality disorder is often associated with abnormal activity in the fear and emotional centers of the brain. In addition, SPECT reveals that mild traumatic brain injuries are a major cause of psychiatric symptoms, including many of the same changes in mood, personality, and behavior that are seen in people with BPD or BD. Brain scans are also helpful in detecting co-existing conditions.


There is hope for people who are struggling with BPD and/or BD. With an accurate diagnosis and a comprehensive treatment plan that may include medication (as necessary), nutritional supplements, psychotherapy, and lifestyle changes, people with these conditions can minimize and manage symptoms. Research in Archives of General Psychiatry found that 85% of people who sought treatment for BPD no longer met the criteria for the disorder 10 years later. A pair of studies from 2017 found that enhancing resilience and self-management in bipolar disorder improved treatment success.

Borderline personality disorder, bipolar disorder, and other mental health issues can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.

1 Comment »

  1. This was helpful to me

    Comment by Teresa Oteng — July 20, 2021 @ 3:26 AM

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