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. This was helpful to me

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

  2. Well written and concise overview of these two disorders. Even if a seasoned
    Clinician it is useful to re read the symptoms to keep in mind the similarities and differences between BD and BPD!

    Comment by Bill Shryer — July 23, 2021 @ 3:51 AM

  3. I love the Amen clinic. I’m patient and it saved my life.

    Question. How can this treatment become affordable to all. I did not initially come because of financial constraints. Having to pay $4 to 5kout of pocket plus travel expenses time away from business etc. for me I was able to do it because my life was on the line. So many other people in my community church otherwise the poor and our community could highly benefit from the services. They just aren’t affordable to the average low middle-class or poor people. Do you have any programs or assistance available at this time? He long-term goals for this kind of service to be affordable to all. Love to hear your thoughts on this. I am an ongoing patient. I’m a big believer of everything Dr. amen publishes and read and stay on top of everything he does. Love some feedback thanks

    Comment by Michael Flory — July 23, 2021 @ 4:01 AM

  4. I would love to know my diagnosis and what meds work the best. I’ve had several diagnoses so.. I also do not know where you are located. I live in Iowa. Thanks

    Comment by Barb Belstene — July 23, 2021 @ 5:10 AM

  5. Very helpful differentiations.

    Comment by Anamae Storbeck — July 23, 2021 @ 5:14 AM

  6. I have bpd and have experienced all of what is described above. DBT (Dialectical Behavioral Therapy) helped me a lot alongside knowing the love of God, diet, light therapy in winter, improving sleep, and medication. Life can be better! Wishing you the courage to take the first step towards healing.

    Comment by Maureen Suprenant — July 23, 2021 @ 5:18 AM

  7. I have Dr Amens book The End to Mental Illness I lived with my ex who was bypolar and believe yes some mental disorders are probably from brain injury but a lot are close family members we have a 11 year old granddaughter that fits BPD as her father is diagnosed with it I’m hoping Dr Amens book will help she’s in therapy but needs help with eating disorder

    Comment by Leslie Thorstad — July 23, 2021 @ 5:42 AM

  8. Helpful !!!!!!! Thank you

    Comment by Viola — July 23, 2021 @ 6:11 AM

  9. Thank you for another great article.

    Comment by Timothy Lee — July 23, 2021 @ 6:18 AM

  10. Being successfully treated for bipolar II on risperdol and lamotrigine. Diagnosed after surviving several suicide attempts. One where ended up on life support in ICU for 11 days and 4 resuccitations. Without these Rxs I am deeply depressed and suicidal. I had published my memoir AND MAY GOD BLESS by RUTH ANN COMER in it I go extensively into my experiences of having bipolar II and dealing with tormenting suicide ideations and my need to stay on RXs.

    Comment by Ruth Comer — July 23, 2021 @ 6:22 AM

  11. Valuable information. I would like to participate involviment with my local Senior community informing or distributing this information . Senior member’s RELIES /depending much on prescription drugs. This data is important.

    Comment by Dolores — July 23, 2021 @ 6:36 AM

  12. How much does it cost to get a scan and initial treatment in the Seattle area?

    Comment by Laura Johnson — July 23, 2021 @ 6:54 AM

  13. Can you suggest helpful supplements for these issues?

    Comment by V. — July 23, 2021 @ 7:23 AM

  14. Do you accept any kind of insurance?

    Comment by Trish Rhoades — July 23, 2021 @ 7:36 AM

  15. i have two children and 2 sisters with one or both of these disorders…. this information is so helpful.. however, your opinion on diagnosing and then communicating the diagnosis to the patient? Some Dr.’s feel that patients don’t benefit or need to be told they are BPD or are fearful in committing to that diagnosis? Your professional opinion on that?

    Comment by JANINE — July 23, 2021 @ 7:49 AM

  16. I have been given a “soft bi-polar “ or bod diagnosis & over the past 24 years with symptoms & behavioral changes that began @ age 30 started to really become apparent with the beginning of a Doctor giving me RX OPIODS! And that began my addict life for so many years with several re-habs-(never had a drug in my life before this & didn’t abuse alcohol) The fact that so many more WOMEN are put into these categories because of mood & emotional disruption & display is interesting to me! I have been successful on Suboxone for over 3 years now, and with the MAT program I feel so much more in control of my life & emotional well-being! I’m 55 now & would PLEAD to any woman who has a birth, c-sec., or surgery of any kind to have a plan for pain management that limits or even exclude opioids! They really screw up the female brain because we do express many more emotions & have a more diverse capability for different types of love & decisions as a mother.

    Comment by Heidi Sorzano — July 23, 2021 @ 7:51 AM

  17. No mention of BD type 1 & 2. I have been struggling with depression. I do get some manic phases once and a while,but very rare.

    Comment by Hank Savoy — July 23, 2021 @ 8:12 AM

  18. I am a mental health professional. I have all the symptoms of BD and an diagnosed with MDDR, my brother was Bi-polar and committed suicide at 38. Although Narcissism is the new “thing to have” my mother is and was a narcissisist that meets all the criteria except maybe 2 out of 20. I understand childhood trauma rearranges the chemistry if a child’s brain. My brother became a minister and I a mental hlth professiona, to, what I believe now, seek answers to things nobody understood, and most therapists and professionals would exacerbate by negating us and asking us to “work” on it, Bullshit! Ppl need to understand that therapy can keep you too long in a sick situation, and meds are often prescribed to the sane person in a consistently traymumatic situation, as they TRY to be the one at fault. I believe meds can help, but mental illness is way over diagnosed and personality disorders are given a pass on their behavior. Ppl do suffer from mental illness…but not 95% of our population. Ppl need to be given permission to do what their instincts tell them, actuvely seek re conditioning thru behavior modification, and held accountable AS WELL AS taught to TRUST THEMSELVES! All this medication, and joke of therapy, is keeping us sick and giving us added diagnosis! I am all about treatment fir depression, mania, scizoid, , but quite honestly these ppl being prescribed meds for depression for 20 years is absolutely ludicrous. Schizophrenia? yes. Voices, hallucinations, those types of things need lifetime management. Most everything else should be short term medication, behavior modification, feelings forced to be felt instead of suppressed and quit just sitting around with a therapist trying to figure out what caused it and talking about the damage it’s done! That alone adds more shame, more guilt, more fear, and mire responsibility to a client whose health, self-esteem, success rate, and all things good in life if they accept that they aren’t happy, may need some help to get over the hump and learn to do things that make them feel good and permission to get the hell away from ppl who are not good to them! Recognize other ppl’s behaviors to and quit blaming themselves for being abused and not liking it! Leaving shit and assholes behind you and learning to feel the pain of it allows you to REALLY grow and experience what it feels like to be happy!! This everybody has something that can be fixed with medication IS insanity! 85% of the population should be healthy! That’s the way were made!! I’m so suck and tired of everybody being me tally ill while the truly mentally ill are overlooked or encouraged to stay sick and treated like a diagnosis instead if a real person who has a REAL mental illness and wiukd THRIVE with behavior modification and supporf along with their medication!! I oracticed it, worked with my clients on it, seen REAL grieth and HUGE improvements in the quality of life that are both held accountable, trusted, and expected to LIVE, most often without the need for any medication instead of more medication in their future!! “Therapists” need to quit being so lazy and actually work with someone to LIVE a healthy life!! I’m sick to death of this system of excuses, andsthisizers, and “working” through it!! You lived through it! Now do something that makes you happy and work on that!!It’s amazing what happens to ppl!!

    Comment by Lea Wright — July 23, 2021 @ 8:32 AM

  19. How do I share article

    Comment by Michelle — July 23, 2021 @ 8:51 AM

  20. Information about schizophrenia. Please

    Comment by Maudlyn Guerra — July 23, 2021 @ 8:57 AM

  21. Thank you, this is very helpful & hopeful article – the most optimistic I’ve read on bipolar. It seems possible PTSD could be mistaken for bipolar as well. Especially after a SPECT scan parallels the patterns of a gallery SPECT brain scan with emotional trauma A local hospital diagnosed our son with bipolar, and medicated him as such – we know he is not, especially since his SPECT scan revealed emotional trauma. (He had several friends, during the course of 4 years, take their lives) How do we transition him off the meds, that are treating him, unsuccessfully, for bipolar, and give him more appropriate help? He is currently not motivated, depressed/sad and needing help for trauma. Thank you for any advice you can offer.

    Comment by Jeff — July 23, 2021 @ 8:58 AM

  22. How is complex PTSD differentiated from BPD and BP?

    Comment by Kaylene — July 23, 2021 @ 9:02 AM

  23. I see many relationship disorders. Anxiety and Domestic Violence. Thx This was helpful.

    Comment by Mary Dermody — July 23, 2021 @ 9:56 AM

  24. Are children from divorced homes or single parent homes more likely to develop Borderline Personality Disorder?

    Comment by baj — July 23, 2021 @ 10:57 AM

  25. Thank you for continually educating us.

    Comment by Ruben — July 23, 2021 @ 11:50 AM

  26. I didn’t find this all that helpful. It lays out the symptoms, which are indeed similar, but didn’t give me a clearcut means of telling the difference in real-life clinical observation. It doesn’t provide any info that one couldn’t get from the DSM-5.

    Comment by Theresa Gilman — July 23, 2021 @ 3:13 PM

  27. But how to get someone with suspected BPD to agree to have tests or see a psychiatrist when they are in denial that they have a problem ?

    Comment by Wendy Arrowsmith — July 23, 2021 @ 3:22 PM

  28. My son’s might have this.

    Comment by Ruth Hanrahan — July 23, 2021 @ 3:35 PM

  29. How do you help people with these disorders?

    Comment by Ruth Hanrahan — July 23, 2021 @ 3:45 PM

  30. Very helpful and informative information

    Comment by Mark Wilson — July 23, 2021 @ 10:58 PM

  31. Great article. It has taken a long time for me to understand my issues.

    Comment by Maggi Nicholson — July 24, 2021 @ 4:13 AM

  32. This was very interesting to read, My sister took her life in 2002 , she was diagnosed with BPD, and major depression , since her death I have struggled, and have been diagnosed with BP 2 . Reading this article helped me to see that I have more BPD symptoms then Bipolar . I have been on different meds but I’m at the point where I have to except, this is just me, and nothing is going to change. Can someone with BPD change?

    Comment by Susan — July 24, 2021 @ 10:37 AM

  33. Thanks for addressing this topic. It would be helpful if the numbers describing BPD and BP in the population were offered in the same form. In describing BPD % in population is used, “1.6% to 5.9% of the population”. In BP number of millions is used, and only of adults “estimated 6 million American men and women are affected by the condition, which is also seen in kids and teens” which makes if difficult to relate the incidence/frequency of these in the overall population. It’s harder to conceive of how many people are diagnosed with each of these when different measurements are used.

    Comment by Colleen — July 24, 2021 @ 10:53 AM

  34. This would be my self dx

    Comment by Robert Bennett — July 24, 2021 @ 11:13 AM

  35. I work in Disability Law as an Advocate for all my clients. I specialize in Neurological Issues and have been doing this for 25 years. I own and operate my own business as a learned necessity of what we had to do when my oldest son was diagnosed at age 8. As his Mom, I became his Advocate, and have learned that I can help so many others who need a voice. I became so inspired by the SPECT Scans and this ignited a passion for learning about Brain Health. I needed this as a parent but also as a tool, to help me better understand and navigate our journey ahead. I help Children with diagnoses and provide support and resources to the parents. I work with disabled adults who may be diagnosed or not yet diagnosed, to find the appropriate level of care including Disability if warranted. I work with Veterans who have a Diagnosis or suffer from PTSD or other brain trauma. I am a big Advocate of Dr. Amen and have used his scans in several clients’ cases.

    Comment by Sarah Blalock — July 24, 2021 @ 11:42 AM

  36. My sister has this. BPD. How does one help them when they refuse help and or will not accept there is a problem. She’s almost homeless due to spending her entire inheritance and drove everyone away. According to her, it’s everyone else’s fault

    Comment by Carolyn Bonifacio — July 24, 2021 @ 3:05 PM

  37. Very interesting because My son in law was diagnosed bi-polar in his 20’s and he’s in his 40’s now and still has it. They lived in a home with a ton of black mold in the enclosed porch and other mold in the basement. Nowmy daughter seems to have the other version but refuses toget treatment at 40 years old. She is in fear of losing her job.

    Comment by Judith A. Mellott — July 24, 2021 @ 4:28 PM

  38. Very helpful. I actually think I qualify for Borderline Personality Disorder. The difference today and say 29 years ago is that I have done therapy, eat very well, excercise, 12 step was a great help, meditation and have many tools to look at people and situations that trigger me and get to the source, trauma etc that I chose to make a belief around. Today I feel very stable . I’m growing up beautifully at 73 years old

    Comment by Jackie Holt — July 25, 2021 @ 7:00 AM

  39. For years I’ve diagnosed our adopted daughter with both BPD and bi-polar. Reading your article confirms my thoughts on her. She also suffers with ADD.. I’m a retired LMFT.

    Comment by Pat — July 25, 2021 @ 10:19 AM

  40. How it’s it possible to help an adult to recognize that he needs help.

    Comment by Maria Gonzalez — July 25, 2021 @ 1:34 PM

  41. That’s exactly how I feel.

    Comment by Cynthia Sanchez — July 25, 2021 @ 2:34 PM

  42. It appears that the treatment for both BP and BPD are the same yet you say they are both distinctly different disorders. How does pinpointing which disease one has make a difference in their outcome?

    Comment by Sherry Lynn Metcalfe — July 25, 2021 @ 6:10 PM

  43. This was very helpful thank you! My adult son has BD, intermittent explosive disorder and ADHD.

    Comment by Angela Tombe — July 26, 2021 @ 6:03 AM

  44. This was helpful

    Comment by Melissa McElmurray — July 26, 2021 @ 1:02 PM

  45. Hello Ruth, thank you for reaching out. At Amen Clinics, we utilize brain SPECT imaging as a diagnostic tool in determining an accurate diagnosis for our patients. For more information about SPECT scans and our services, please contact our Care Coordinators here: https://amenclinics.com/schedule-visit/.

    Comment by Amen Clinics — July 26, 2021 @ 5:33 PM

  46. Hello Maria, thank you for your comment. We have a couple articles that may help you with starting a conversation with a loved one:

    Comment by Amen Clinics — July 26, 2021 @ 5:35 PM

  47. Hello Wendy, thank you for reaching out. We have a couple of articles that may help you with starting a conversation with a loved one:

    Comment by Amen Clinics — July 26, 2021 @ 5:36 PM

  48. Hello Kaylene, thank you for your comment. Here is an article about Complex PTSD and PTSD, which may be helpful in comparison to this article on Bipolar Disorder and Borderline Personality Disorder:

    Comment by Amen Clinics — July 26, 2021 @ 5:39 PM

  49. Hello Jeff, thank you for reaching out and sharing with us. We’d be happy to contact you directly with more information about SPECT and our services. We look forward to speaking with you.

    Comment by Amen Clinics — July 26, 2021 @ 5:41 PM

  50. Hello Maudlyn, thank you for reaching out. We’d be happy to contact you directly with more information about SPECT and our services related to schizophrenia. Here is more information on our website: https://amenclinics.com/conditions/schizophrenia-and-schizoaffective-disorders/. We look forward to speaking with you.

    Comment by Amen Clinics — July 26, 2021 @ 5:42 PM

  51. Hello Michelle, thank you for your comment. At the top of the article, underneath the title, there are share buttons for the most common social media platforms as well as a print button.

    Comment by Amen Clinics — July 26, 2021 @ 5:43 PM

  52. Hello Janine, thank you for reaching out. We have a couple of articles that may help you with starting a conversation with a loved one:

    Comment by Amen Clinics — July 26, 2021 @ 5:44 PM

  53. Hello Trish, thank you for reaching out. Reimbursement by insurance companies varies according to your plan. Amen Clinics, Inc. does not bill insurance. At the end of the evaluation, patients are given a “walk-out statement” containing applicable diagnosis and billing codes, which can then be submitted to insurance companies for possible out-of-network reimbursement.

    Comment by Amen Clinics — July 26, 2021 @ 5:46 PM

  54. Hello, thank you for reaching out. You can find Dr. Daniel Amen’s recommended brain-directed supplements here: https://brainmd.com/.

    Comment by Amen Clinics — July 26, 2021 @ 5:47 PM

  55. Hello Laura, thank you for reaching out. We’d be happy to contact you directly with information about our services at Amen Clinics Seattle and our pricing. We look forward to speaking with you.

    Comment by Amen Clinics — July 26, 2021 @ 5:48 PM

  56. Hello Barb, thank you for reaching out. We’d be happy to contact you directly with more information. We currently have 9 locations nationwide: https://amenclinics.com/locations/. We look forward to speaking with you.

    Comment by Amen Clinics — July 26, 2021 @ 5:50 PM

  57. Thank you for your comments Lea Wright, to which I agree!

    Comment by Julie S — July 27, 2021 @ 8:42 AM

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