Understanding The Diagnostic Processes
BPD and NPD have similar diagnostic processes. It may begin with your healthcare provider, who will give you a physical exam and look at your medical and family histories.
Depending on your symptoms, your healthcare provider may order blood work or other tests to rule out other conditions.
You will then undergo a mental health evaluation. Your primary care provider may perform this themselves or refer you to a mental health specialist.
When Should I Go To The Emergency Room For Bipolar Disorder
If youre experiencing any of these situations, its essential to call 911 or get to the nearest emergency room:
- Thoughts of death or suicide.
- Thoughts or plans of hurting yourself or others.
- Experiencing hallucinations and delusions.
- Symptoms of lithium toxicity , such as severe nausea and vomiting, severe hand tremors, confusion and vision changes.
A note from Cleveland Clinic
Bipolar disorder is a lifelong illness. But long-term, ongoing treatment, such as medication and talk therapy, can help manage your symptoms and enable you to live a healthy, purposeful life. Its important to see your healthcare team regularly to monitor your treatment plan and symptoms. Know that your healthcare providers and loved ones are there to support you.
Last reviewed by a Cleveland Clinic medical professional on 04/12/2022.
References
Do I Have Borderline Or Bipolar
If you think you might have bipolar disorder or borderline personality disorder , understanding the difference can be confusing. Maybe youve struggled with mood swings, thoughts of self-harm, or making impulsive decisionsall of these are common among people with both conditions. But despite their similarities, bipolar disorder and BPD also have a lot of differences. Understanding these differences can help you decide what steps to take to improve your mental health.
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Effects Of Diagnosis Of Bipolar Disorder On Personality Traits
ANCOVA showed that bipolar patients scored significantly higher on novelty seeking = 29.6 p < 0.001), harm avoidance = 86.4 p < 0.001) and self-transcendence = 22.3 p < 0.001) than healthy individuals. The bipolar patients scored significantly lower on self-directedness = 181.5 p < 0.001) and cooperativeness = 28.8 p < 0.001). Bipolar patients did not differ significantly from healthy individuals on reward dependence = 0.8 p = 0.39) and persistence = 2.5 p = 0.12). The means and S.D. for each dimension score for each of these groups are displayed in Table 2.
What Is The Outlook For Bipolar Vs Bpd
Both BPD and bipolar disorder are serious mental health conditions that greatly affect a persons life. The good news is that both can be treated effectively by mental health professionals. Treatment may not make all symptoms go away, but it can reduce the effects so you can live a happier, healthier life.
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Personality Differences In Bipolar Disorder With Comorbid Alcohol And/or Anxiety Disorders
Alcoholic bipolar patients scored lower than non-alcoholic bipolar patients on persistence. Lower levels of persistence also are associated with a diagnosis of metamphetamine abuse , but studies using the TCI found no association between alcohol abuse and persistence, in spite of findings of higher novelty seeking and lower self-directedness in alcoholic patients compared to healthy individuals . Persistence is related to the ability to persevere despite frustration and fatigue, and it is possible that bipolar patients with low persistence may have more difficulty in stopping alcohol use despite its adverse consequences. The same may be so for methamphetamine abuse. It is noteworthy that alcoholic bipolar patients presented numerically higher scores on novelty seeking and lower scores on self-directedness than bipolar patients without any comorbidity , and there is a possibility that, due to the small sample size of this specific subgroup , these numbers failed to reach statistical significance. In spite of the cross-sectional design of our study, it is very tempting to speculate whether lower persistence combined to higher novelty seeking and lower self-directedness might jointly predispose bipolar patients to develop alcohol use disorders, contributing to the high prevalence rates of alcoholism in this population.
When To See A Doctor For Borderline Personality Disorder Or Bipolar Disorder
Having occasional mood swings and feelings of sadness or depression is a normal part of life, but if you begin to have these symptoms or any of the symptoms of BPD or bipolar disorder on a regular basis, then it may be time to see a doctor. Because the symptoms of BPD and bipolar disorder overlap with other mental illnesses like anxiety, its important that a mental health professional checks out your symptoms to make an accurate diagnosis.
Borderline personality disorder and bipolar disorder that go untreated can make life really hard. Psychiatrists and psychologists are trained to help people with these disorders have a higher quality of life, so its always best to seek medical advice if you think you have one of these disorders.
In addition, people with bipolar disorder or BPD who are having suicidal thoughts or behaviors should seek immediate medical attention and go to the emergency room. Not seeking help could result in self-harm or the harm of another.
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Symptoms: Similarities And Differences
Not everyone with BPD has narcissistic traits. Most people with BPD or NPD dont have the other disorder. Research suggests 4.5% of people with BPD have NPD.
On the surface, BPD and NPD look quite different. When you dig deeper, though, you find some similarities.
In particular, the manic phase of bipolar disorder can make a person feel that theyre especially powerful, important, or talented. Thats a key trait of narcissism.
Other symptoms BPD and NPD have in common include:
- Setting high, often unachievable goals
- Impulsivity and risky behavior
- Relationship problems
- Appearing to be insensitive or dismiss the needs of others
The nature of BPD can help you distinguish between garden-variety narcissism and the pathological symptoms of NPD.
- In NPD, narcissistic personality traits are always present
- In BPD, narcissistic traits only tend to surface during manic episodes.
It also helps to look at other symptoms. That may help you rule out one of these disorders.
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Preoccupation with fantasies of power, and intelligence
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Unreasonable expectations of special treatment
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Constant need for attention, admiration
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Lack of empathy
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Obsessive self-interest
In NPD, what appears as arrogance is an attempt to hide deep-seated fears and insecurities. This can lead to depression and other traits that may be similar to depressive symptoms of bipolar disorder.
Suicidal thoughts and behaviors are common in both disorders.
For more mental health resources, see our National Helpline Database.
What Causes Borderline Personality Disorder
Healthcare providers believe BPD results from a combination of factors, including:
- Childhood abuse and trauma: Up to 70% of people with BPD have experienced sexual, emotional or physical abuse as a child. Maternal separation, poor maternal attachment, inappropriate family boundaries and parental substance use disorder are also associated with BPD.
- Genetics: Studies show that borderline personality disorder runs in families. If you have a family history of BPD, youre more likely but not guaranteed to develop the condition.
- Brain changes: In people with BPD, the parts of their brain that control emotion and behavior dont communicate properly. These problems affect the way their brain works.
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Whats The Difference Between A Mood Disorder And A Personality Disorder
Diagnosing a personality disorder in someone who has a bipolar disorder is complicated. Personality disorder means an enduring and problematic pattern of behavior, especially in relationships with others. Theoretically, this disorder is distinct from mood symptoms like depression, mania, or hypomania. But a sharp distinction is only possible if the problematic pattern of behavior occurs when mood symptoms are completely resolved. Unfortunately, most people living with mood disorders are still waiting for the day when that happens. In reality, the theoretical distinction between personality disorder and a mood disorder is hard to find.
Diagnoses of personality disorder also have a complicated history. They were often seen as more psychological while mood disorders were seen as more biological. This view sometimes led to more blame and shame being attached to personality disorders.
Thinking about your relative, I will assume that the earlier diagnosis of bipolar disorder is correct. If someone has had a true manic episode, then we would make a diagnosis of type 1 bipolar disorder. True manic episodes are not symptoms of personality disorder, so the question is whether he has a personality disorder in addition to bipolar disorder.
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Splitting And Dialectical Behavioral Therapy
One common symptom of the disorder is splitting. Splitting involves viewing people or things as completely good or bad without being able to see gray areas, or that good and bad can coexist. For example, one moment a person might view their therapist as the best in the world. Then that therapist does something to trigger the patient, and suddenly the therapist is the worst the patient has ever known.
What can cause splitting? As children, people may experience abuse from someone who at times acts with love and concern and at other times behaves in dangerous and abusive ways. Learning to integrate those opposite versions of the same person into one can pose great challenges to children who live with abuse.
As a result, these children may view things in terms of either-or and think of the abuser as two different people. As these children mature, they may generalize this perception that good and bad exist in completely separate realms, and apply it to all aspects of their life.
Although this defense mechanism may have served a useful purpose at one time, in adulthood it can act as a disruptive force, exhausting those who use it as well as others around them.
Dialectical behavioral therapy can help address splitting and the unregulated emotional shifts those with borderline personality disorder tend to experience. DBT involves a two-pronged approach: individual therapy paired with group-based skills training led by two trained practitioners.
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Why Are Bipolar Disorder And Borderline Personality Disorder Often Confused Or Conflated
Sometimes interacting with someone with a bipolar diagnosis compared to interacting with someone with a diagnosis of borderline personality disorder may feel similar. You may feel like you never know what to expect from one day to the next, with the persons mood or behavior being extremely variable. The origins of that unpredictability are different, but the effects on communication and relationships can be comparable.
If you have a relationship with someone who has bipolar disorder, when they experience an untreated manic or hypomanic episode, they may be euphoric, feel like theyre on top of the world, theyre the life of the party, they express love for you, etc. But when that episode ends, or maybe even transitions into a depressive episode, your interactions with that person may change dramatically.
Similarly, relational interactions with people with untreated borderline personality disorder may feel extreme. When they feel safe and secure in the relationship, they may express love for you, seem excited to spend time with you, and be very supportive. That behavior could look a lot like someone experiencing a manic or hypomanic episode. However, if the instability in the relationship emerges, that behavior can quickly flip into a very negative social interaction.
How To Increase Your Chances Of Getting The Right Diagnosis
To reduce your risk of a misdiagnosis, be sure to find a clinician who will conduct an extensive structured interview that addresses both your current symptoms and symptoms youve experienced in the past, Cullen says.
A psychiatrist, a psychologist, a clinical social worker, or a psychiatric nurse can help diagnose BPD correctly.
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What Else Could It Be
BPD and bipolar disorder are often confused or misdiagnosed for one another. You may also be diagnosed with one of these conditions when you actually have an entirely different mental health condition.
Can you have both BPD and bipolar disorder? Yes, its possible but its rare. This is called a dual diagnosis.
Other conditions that might be confused with bipolar disorder and BPD include:
Other possible diagnoses include antisocial personality disorder or narcissistic personality disorder. These conditions are diagnosed less often than BPD.
If you think your diagnosis may be incorrect, you can reach out to a mental health professional for a reevaluation. And its OK to get a second opinion.
It can help to look for a pro who specializes in treating BPD or bipolar disorder.
Borderline Personality Disorder Vs Bipolar Disorder Prevalence
Borderline personality disorder
- Affects 1.4% of U.S. adults
- 1 in 16 Americans will have BPD at some point in their lives
- Affects 14% of the global population
- Is the most common personality disorder in clinical settings
- Affects 2.8% of U.S. adults
- 4.4% of U.S. adults will have bipolar disorder at some point in their lives
- 46 million people have bipolar disorder globally
- Of all mood disorders, bipolar disorder causes the most severe impairment
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Borderline Personality Disorder Causes
The exact cause of BPD is not entirely known, but research suggests that it can be influenced by environmental factors, especially those in early childhood.
A history of emotional, physical, or sexual abuse or parental neglect is prevalent in people with BPD. Parental substance abuse is another potential cause. Research has shown that experiencing stress and trauma as a child and an inability to cope can contribute to BPD later in life.
Genetics, chemical imbalances, and brain structure may also play a role in BPD. People with a family history of BPD are at higher risk of having the condition. Many people with BPD have altered brain neurotransmitter function, particularly serotonin.
Studies have shown that people with BPD can have structural and functional changes in the brain, especially in the areas that control impulses and emotional regulation like the amygdala, hippocampus, and orbitofrontal cortex.
Who Does Bipolar Disorder Affect
Bipolar disorder can affect anyone. The average age of onset is 25 years, but, more rarely, it can start as early as early childhood or as late as in your 40s or 50s.
Although bipolar disorder affects people assigned female at birth and people assigned male at birth in equal numbers, the condition tends to affect them differently.
People AFAB with bipolar disorder may switch moods more quickly. When people with bipolar disorder experience four or more manic or depressive episodes in a year, this is called rapid cycling. Varying levels of sex hormones and thyroid hormones, together with the tendency for people AFAB to be prescribed antidepressants, may contribute to the more rapid cycling in this population.
People AFAB with bipolar disorder may also experience more periods of depression than people AMAB.
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Effects Of Comorbid Alcoholism And/or Comorbid Anxiety Disorders On Personality Traits
We studied the effects of comorbidity by dividing the bipolar sample according to the presence of comorbid alcoholism and/or anxiety disorder. Nineteen patients presented no comorbid condition, 10 presented only comorbid alcoholism, 23 presented only comorbid anxiety disorder, and 21 presented both comorbid alcoholism and anxiety disorder. These 4 subgroups did not statistically differ on age = 0.48, p = 0.7) and YMRS score = 2.3, p = 0.09) as well as age at disease onset and length of illness, but were statistically different in the distribution of gender and HDRS score = 6.7, p < 0.001) .
Borderline Personality Disorder Vs Bipolar Disorder
BPD is a type of personality disorder that causes people to feel, think, relate, and behave differently than people without the condition.
Bipolar disorder is a type of mood disorder, which is a category of illnesses that can cause severe mood changes.
People with BPD experience an ongoing cycle of varying self-image, moods, and behaviors.
These patterns typically cause issues that affect a persons life and relationships and the way in which they understand and relate to others.
According to the National Institute of Mental Health , about 1.4 percent of adults in the United States have BPD.
Bipolar disorder affects a persons mood, energy, thoughts, activity levels, and functionality in cycles that can last for days to months. It is more common than BPD and affects an estimated 2.6 percent of the population in the U.S.
People with BPD experience instability in their self-image, moods, and behavior. These symptoms can lead to impulsive actions and problems with interpersonal relationships.
Symptoms of BPD include:
- impulsive or reckless behavior, such as unsafe sex, drug misuse, reckless driving, and spending sprees
- intense episodes of depression, anger, and anxiety
- chronic feelings of emptiness
- fear of being alone
Not everyone with BPD experiences all of these symptoms. Some people may have only a few minor symptoms, while others experience severe and frequent symptoms.
Some of the most common symptoms of mania include:
- extremely elevated mood
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Bipolar Disorder & Borderline Personality Disorder: What Are The Differences
Diagnosing mental illnesses can be challenging as there is usually no way to physically measure or run lab tests that can help determine one diagnosis from another. Helping an individual find the best treatment options for their unique condition also poses a challenge. Mental health professionals depend on symptoms and the pattern these symptoms show over time to make their diagnosis. On March 30th, we recognize World Bipolar Day. Bipolar disorder is commonly confused or even misdiagnosed as Borderline Personality Disorder. Lets take a look at the differences and similarities:
Similar Symptoms
More often, borderline personality disorder is misdiagnosed as bipolar disorder. Both conditions have symptoms that mirror each other, such as mood swings, impulsive behaviour, and suicidal thoughts. However, the conditions have different causes and different treatment options. Experience medical professionals can determine the correct diagnosis and appropriate treatment for each individual. Patients and their family members can assist in this process by making note of the symptoms, describing them accurately, and monitoring them over time.
Key Differences
Borderline personality disorder is not biological like bipolar disorder. Medication is often not the primary treatment, but instead the disorder is managed through psychotherapy or therapy combined with medication to treat specific symptoms.