Bipolar vs Borderline Personality Disorder – How to tell the difference

Bipolar disorder versus borderline personality disorder what's the difference or how do you tell the difference? That's what I'm gonna talk about today. This is actually based on a viewer question.

If you're new to my channel, I'm Dr Tracey Marks a psychiatrist and I published weekly videos on mental health education and self-improvement. So if you don't want to miss an episode, click Subscribe and the notification button so you'll know when the new the next videos coming out. The viewer question is from paper parade and she says can you explain the difference between a borderline with depression and bipolar?

I'm gonna focus on the difference between bipolar disorder and borderline personality disorder because depression is actually a part of bipolar disorder. There's a big difference between the personality disorders and the psychiatric illnesses like depression, anxiety, schizophrenia, bipolar disorder. Personality or your personality is your hardwiring and the illnesses are your state at the time.

Another analogy would be comparing your personality to the climate of a region and a disorder like depression would be the weather that you're having at the moment. I grew up in Florida which is a warm climate and we basically had two seasons: hot and not hot. But then we'd have hurricanes that could rip through and completely disrupt the environment.

But once hurricane season passed, we'd still be left with a warm climate. The climate affects how the weather manifests at the time likewise your personality makeup affects how your illness manifests. So going back to the geographical example, Russia has a very cold climate and this affects the type of storms that you see there.

So you get blizzards in cold climates and sandstorms and desert climates and tropical storms in tropical climates. So if a person with say narcissistic personality disorder gets depressed, it's going to look different from the person with dependent personality disorder who becomes depressed. The narcissistic person because of their self-centeredness may look more angry and self-loathing whereas the dependent person because of their neediness can become more pitiful and helpless when they get too depressed.

Now these are just broad stroke examples. So back to borderline personality disorder, this is actually a really big topic but I'm only going to briefly define the disorder for you and I'm going to use our Diagnostic and Statistical Manual of Mental Disorders the fifth edition and I'm going to read the definition. So borderline personality is defined by the following: a pattern of unstable relationships self-image and emotional expression marked by impulsivity, beginning in early adulthood and present in a variety of contexts as indicated by five or more of the following.

It's important that you realize that it's five or more of these characteristics so what you don't want to do is take out one and say oh I have that does that mean I have borderline personality disorder? No unless you have several of these things. Number one is frantic efforts to avoid real or imagined abandonment.

An example of this is the person who may seem to read into things too easily. Things that you say are interpreted to mean that you're done with them or that you're abandoning them in some way. Number two: a pattern of unstable in intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

In this kind of relationship, the person with borderline personality disorder may at one point think that you're the best thing ever and you can do nothing wrong and in the next moment or the next day you're the worst thing ever, the exact opposite. Number three is an identity disturbance You have a markedly persistent or unstable self-image or sense of self. This kind of identity disturbance occurs at a deep level and not to be confused with whether you're not sure if you're meant to be a teacher or an astronaut.

This is a confusion about core identity issues like your gender or your sexuality or even your spirituality. Now I tiptoe around this because I don't want you to walk away thinking that anyone who wants to change their gender has borderline personality disorder in fact as I mentioned before an important thing to remember with this is that the diagnosis is based on a grouping of symptoms of the things that I've listed. So you need five of them and it's not that anyone who's angry say has borderline personality disorder.

Anyone who's ever cut themselves must be borderline. It's about having multiple things that fall into this category and having it present a problem for you in many ways not just in one relationship. Number four is impulsivity in at least two areas that are potentially self damaging.

Some examples of this could be reckless spending or reckless sexuality drug abuse or binge eating. Number five would be recurrent suicidal behavior, gestures or threats or even self-mutilating behavior. And this would be things like cutting yourself or taking over doses of pills even though you don't really want to die you're just responding to internal distress and that's why you're doing these things.

Number six would be an unstable, reactive mood and this would be things like episodic low mood, irritability or anxiety that usually lasts a few hours or a few days. And this is one of the key differences between borderline personality and bipolar disorder and I'll expand on that after I get through the criteria. Number seven is chronic feelings of emptiness.

And this is one of the reasons people with borderline personality disorder cut themselves it's a coping mechanism to help them feel real. Some people will cut themselves though to relieve tension. Number eight is inappropriate, intense anger or difficulty controlling anger.

And this can look like temper tantrums, constant anger or physical fights. Number nine and the last one is transient stress-related, paranoid ideation or severe dissociative symptoms. Clinicians sometimes call these micro psychotic episodes.

They're not full-blown psychosis but they're close and if you don't know what psychosis is I'll have a link for you in the corner that on a video where I have talked about or defined psychosis but let me explain what dissociation is. Dissociation happens when a person disconnects with their present situation and this disconnection can be from the current environment or from their thoughts or even from themselves and an example of this is a person who's been subjected to repeated physical or sexual abuse and one of the ways they cope to deal with the act at the time is just to mentally pull away as if it's not really happening to them. And that's one of the ways that they can deal with getting through it.

Well with borderline personality disorder, dissociation happens a lot in different circumstances. So that's the criteria for borderline personality disorder. It's a lot of stuff and so it's not a matter of taking one of these things out and saying I must be borderline because I cut myself, you need to have at least five of these nine things that I just listed going on at the same time or in general that's the kinds of things that you do or feel.

So back to borderline personality disorder and bipolar disorder they look very similar because you can have the mood swings and impulsivity, but in the case with borderline personality disorder you're more likely to have mood swings that can shift from hour to hour over the course of the day. With bipolar disorder the group of symptoms, not just low or high moods but the group of symptoms that make up an episode need to last at least two weeks if you're in the depressed state and one week if you're in the manic state. So you aren't shifting in and out of states hour to hour.

Also the sense of fear of abandonment and unstable identity are things that have more to do with your hardwiring and it's also influenced by your environment as well. It kind of goes to the nature versus nurture Theory how much of who you are is based on genes versus how you were raised in your formative years. And these issues are not part of bipolar disorder.

Think of mania as like a hurricane that swoops in and swoops out and leaves the hot climate behind. And some other examples of the practical differences is that bipolar disorder does not make you do manipulative things. Manipulative behavior has to do with your personality.

Also people with who are manic or depressed at the time don't engage in self-harm only because of their mood state. So if you get depressed, the coping skills that you employ at the time have to do with your personality and it's not the depression itself. So the depression may push you into doing something that is self harming but it's your personality type or your personality coping skills that reacts to the depression with self-harm.

The treatment for borderline personality disorder and bipolar disorder are very different but they can overlap. The primary treatment for borderline personality disorder is a psychotherapy called dialectical behavioral therapy or DBT. It's an offshoot of cognitive behavior therapy that was developed specifically for borderline personality disorder and when it's implemented by someone trained in DBT it's very effective and it's usually a combination of group and individual sessions.

The primary treatment for bipolar disorder is medication management. Sometimes the with the depressive episodes if they're mild to moderate they can respond well enough to cognitive behavioral therapy. But manic episodes usually require medication.

People with borderline personality disorder can still have a mood disorder, so you can have both problems. So if a person with borderline personality disorder also becomes depressed, then they may require medication to get through the depression. Also sometimes the swinging moods that you can have with borderline personality disorder can respond well to mood stabilizers even though it's not considered bipolar disorder.

So mood stabilizers are mood stabilizers and they can help people with borderline personality disorder who have a lot of mood shifts or intense anger but the reason you'd be using the the mood stabilizer is to treat the mood instability that goes along with the personality disorder and it doesn't mean automatically that you must have bipolar disorder. So this can get confusing, there's a lot of nuances to this. That's why the best treatment is really should be determined by a clinician who's evaluated you.

But the gist of it is that there is an overlap between borderline personality disorder and bipolar disorder. Sometimes people with borderline personality disorder would need the same kind of medication that a person with bipolar disorder would need however bipolar disorder tends to be more episodic like bad weather whereas borderline personality disorder has a fairly consistent set of behaviors that go up and down in intensity and that tend to hang around for a long time. That's it for this topic if you're new to my channel it may seem a little disjointed with needing to go to other videos to get more information and that is kind of by design because I don't want to make these videos so epic in length that with all these definitions and going through all these criteria and then it makes it hard, I mean it's hard enough to go through the criteria just for one disorder.

You see you had to read through that long list, but I think the best way to get a good grasp on any of these topics is to chunk it out in little pieces at a time. So that's why I've developed playlists to help you for the various illnesses to kind of help you get through them in a little bit by little bit and as I continue to make more videos I'll continue to develop the playlist in a way that you can start with one and just go through and have a more complete understanding of the various psychiatric issues. Thanks so much for watching.

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