eli5: What are the differences between Bipolar and Borderline Personality Disorders?
In: Biology
I am both.
Bipolar is mood swings from a high to a low, manic to depressive.
Borderline personality disorder is basically a rebellion against authority, from my understanding.
Bipolar disorder has to do with depressive and manic mood swings. One can be depressed for some months then can become manic for a week or more. This may vary from person to person but that’s the jist.
BPD has to do with unstable relationships and self image often accompanied by impulsiveness.
Bipolar is a mood disorder, having to do with what are called mood “episodes.” An episode is a period of time, at least several days but usually 1-2 weeks or longer, where you have significant, persistent alterations in your overall mood from a normal, well-functioning baseline. A depressive episode is what will be more familiar to most people, because they basically have all the features of major depressive disorder (in fact MDD is a.k.a. “unipolar depression” in contrast to bipolar). The other pole is what are called manic episodes, during which the person with the disorder has at least several days of either very elevated or expansive mood, though often in a very unstable way; they typically also have overall increased activity, starting unrealistic projects and acting very impulsive. They may also be paranoid and develop severe delusions, and usually feel like they have a decreased need for sleep. Sometimes mania feels GREAT to the sufferer while they’re in a manic state, and they can put themselves in real danger because of the delusions and impulsivity that come with it.
Borderline personality disorder is a bit less understood, and while the DSM does have a fairly stable description of it there is a bit more criticism and some alternate ideas. But, as we understand it currently, BPD is a personality disorder: whereas we believe bipolar is caused by issues with the brain’s functioning that leads to mood episodes emerging, BPD is more about habits, relationships, and cognition. To oversimplify, we think bipolar is more about “brain” and borderline is more about “mind.” The characteristics of BPD are a lack of a strong sense of self, extreme fear of abandonment (and concomitant extreme reactions to real or perceived abandonment), unstable emotional reactions and impulsivity. People with BPD tend to alternate quickly between extremes of emotion, not having a stable middle ground between despair and euphoria, and often seem to change their personality on a whim. As opposed to the mood episodes of bipolar, which are characteristically multiple days long at *least,* mood swings in BPD can be *extremely* rapid, with the sufferer going from euphoria to despair and back sometimes within the space of a single conversation.
the two have nothing to do with each other. apples and oranges comparison.
axis 1 disorders are typical psychiatric disorders, and generally responsive to medications. bipolar 1 and bipolar 2 are axis 1 disorders.
axis 2 disorders are personality disorders, including borderline personality disorder.
I’ll try it as ELi5
Bipolar affects people’s mood and causes people to either be very happy or very sad. This happiness or sadness goes on for a long time, at least days but more likely weeks/months. The person has a hard time just being in a regular mood.
The happiness or sadness is so extreme that it hurts people’s enjoyment of life and their ability to do everyday things. It’s caused by changes in the brain that the person has no control over although they can do things to stop the happiness or sadness getting really bad.
Medication from the doctor can be really helpful in making it better it but it never fully goes away.
Borderline PD affects people’s emotions and can also make people feel very happy or very sad. This happiness or sadness often changes very fast and multiple times during the day and is often caused by interactions with other people .
Borderline also really hurts people’s enjoyment of life and their ability to do everyday things. It’s (usually) caused by things that happen to the person in their life and how the person views these events. This is often called trauma. This also affects the way these people interact with other people. They are often very very sensitive and terrified of being hurt by others or abandoned by them. This can cause them to behave in what might look like strange ways to others.
Medication doesn’t help to fix borderline but talking to a doctor or other mental health expert lots and lots of times can help the person to fix it and it can completely go away.
Both illnesses are really serious and need treatment. If people get the right treatment, they can often lead very nice lives.
Non ELi5 addition
BPD is often deliberately labelled by private psychiatrists as Bipolar so that they can prescribe medication for it (no meds are indicated for BPD but they are for bipolar). Or people are given both diagnoses. That’s more profitable. I know people don’t want to hear that but I’ve worked in the industry for a long time and it’s a very horrible truth.
BPD gets completely neglected, misdiagnosed, untreated. It’s such a serious and debilitating illness too. It’s just cheaper to throw a pill at it than to provide therapies like DBT, which are expensive and time consuming.
On the flip side, some people don’t want the BPD diagnosis due to stigma and keep looking until they find someone that diagnoses them with bipolar instead.
The treatment outcomes for BPD, when done correctly, are very good.
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Bipolar describes a person who goes through acute periods of mania (high energy, erratic behavior and often paranoia) and depression (basically the opposite of that).
Borderline personality disorder is the tendency to react to adverse situations, usually with extreme rage or depression.
Bipolar Disorder is a mood disorder characterized by the display of periods of depression and mania/hypomania.
Both depression and mania can be life threatening. Extreme depression can lead to suicide attempts and mania can lead to life-threatening behaviour such as holding a delusional belief that one can fly. Mania can be accompanied by psychosis whereas the less severe Hypomania usually is not.
Bipolar Disorder has 3-4 different classifications depending on the presentation of symptoms. Treatment is a combination of medication and therapy.
Periods of depression and mania/hypomania are usually temporal rather than trigger based.
Outside of periods of depression or mania/hypomania, individuals with BiPolar disorder are otherwise neurotypical.
Borderline Personality Disorder is a personality disorder, it’s a collection of deeply ingrained, inflexible, and incredibly maladaptive core beliefs, thought processes, behaviors, and coping mechanisms.
Individuals with BPD have an incredibly hard time handling emotions, especially negative ones. Feelings of sadness, abandonment, loss, disappointment, and anger can be overwhelming. This often leads to self destructive behaviour including drug abuse, self-mutilation, suicide attempts, impulsive spending, etc…
Individuals with BPD can be catastrophically triggered by everyday events that wouldn’t cause any amount of distress to an otherwise normal individual. A late pizza delivery, change of personal plans, snarky waitress, or a refusal to have sex can all lead to explosive toddler-like tantrums. As you may imagine, individuals with BPD have an incredibly hard time maintaining interpersonal relationships.
Unlike Bipolar Disorder, the symptoms of BPD are chronic and pervasive. Medication can be used to treat comorbidities but they won’t change the underlying maladaptive behaviors.
They can look similar to each other, as they have some overlapping symptoms. The big difference in my head is duration, speed of mood shifts.
Not sure if this still falls in eli5 territory, but this video really helped me understand BPD a lot better.
P.S. The video also spends some time differentiating between BPD and bipolar. Does it much better than I could.
Here’s my attempt as someone with both.
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Bipolar:
Bipolar Disorder (aka Manic Depression) is a “hard” mood disorder. If you are diagnosed with it, generally speaking you have the disorder for life. It is characterized by oscillating episodes of depression and mania. People with Bipolar disorder tend to be diagnosed while in a manic or hypomanic (lesser manic) episode, and tend to be misdiagnosed with unipolar depression. Bipolar disorder also has a strong genetic inheritance.
The episodes can last from a few days to months, and are usually interspersed by periods of mood stability. Sometimes both moods can happen at once in an episode, becoming a “mixed episode” (aka dysphoric mania).
Bipolar disorder can be extremely disabling and debilitating, and can be the root cause of many other things such as: substance abuse, psychosis (delusions, hallucinations), relationship problems, career problems, school problems, suicide, and others.
Treatment almost always requires consistent medication (e.g. mood stabilizers, antipsychotics, antidepressants), and generally other holistic lifestyle changes. Bipolar disorder is progressive, meaning that without treatment, the illness becomes worse with each episode. Successful treatment is characterized by cessation of mood episodes, or reduction in frequency and severity of episodes.
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BPD:
Borderline Personality Disorder (aka EUPD Emotionally Unstable Personality Disorder) is a “soft” personality disorder. If you are diagnosed with it, generally, you can eventually not have it anymore with lots of sustained hard work.
BPD is characterized by emotional instability, especially in regard to your sense of self and your social and romantic relationships. BPD tends to arise from trauma/abuse in childhood. Symptoms can show up as inappropriate reactions to perceived slights, unstable relationships, codependency, exacerbated rage, sadness, or elation, and rapid mood swings, switching in a matter of days or even hours (these mood swings are not comparable to Bipolar mood episodes).
BPD is not generally disabling, but can be extremely debilitating and harmful to people’s relationships with themselves and others, with cascading effects such as: substance abuse, self harm, relationship problems, increased risk of being abused or abusing others in relationships, suicide, and others.
Treatment generally consists of a specific kind of skills-based therapy called DBT (Dialectical Behavioral Therapy), which was specifically created for those with BPD and others with a high risk of suicide. Medication is generally not effective as treatment. Holistic lifestyle changes are also used. With consistent use of skills learned in therapy, people can stop exhibiting symptoms of BPD to the point of not being diagnosed with the disorder anymore.
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This is only my in-a-nutshell explanation, please don’t take this as some sort of expansive authority on either disorder.
I would like to emphasize that mental health is a constantly shifting field and that every persons experience with any given disorder will be unique to them. If you feel that you need help, please reach out to a therapist, psychiatrist, or even just someone you trust.
Both Bipolar and BPD are highly stigmatized by the general public and healthcare professionals. I guarantee you’ve met someone with one and/or the other at some point in your life. Try to be kind to yourself and others, we’re all going through our own battles.
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