Anonymous asks:
What’s the difference between bipolar disorder and borderline personality disorder?
Bipolar disorder and borderline personality disorder (BPD) are often confused and misdiagnosed. They can even co-occur. However, I will explain the fundamental differences.
Bipolar disorder is a mood disorder characterized by distinct mood episodes. There are two types of bipolar disorder – I and II. In order to meet criteria for bipolar I, an individual needs to meet criteria for at least one manic episode. Mania is characterized by elevated mood with a number of symptoms (decreased need for sleep, more impulsivity, pressured speech to name a few) that last for at least a week and may lead to marked functional impairment (e.g. hospitalization and may involve psychosis).
Bipolar disorder II requires a history of at least one hypomanic episode (similar symptoms to mania but at a milder volume and for 4 or less days) AND a depressive episode (loss of interest in things you used to enjoy, lower energy, change in appetite/ sleep to name a few) lasting for two or more weeks. While bipolar disorder I is more likely to lead to hospitalization, both are serious disorders. Of note, while many individuals with bipolar I experience depression at some point, it is not essential to the diagnosis.
Overall, bipolar disorder involve pronounced shifts in moods during distinct periods of time called episodes. Outside of these periods, there tends to be more stability and diminished symptoms. Bipolar disorder also responds quite well to proper medication management often involving mood stabilizers. Therapy such as Interpersonal and Social Rhythm Therapy that promotes stability in routine to reduce mood symptoms is the gold standard of care for treatment.
In comparison to bipolar disorder, BPD is a personality disorder characterized by difficulty regulating emotion that can lead to impulsivity, unstable relationships, self-harm, frequently shifting identity, and other symptoms. BPD is a developmental disorder with symptoms often identifiable from very early in childhood. Many individuals with BPD display heightened sensitivity to stressors in their environment due to a more responsive nervous system where fight or flight is easily activated by stress.
Emotion dysregulation occurs much more quickly. Changes in mood are much shorter, not typically defined as episodes. Symptoms tend to be relatively consistent across a long period of time, though symptoms may improve to some degree across the lifespan. There is not a specific class of medication to treat BPD but symptoms can be well-managed with a combination of medications (antidepressants, mood stabilizers for example) in tandem with therapy. Dialectical Behavior Therapy and Mentalization-Based Therapy are two modalities that facilitate improvements in emotion regulation and management of interpersonal relaitonships.
Dr. Stephanie Freitag PhD is a licensed clinical psychologist based in Brooklyn, New York. She runs her own private practice where she treats patients in seven states (CA, CT, FL, GA, MA, NJ, NY). As a specialist in bipolar disorder, she uses Interpersonal and Social Rhythm Therapy (IPSRT) to support patients in individual and group therapy. She most recently trained at the Emory School of Medicine where she is currently an assistant adjunct faculty member who publishes research on bipolar disorder and intimate partner violence. Beyond her clinical work and research she is passionate about advocacy and believes strongly in fighting the stigma associated with mental illness.
