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Borderline Personality Disorder and Bipolar Disorder: The Difference

Trying to distinguish between Borderline Personality Disorder and Bipolar Disorder is difficult, because these two disorders share so many characteristics. The treatments for both conditions are similar, as well.

Some of the specific symptoms found in Bipolar Disorder are also found in patients with Borderline Personality Disorder. Mood instability is common to both disorders. However, although impulsivity is associated with both disorders, it is only associated with bipolar manic episodes and not with bipolar depressive episodes; whereas it is a general symptom of Borderline Personality Disorder.

Self-injury (self-harm) is a prominent characteristic of Borderline Personality Disorder and is also a symptom of Bipolar Disorder, although harming oneself is diagnostic of Bipolar Disorder only in the sense of a possible suicide attempt or as an aspect of bipolar depression.

There is one symptom that differentiates the two disorders – people with Borderline Personality Disorder have a profound fear of abandonment, which is not a symptom of Bipolar Disorder.

The greatest difference between Borderline Personality Disorder and Bipolar Disorder is in the effectiveness of treatment; i.e., in treatment approaches. Although psychotherapy is suggested as part of the treatment approach for patients with Bipolar Disorder, the most effective treatment is in the form of medications – specifically, mood stabilizers and antidepressants. Antidepressants are also effective in treating patients with Borderline Personality Disorder, but because their disorder is more deeply rooted in their emotions, psychotherapy is the more effective approach.

Although very similar in general, there are two important differences in treatment for Borderline Personality Disorder and Bipolar Disorder. In Bipolar Disorder, Antidepressants are only used with caution, whereas they are used routinely in the treatment of Borderline Personality Disorder. Secondly, although Borderline Personality Disorder treatment relies upon psychotherapy as first-line treatment, with medications coming second, treatment for Bipolar Disorder is handled in the reverse – or with medications and therapy used at least concurrently.

The type of therapy used to treat the two disorders is also different: For patients with Borderline Personality Disorder, a therapy called Dialectical Behavior Therapy is the best therapeutic approach. This type of therapy was developed specifically for patients with this disorder; whereas other traditional forms of therapy are still used for patients with Bipolar Disorder.

Although in some cases, patients with Borderline Personality Disorder have been known to need psychiatric hospitalization to control rages and extreme outbursts of anger, psychiatric hospitalizations for patients with Bipolar Disorder are usually for psychotic symptoms of delusions and hallucinations. This is another difference in the two disorders.

There is no one diagnostic or medical test to determine whether someone has either Borderline Personality Disorder or Bipolar Disorder, much less a test to determine the difference between the two disorders. However, there are separate criteria for each disorder as set forth in the Diagnostic and Statistic Manual for Mental Disorders – Fourth Edition (DSM-IV), by which a psychiatrist can determine a diagnosis.

About the Author

David Oliver is the founder of BorderlineCentral.com a one stop source of information on how to cope and deal with borderline personality disorder.

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