Understanding the Differences: Bipolar Disorder, Normal Mood, and Borderline Personality Disorder

At Mental Health and Wellness Associates our top psychiatrists are experts in the evaluation of mental health conditions. We often work with individuals who are struggling to understand their symptoms. In many cases, they are having trouble differentiating between normal mood fluctuations, bipolar disorder, and borderline personality disorder (BPD). 

In this article, we will help you understand the differences between these three and how a psychiatrist can assist in making a formal diagnosis and an individualized treatment plan.

1.    Bipolar Disorder: Bipolar disorder is a mood disorder characterized by extreme shifts in mood, energy, and activity levels. It often consists of two main phases: depressive episodes and manic or hypomanic episodes. Depressive episodes involve persistent sadness, loss of interest, low energy, and feelings of worthlessness. Manic or hypomanic episodes, on the other hand, are marked by elevated mood, increased energy, racing thoughts, impulsivity, and grandiosity. Bipolar disorder is a chronic condition that may requires ongoing treatment with mood stabilizers, therapy, and self-management strategies.

2.    Normal Mood Fluctuations: It is important to recognize that everyone experiences fluctuations in mood and energy levels to some degree. Normal mood fluctuations are typically influenced by daily events, stressors, and life circumstances. These shifts are temporary and do not persist for prolonged periods. They do not interfere significantly with one's ability to function or maintain stable relationships. However, if mood fluctuations become severe, persistent, or impair daily functioning, it may be a sign of an underlying mood disorder that requires professional evaluation.

3.    Borderline Personality Disorder (BPD): Borderline personality disorder is a personality disorder characterized by pervasive instability in emotions, self-image, and relationships. Individuals with BPD may experience intense mood swings, impulsivity, chronic feelings of emptiness, fear of abandonment, and difficulty with identity. While BPD and bipolar disorder share some symptoms, such as mood instability, they differ in important ways. BPD primarily affects a person's sense of self and interpersonal relationships, whereas bipolar disorder primarily involves mood dysregulation. Treatment for BPD typically includes dialectical behavior therapy (DBT), individual therapy, and medication management, if necessary.

While a well trained and experienced psychiatrist is likely the best place to turn for a formal diagnosis, there are distinguishing factors that we can discuss:

a. Duration and Pattern: Bipolar disorder often follows distinct episodes of depressive and manic/hypomanic symptoms that last for days, weeks, or even months. Normal mood fluctuations are less likely to persist for extended durations of time and usually are triggered by situational factors. In contrast, individuals with BPD experience chronic emotional instability and reactivity that can last for years.

b. Triggers: Bipolar disorder episodes often occur without apparent external triggers, while individuals with BPD are more susceptible to mood shifts in response to interpersonal conflicts, external triggers or perceived abandonment.

c. Relationship Dynamics: People with BPD may exhibit intense and unstable relationships, alternating between idealization and devaluation. In bipolar disorder, relationship dynamics are less influenced by shifting emotions and more by overall mood state.

d. Self-Image: Those with BPD often struggle with a fragile sense of self and may exhibit identity disturbances. Individuals with bipolar disorder typically have a stable self-identity outside of mood episodes.

e. Treatment Approaches: Bipolar disorder is often primarily managed with mood stabilizers and other medications, while BPD typically requires specific psychotherapies like DBT to address emotional dysregulation and interpersonal difficulties. However, medication management can also be helpful to target specific BPD symptoms. 

Recognizing the differences between bipolar disorder, normal mood fluctuations, and borderline personality disorder is essential for accurate diagnosis and effective treatment. If you suspect you or a loved one may be experiencing symptoms consistent with any of these conditions, consult with a mental health professional for a comprehensive evaluation. They can provide the guidance and support needed to develop an appropriate treatment plan tailored to individual needs.

If you live in the state of California and are looking for help, we would be happy to speak with you. If you are interested in becoming a new patient, please schedule a time to speak with our practice manager (using the "book online" button above) or call our office today.

References:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.

National Institute of Mental Health. (2021). Bipolar Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.

National Institute of Mental Health. (2021). Borderline Personality Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml.

Psych Central. (2020). Understanding the Differences Between Bipolar Disorder and BPD. Retrieved from https://psychcentral.com/lib/understanding-the-differences-between-bipolar-disorder-and-bpd/.