Borderline Personality Disorder and Bi-polar Disorder:  What's the difference between the two?

In bipolar the self-destructive behaviors are because the individual feels all powerful and invincible, whereas in the BPD the self-destructive behaviors are an attempt to stop pain. It's a huge difference.

In bipolar disorder mania or hypomania must be present for the diagnoses to be made. Many individuals with the BPD have been erroneously diagnosed with bipolar because of the mood swings, even though they've never had mania or hypomania.

Bipolar I is the classic mania alternating with depression. Bipolar II is depression alternating with hypomania. Bipolar III is when the hypomania or mania occur only with antidepressant medication. Mixed bipolar is also called rapidly cycling bipolar where the person alternates between severe depression and severe mania in a very short period of time - sometimes minutes or hours. Cyclothymia is likely a form of bipolar with mini highs and mini lows in a cyclical manner.

Abnormal functioning in the serotonin system is found in the BPD, and not in bipolar. Interestingly while mania is usually a high that's gotten out of control, many also get severe agitation and dysphoria (anxiety, rage, depression and despair). So far everyone I've seen who had an agitated mania also had the BPD, but I'm not aware of any studies on this. Mania is clearly a stress, and stress triggers BPD dysphoria. What I do for my patients is have them add "mania or hypomania" to the Dysphoria Instruction Sheet - since both BPD dysphoria and hypomania/mania are treated with the exact same medications.

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