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Bipolar Disorder and Comorbid Borderline Personality Disorder

Bipolar disorder and borderline personality disorder have crossover traits and so a person with bipolar disorder can often mistakenly be diagnosed with borderline personality disorder. In fact, some feel that diagnosis with both disorders is inappropriate unless the patient’s bipolar disorder is in remission.

But some people do meet the diagnostic criteria for bipolar disorder and borderline personality disorder. I would have put this number much lower than it actually is thought to be. From the research I’ve done, it appears that borderline personality disorder is comorbid to bipolar in around 40% of cases. This is particularly surprising as it was once thought that personality disorders were only comorbid to bipolar in 12% of cases or less.

But what is borderline personality disorder and what does it mean if you’re diagnosed with both bipolar and borderline personality disorder?

What is Borderline Personality Disorder?

Borderline personality disorder is so called because it was considered to be on the border between psychosis and neurosis. According to Medscape Reference, the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV-TR) provides the following diagnostic criteria for borderline personality disorder:

Borderline personality disorder is marked by a pervasive pattern of instability of interpersonal relationships, self-image, and affects and marked impulsivity beginning by early adulthood and present in a variety of contexts as well as five of the following:

  1. Frantic efforts to avoid real or imagined abandonment (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  3. Identity disturbance: Markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least 2 areas that are potentially self-damaging (eg, spending, sex, substance abuse, reckless driving, binge eating) (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  6. Affective instability due to a marked reactivity of mood (eg, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling anger (eg, frequent displays of temper, constant anger, recurrent physical fights)
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms

Some of those symptoms, like suicidal behavior, do overlap but many do not.

Impact of Borderline Personality Disorder on Bipolar

The trouble is when people are diagnosed both with bipolar disorder and borderline personality disorder their courses of illness tends to be worse. People with both diagnoses tend to have a history of substance abuse and have had childhood symptoms of attention-deficit/hyperactivity disorder. Moreover, this dual-diagnosis group is at a higher risk of suicide.

Treating Bipolar and Borderline Personality Disorder

Two medications have shown usefulness in treating this subgroup. Divalproate has shown usefulness in treating symptoms like irritability, anger, volatility and impulsive aggression. Lamotrigine has also shown usefulness.

Of course, I would be remiss if I did not mention dialectical behavior therapy. This therapy was specifically designed to treat borderline personality disorder and is currently being tested in bipolar populations. While I know of no research on a dual-diagnosis group specifically, it stands to reason this group would see benefits.

In all, it’s critical to take any comorbid condition seriously as it can complicate treatment of any other condition.

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter or at the Bipolar Burble, her blog.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar.

Find Natasha Tracy on her blog, Bipolar Burble, Twitter, Google+ and Facebook.

33 thoughts on “Bipolar Disorder and Comorbid Borderline Personality Disorder”

  1. I have both. The personality started at a very young age mum wouldn’t get nowhere with gp ECT as back then kids weren’t labelled and helped like today. At 18 started antidepressants tried far too many up to 23 still not seen by mental health. Until I OD. Then from 23-30 DBT CBT got knows how many meds tried finally at 32 they tell me I have an emotionally unstable personality disorder with bipolar type 1. At 34 finally find lithium and lomotrogen combined work for me I’m 35 and I still ride the roller coaster of both setting each other off but more stable for longer periods. Find it so hard for people to under 1 let alone both combined and when triggered trying to explain which is what playing up ect is a nightmare. On top of this I have non specific widely spread chronic pain. Both physical and mental upset each other. I’m a single mum of 3 young children so very good at hiding my pain and mental illness from them the best I can. I find meds routine excersise good diet mindfulness using DBT CBT techniques and using my WRAPs folder together helps get me through it.

  2. Hi All,

    I know this article is old and most people haven’t commented in over a year however I’d like some insight from the POV of someone who suffers/diagnosed with BPD and BP2. I was dating someone for about 3 years. We were really close friends with benefits. We eventually became closer over the course of 2015. He told me in 2014 (while in a hypomanic state) that he had been diagnosed with both as a teen. He is living unmedicated because he says he hates the way it makes him feel. For as long as I’ve known him he has not been on medication or therapy that I am aware of. With that being said I didn’t do my homework on both conditions. I thought I knew what Bp was. I had friends that were BP and he did not act like them. In any case of course I started to see red flags and was always confused as to why he alienated me from his friends, always wanted to stay in, wanted to spend my money, would disapear for days sometimes weeks and also triangulate with another female friend of his. We definitley loved each other and I understood that sometimes he needed space but he started becoming distant in Feb. right after Valentines Day.
    He began pushing me away. He took a trip to Las Vegas after he had been borrowing money from me left and right. I was shocked when he told me he was going. When I asked why he said he “Just needed it” and “it was time”. I was confused and felt like there was something wrong so I didn’t get mad at him I just told him ok and to call me when he got there. He did and he told me that he had a dream that his dead bestfriend told him he was going to win. I was then pretty worried but knew there was nothing I could do. He also was honest with me in the past about hookers etc when he goes to Vegas so I started to also wonder what was coming back with him. In any case he sent me a photo at 2 am, he was alone. He also tired to call but I was asleep. He called the next day and said he won and was going to leave early. He never called me when he came back until I reached out 4 days later asking what’s going on. He was kind of strange so took him to dinner to tell him I cared and I was hoping the fight we had on Valentines day didn’t drive him to run away like that. He told me it wasn’t and we both said I love you’s. He was fine for about 2 weeks however he was borrowing more money from me. Then he told me he needed $200 to go see his bestfriend. I told him no and gave him $50 and asked him to leave. He never takes work off yet he took 2 days off and went no where because no one would give him money. In my gut I felt like he was borrowing money to go out with another girl but I thought there is no way…

    I see him a couple more times and he’s getting more and more distant. We woke up and he said something mean to me in a joking way. For whatever reason with all the constant stresses I was really hurt. Plus what he said was awful. I called him out on it and he said sorry. He felt really bad etc. He didn’t want to talk about it. After that night he left and blew me off for 2 days. When I spoke with him he sounded different on the phone. Like the call was staged or being had for someone else in the room. Really weird. That really made me mad because I felt like he was cheating. Usually I’m right. We went to dinner and had a great time and he paid me back the cash he owed me. Then he just ghosted me. Told me he was going to start buying furniture for his room etc. Told me he was going to buy a coffee maker and he doesn’t even drink coffee. I was really over it and thought he was just using me and obviously cheating.

    Finally on St. Patricks day I felt like he was blowing me off for the 2 time in a row even though he said he’d meet up with me. He told me he was going to go running (at 8pm) and call me after. I knew where this was going so I drank. I emotionally drank and ended up flipping out. I got really angry and felt used. I texted him a bunch of mean and horrible things telling him he was using me and a loser and he should F*** off and stay that way.

    I didn’t talk to him for about week. Sent an apology email. He told me he’d call me. Never did. Texted me we’d talk about it. Then not respond to me. I eventually started to freak out and went out again drinking with friends. I texted him I was in pain and to please talk to me blah blah. He continued to ignore me. I called and he blocked me. I was frusterated and went to his apt to speak with him in person. Long story short I was obnoxious knocking on the door till his roommate answered. She told me he wasn’t there. I didn’t believe her. On the way out I told her he was a peice of sh** and that he does stuff like this because he’s bipolar. (quick side fact—months before he told me that his roommate knew and had a friend with BP)

    I was drunk and ended up coming back about 5 minutes after she told me he was not there and knocked again. I called an uber to come get me. Then the cops showed up. When that happened I knew he was inside hiding. My uber came just in time and I left.

    Woke up next day and caught myself feeling like an idiot for being pushed to my limits like that. I’m usually more controlled when it comes to situations like that. Now, I know he knew exactly what he was doing and just playing me to react crazy. It’s not like this is the first time he’s done this.

    So going on we didn’t talk. He iced me out and we didn’t really communicate. I’d try but he’d ignore me. Finally one night I sent him a text and he called me. He told me some BS story that he was being kicked out of his apt and it was all my fault. He said that his roommate told him he had to move a couple weeks after I came over and caused a disturbance. He said she told him it was because she got a promotion but he thinks it was because I told her that he was bipolar. I knew this was BS but he was also nuts on the phone, blaming me for everything. Telling me he was really angry with me and thought about hurting me he was so mad. Then he told me that loved me but he was too angry to be around and he “never ever ever wants to talk to me again.” I asked him what happened and why was he pushing me away. I told him I thought there was someone else. He told me there wasn’t and some BS line saying “don’t believe all those things you think in your head” In my head I was like whatever dude, your cheating.

    Then he told me maybe we could be friends in a couple months but he’s not sure. He then told me “good luck” and said “I’ll talk to you later”. I was heartbroken and shocked. I tried reaching out a couple times after that via text and no response. I finally cut all contact and changed my number. I had to reach out to him last month due to emails from my landlord that I had to ask him about. I called and we spoke. He was indifferent and the call was short. He asked about my dog and just sounded angry. Told me he didn’t want to talk because he was at work. After that I sent a text that I was done with reaching out to him and I was cutting my phone line off again. That was the last time we spoke.

    Any thoughts on this? Will he have any regret once he crashes? Do BP/BPD suffers regret when they have done breakups like this? Any advice on what I should do here?


    1. This probably wont get seen as it was a while ago you psted this but hey worth a go..
      I went threw something along the lines of what you were put threw but I allowed it to be repeated amd repeated and youre right, it makes you feel like an idiot and its true they do it to make you seem like youre the crazy one for losing control. It friggin hurts. Im 21 and my “friend with benifits/ partner” had bipolar and he was an addict which made things soso much crazier. The thing is that when they snap out of it that they will 8/10 will come back or make contact with you in some way and try “rekindle what you both had” becuase of some bs reason. But the BP will be works as their excuse or reason. Its honestly and i cant stress this enough, not worth accepting that reason and having them back with you again. Espesially if they arnt getting any treatment, because in a few months maybe even a year or more, it WILL happen again.. They will use you for money and leave. It will hurt just as much but you will feel even more stupid for letting yourself let it happen again.
      Sure they regret the things they have done or said but they arnt sorry because it was the BP or it was the drugs or it was them feeling traped and too comfortable blah blah oh and that their wasnt anything to be commited too. Even after you lend them money or cook them breakfast (he even got me plucking his fucking eye brows and i hope you never had to do that lol).
      But yeah if this helps just know youre always vunerable to letting his wedge back in to your life and youll think everythings back how it should have been before he went all fuck wit on you and it will feel like that for a time.. just if you do dont let yourself beleive you have the upper hand this time because you have your guard up or what ever, because you know how to “have your boundrys towards what he does” sure maybe you do but when he does it all over again and youre trying not to go crazy over it like last time, it means nothing.. It just hurts you the same all over again but you just feel completely out of control because you tryed to control it better this time and it didnt work for you or him. This might seem like a fuck men and BP but its not that, because he is still the person you love/loved but mental illness makes them someone else aswell that is damaging to their mindsets and lives untill they get legit help. Youve known him for 3 years but you have only known his BP for a short amount of time and It was cruel and crept its way to your head as it is for him. So im giving you insite to the likelyness of what could happen it you let it…

      My X and I were living together for 2 years together on and off for 4 and its was a hell pit of anger hope naiveity, hate love hurt list goes on. He ended up getting a girl preganat when we lived together and went to jail 2 times, the amount of times i called the cops on him just to make it all stop and then be too scared to show them where he was hiding because i didnt want him to get mad at me is stupid. I help him when he was sad i laughed with him when he was happy and tolerated him when he was on drugs for so long and i trusted him when we opend our hearts in conversation and I loved him more then is healthy for a human being. And he left, came back when he was “better” then got bad and left agin and again and each time i put up more walls and rules for myself so i wouldnt get hurt becuase i expected he was going to leave i just hoped he wouldnt.. so only i get left with all these emothional and spiritual barries that only fucks me up when trying to make friends becuase he made me disconect from all my closest friends. Any way im rambeling.. sorry.. But if you get this i hope it helps, its also comforting to just have the insite even if you dont agree idk. Good luck with it all xxx

  3. I’m 38 and I’ve recently been diagnosed both BPD & BP1. My history suggests I was very stubborn in reflecting and identifying I had a mental health disorder. I am great at performing, especially my wellness. I’ve been violent and have taken huge risks which each time I have scathed jail time. My baseline is a loving and caring professional but in the past 9 months I have been in a mixed state which has sent me plummeting to the darkest depression then sky high – my behaviour has prevented me from working. 1 month ago I identified I have a real problem after I hurt someone close to me. The guilt led me to my Dr. I now take medication ritually and see a psychiatrist, psychologist and a counsellor fortnightly. This dual diagnosis has helped me come to terms with myself but still in the throes of working out the correct medication and dosage

  4. I can honestly say I don’t feel alone for once in my life!! I feel so at home reading the words of people who suffer just as I do. It’s like reading words of people who suffer and live with the same issue as I do. The relief I now feel knowing I’m not alone is unmeasurable and such a stress relief. Like yes I know I wasn’t alone out there in this world, but to read it and see it with real people on here is so different then I could have ever imagined!! God bless us all!!

  5. I’ve been diagnosed twice with BPD between the ages of 17 and 23 but something never felt fully right. From time to time (More common now at the age of 31) I get long periods of moods lasting a week to sometimes 2 weeks becoming pro something like religion, secret societies etc. I end up doing masses of research for days on end, excited over what I learn and talk non stop about what I’ve learned. This then turns bad, I’ve always said any high or “good day” I have is always followed by a major low and this leads to being frightened, normally thinking bad of what I was pro before, sometimes believing that secret societies are the evil and control everybody’s day to day lives. Still inbetween those long periods I sometimes feel I’m having a mood swing within a mood swing, anger and irritation arise a lot. My vision also now seem to be effected, sometimes its a little like a music video. its hard to explain but I can tell the difference from the world I see while writing this and the one I experience then. I don’t know really why I’m writing this but I’m hoping someone has pointers because this does not feel like just BPD. The NHS in the UK is a failure and I’m worried they may have missed something. As a teen I was wild, did many silly things and had a sex drive like no other, apart from being wild, its like most of what I was like as a teen is back, 14 years later. Any help would be appreciated and to my brothers and sisters out there, we aren’t alone 😀

    1. Hi SW, I am curious if you’re referring to Borderline, or, Bipolar, when you say BPD. I literally do the exact same thing; obsess and research a specific topic or hobby for a couple of weeks and then I lose all interest.

  6. I was diagnosed BP1 in my 30’s (will be 47 in a few weeks) and as Ive gotten older it has gotten worse. When I am manic I have done all sorts of things I wouldn’t normally do, I have spent money like crazy. Its put such a strain on our marriage. We’ve been married almost 30 yrs. In the last few years Ive found a wonderful T, after I was inpatient 2x. He is amazing and I have been diagnosed not only BP1 but BPD. He said I am textbook both.
    I wonder why my husband even stays with me. I am a disaster. He loves me but when is enough enough… My T said some BPD people are not nice underneath but I am, it was wonderful to hear… things I don’t hear from my husband..
    The other day when I got upset when once again we were arguing about money when I turned away and started crying he actually told me “oh don’t do that, don’t go down that rabbit hole because your upset” that hurt so much…. Doesn’t he get it. I can’t control it.
    I am angry, frustrated, depressed and my anxiety is so bad.. I cycle and its the BP and I guess the BPD… I feel lost. To where I want to cut again, but I know he would just be frustrated with me and not strong…
    His motto is to ignore me at times in stead of fighting with me when he knows he will never be right when Im Manic or Depressed… Again, why try…
    Does anyone feel this way? I know he loves me deeply but is it enough?

    1. Sometimes it is important to put ourselves in the other person’s shoes, as your spouse may be frustrated himself and is just trying to cope with his own ups and downs of life as it is. Empathy on both sides is very important.

  7. Thank you everyone for writing.
    I am currently separated (via a restraining order) from my estranged husband. I am positive he has some kind of undiagnosed mental illness (bipolar, BPD, etc) due to his erratic behaviour and denial of the same.
    For years now he has blamed our problems on me or his family or coworkers. He’s always telling me I am ‘crazy,’ cannot self-regulate, emotionally stunted, looking up my ‘illness’ on websites, etc. But he utterly fails to see how charges of domestic abuse against him were his fault (“you overreacted”), or how child services investigated him for going after our son (“I just hit my head and reacted badly to that, that’s why…it’s an old head injury”). He has a spotty job record, serious anger and control issues, hoards, goes through periods of isolating or sleeping a lot, blames everyone and cannot see how his own behaviour brings his problems upon himself, can get very arrogant, is very smart, codependent (self-confessed), in recovery off/on for drug and alcohol abuse, twice tried to kill himself in his early-mid 20’s (once when prescribed anti-depressants), and will go through periods of acting out sexually (dating sites, Craigslist, hookers, etc).
    He can get verbally abusive and rages, is irritated easily, demands respect and nonresistance if you try to point out his behaviour (cannot take criticism), is hard to understand as he will talk fast and bounce from thought to thought (even a previous marriage counsellor asked him to stick to one subject!), and will go through phases where he’s telling everyone he’s going to write the next best selling novel,(then I’ll regret being such a bitch all the time) while at the same time can’t finish anything he starts, etc.
    And now he is blaming me for there being a restraining order against him. Says he going to counseling but then sends me nasty, vindictive emails! What sane person would do that knowing there is already an order against him that could be used against him? It makes no logical sense to me.
    Does this behaviour ring a bell for anyone (besides alarm bells)? I cannot help but think he’s either really sick and mentally ill, or he’s just a very abusive person living in denial of his actions.
    Oh, and his family thinks he’s bipolar but he just thinks its all us who are messed up!

  8. I was diagnosed with bp-1 and BPD in 2012 at the age of 31, (despite seeing psychiatrists since I was 14) following a particularly bad episode. Resulting in my family having to step in and look after my children. Following this I made the decision that I wanted my children to have a more stable home environment.

    Since then I have enrolled on a degree course and will be going into my final year in Sept (studying sociology). Studying has become an obsession, even though assignments take me 3 times as long to finish because everything I have read becomes jumbled up in my head with all my other thoughts.

    I agree with you bipolar artist about feeling stigmatised. For me this comes from one particular member of staff
    at the university. Each time I phone to explain I need an extension on assignments she advises me to suspend my studies. This hurts because I persevere against all odds, often increasing my anxiety levels to the point of being physically ill.

    I don’t expect a pat on the back or any sort of recognition from her for my determination. I’ve done this for myself and my very supportive partner, but mostly my children. My daughter was bullied for having a mental mum. I want them to see that no matter how tough things get I am more than the diagnosis. Bp and BPD are not only a part of who I am. Its really difficult to remember that though when you come across people who make yourself feel like you have a neon flashing arrow pointing at you.

    That’s my mini rant over.
    Would just to add I’m glad I found this site. Its really helpful to read other people’s experiences and reflect on my own.

  9. I have been diagnosed with bpd. since age 18 recently diagnosed with bipolar 1 my psychiatrist says it doesn’t change diagnosis but adds to it. though when ended up in er they sent me home even though mania pretty bad when I came out of the drug and alcohol fog that led to me overdosing on med’s. my phyciratrist said likely because my borderline diagnosis. I am starting to realize how stigmatized I was every time ended up in ER because of diagnosis of BPD now that been manic she said that if mania gets worse to go to ER and say phyciratrist said to go and that in mania snd med’s still being adjusted so they don’t see it as bpd behavior of going to ER. Sad I’ve been flagged that when I have other issues they figure all bpd. kind of like being bipolar it’s less stigmatized though I have both.

  10. I’ve recently been diagnosed as having both bipolar and borderline by a very good psychiatrist. I can tell you from my experiences over the last 6 months that the two feel very different indeed (for me). I’ve had a period of Hypomania and depression in this time. I made some major improvements in my life and I came out of the depression (I would say i’m in remission from the bipolar at present). But in the weeks since i’ve been in remission, the borderline personality disorder has ‘come out’ and i’m feeling pretty much how i’ve always felt. I am now seriously insecure, paranoid, angry, very emotionally sensitive and volatile, I do not have these feeling when i’m depressed or hypomanic. The two probably interact with each other at times to a greater or lesser degree but I can definitely say they feel very different and in all honesty, I cope more easily with the bipolar aspect. Hypomania is easy to deal with because I guess i’m one of the lucky ones who doesn’t have the negative aspects, just the energy and euphoria. The depression while very painful, I can cope with because I know it isn’t going to last forever (it’s normally only a few months).I wasn’t bipolar as a child but I would definitely say (looking back on how I felt etc) that I was borderline (I was sexually and emotionally abused from a very young age).
    I don’t think for one minute that all dually diagnosed people will have the same experiences as me, but for me the differences stick out like a sore thumb.

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