Alright Folks. Today I’m going to start a series that has been on my mind for an extremely long time. Not only here on my blog, but in my actual life.
Borderline Personality Disorder versus Bipolar Disorder
This is a subject that is near and dear to my heart because while we all know that I’m Borderline, it’s a lesser remembered thing that my sister is Bipolar. In fact, the reason we finally bonded in friendship was over shared emotional distress and maladaptive coping mechanisms. There are a lot of things about Bipolar that look very similar to Borderline Personality Disorder, which often and unfortunately, leads to a lot of misdiagnosis in both directions. It gets even muddier because it also appears that you can potentially have comorbid Bipolar Disorder AND Borderline Personality Disorder. There’s always something fishy about that one to me though. Anyways, let’s get started with the big question first:
What is Bipolar Disorder?
The Mayo Clinic defines: Bipolar disorder — once upon a time called manic-depressive disorder — is associated with mood swings that range from the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.
The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.
Episodes and transitions between episodes can occur slowly averaging about one transition per year, to something much faster (and therefore more easily confused with BPD).
So what exactly is this idea of a manic phase for bipolar disorder?
Mania is arguably the defining feature of Bipolar Disorder. Mania is a distinct period of elevated or irritable mood and can even take the form of euphoria, that lasts for at least a week (unless hospitalization is required). It’s very common for someone that is manic to experience an increased amount of energy and a decreased need for sleep, even leading to a mild insomniac effect. People often only get 3-4 hours of sleep a night, even going days without sleep!
It’s common for someone experiencing mania to have a low attention span and be easily distracted. Impaired judgment and impulsivity are also common. Spending sprees, risky behavior that isn’t typical for them, indulging in drugs and alcohol, stimulants, or sleeping pills isn’t uncommon.
Behavior can be aggressive, intolerant, or intrusive into the lives of those around them. Feelings of grandiosity, maybe even with delusional ideas, can manifest. They can feel uncontrollable, unstoppable, or like they’ve been “chosen” in some way. People can experience hyper-sexuality. At the most extreme end of mania there can even be a psychosis, or a psychotic break from reality, where thinking is also affect alongside mood.
The experience of mania is different depending on the person and even the time of year. For some people mania translates as severe anxiety and get very irritable, even to the point of rage, while for other people it’s more of a grandiose feeling of being invincible and euphoric.
The biggest thing to remember is… this experience of full blown mania, disrupts the person’s life for a period of time. It’s not just an experience of having a really good day. It’s not just being over-stimulated for a while. And while you can be diagnosed bipolar with only one noticeable period of Mania, it’s more than likely to be a cyclic occurrence throughout a person’s life.
Now for it to be “bi”polar, there’s that accompanying idea of an up with the down. Depression. We’ve talked about Depression before because depression is often co-occurring with Borderline Personality Disorder as well. All those signs and symptoms of depression that we talked about before, are the same. Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal thoughts. All things we’ve noticed before with depression.
Bipolar depression in severe cases may become psychotic, which is a condition also known as severe bipolar depression with psychotic features. These symptoms include delusions or, less commonly, hallucinations, usually unpleasant. These hallucinations can be auditory, visual, and even olfactory. One particular expression of depression, that often gets bipolar confused for BPD, is the expression of self-harm. It’s not as common with bipolar as it is with BPD, but it can definitely manifest. A major depressive episode persists for at least two weeks, and may continue for over six months if left untreated.
Mixed Affective Episodes
Finally there is the idea of Mixed Affective Episodes. This happens when, in the context of bipolar disorder, a mixed state condition of having simultaneous symptoms of mania and depression occurs. Typical examples include weeping during a manic episode or racing thoughts during a depressive episode. Individuals may also feel very frustrated in this state, for example thinking grandiose thoughts while at the same time feeling like a failure. Mixed states are often the most dangerous period of mood disorders, during which the risks of substance abuse, panic disorder, suicide attempts, and other complications increase greatly. Imagine feeling the darkest despair of suicidal depression coupled with the impulsive recklessness of a manic state! That can easily lead to fatal devastation.
I’m going to let you in on a spoiler here when it comes to the difference between Bipolar Disorder and Borderline Personality Disorder – Chemistry and Genetics. With Bipolar Disorder this is the prominent factor, though environmental factors can contribute as well.
The exact cause of bipolar disorder is unknown, but several factors seem to be involved in causing and triggering bipolar episodes:
Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.
Hormones. Imbalanced hormones may be involved in causing or triggering bipolar disorder.
Inherited traits. Bipolar disorder is more common in people who have a blood relative (such as a sibling or parent) with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder. (One of our grandmothers distinctly presented as Bipolar.)
Environment. Stress, abuse, significant loss or other traumatic experiences may play a role in bipolar disorder. These things can trigger and exacerbate the onset and expression of severity of bipolar symptoms. When people who are genetically predisposed toward bipolar disorder experience stressful events, the stress threshold at which mood changes occur becomes progressively lower, until the episodes eventually start (and recur) spontaneously. There is evidence of hypothalamic-pituitary-adrenal axis (HPA axis) abnormalities in bipolar disorder due to stress along with other environmentally exacerbated neuro-effects. They can also lead to a greater expression of other co-occurring disorders such as PTSD.
So there you have it. That’s probably the most basic breakdown of Bipolar that I can give you. Before I get into comparing and contrasting Bipolar with BPD I want to talk about the different subtypes of Bipolar as well, because this also contributes to the confusion.