Understanding the difference between bipolar disorder and borderline personality disorder (BPD) in young people.
Many young people are becoming more familiar with different mental health conditions. It is not uncommon to hear discussions about anxiety, depression, or eating disorders at family dinner tables or in classrooms. The past decade has also seen many healthcare organisations push for better mental health awareness, emphasising just how important it is, particularly for young people.
However, there are several conditions which remain shrouded in misunderstandings or confusion. An excellent example of this is bipolar disorder and borderline personality disorder (BPD). These two serious conditions are often confused with one another, which makes it difficult for young people to clearly understand the differences between them.
This confusion may arise simply from the fact that both conditions begin with the letter ‘B’, or it may be because the symptoms exhibited by these disorders can occasionally overlap and resemble one another in presentation. Still, the fact remains that bipolar disorder and borderline personality disorder are different conditions. Recognising this is critical to ensuring that young people who are struggling with these disorders feel recognised and are able to seek treatment that addresses their specific needs.
In this week’s blog, we will explore the differences between bipolar disorder and BPD and look at some of the ways these disorders are likely to manifest in young people.
Bipolar Disorder
Bipolar disorder is a mood disorder, meaning it affects a person’s emotional or affective state. An individual with bipolar disorder will experience regular and prolonged periods of emotional instability, which result in major disruption to daily life. Researchers and psychologists refer to this as chronic affective instability: chronic meaning frequent, and affective meaning to do with emotions.[1]
There are two major types of bipolar disorder – bipolar I and bipolar II – but both are characterised by regular alternation between two very different mood states. The first is an energetic, hyperactive, and often exuberant state known as mania. The other is a slow, fatigued, often very sad state known as depression. In the past, bipolar disorder was called manic depression based on these two states. Neither mania nor depression is rational; oftentimes, individuals experiencing either one will find daily tasks and routines impossible to complete.[2]
Bipolar disorder is associated with one of the highest mortality rates among mental health conditions. Approximately 25% of individuals who are diagnosed with bipolar disorder attempt suicide, and 11% of individuals die from it.[3]
Since mood elevation and variability are very common as a part of normal development through adolescence, it can be difficult to identify bipolar disorder in young people.[4] Knowing how to differentiate between a normal period of sadness or happiness and a period of depression or mania can present a challenge, not only for friends, parents, or loved ones of teenagers but for teenagers themselves.
Researchers believe that periods of mania, in particular, are at the core of defining the psychopathology of bipolar disorder. As such, knowing the signs and symptoms of mania could be critical in diagnosing and providing treatment which is timely enough to prevent harm.
Below are some of the common signs and symptoms of mania:
- Insomnia (inability to sleep)
- Daily sense of agitation
- Regularly engaging in reckless or dangerous behaviours
- Significant weight loss or intense fluctuations in appetite
- Feelings of inappropriate guilt
- Inability to concentrate, think, and make decisions
- Recurrent thoughts of death and/or suicidal ideations[5]
Borderline Personality Disorder
Where bipolar disorder is characterised by intense swings in mood from depression to mania and back again, borderline personality disorder (BPD) is characterised by an inability to regulate feelings altogether. Individuals struggling with BPD will be unusually – often dangerously – impulsive and have difficulty managing their feelings towards themselves and others.[6]
Similar to bipolar, BPD entails a loss of control over one’s emotional state. Unlike bipolar, BPD does not follow a cyclical pattern between two emotional states but varies wildly and unpredictably among many emotional states. The primary feature of BPD is instability: in emotions, self-image, and relationships. People with BPD can often seem irrational or extreme to others and frequently appear to be inappropriately angry and paranoid.[7]
Another crucial element of BPD is a pervasive sense of emptiness or confusion surrounding identity.[8] Those who have been diagnosed with borderline personality disorder are prone to feeling empty or hollow inside, and they have a hard time keeping a hold of their sense of Self. Frantic attempts to avoid abandonment by others is also very common in people struggling with BPD, and this disorder is very often associated with self-harm, suicide attempts, and unstable interpersonal relationships.[9]
Again, because adolescence is a period of major developmental transitions at a physical, social, and psychological level, it can be all too easy to dismiss the symptoms of borderline personality disorder in young people as part of the standard emotional turbulence of youth.[10] However, research indicates that BPD usually has its onset in young people, even if clinical diagnosis is often delayed.[11] As such, it is important to be able to identify the distinct symptoms of BPD in order to help support a young person who may be struggling with this mental health condition toward treatment as soon as possible.
The recognised behaviour criteria for diagnosing BPD are as follows:
- Frantic efforts to avoid abandonment
- Unstable interpersonal relationships alternating between idealisation and devaluation
- Identity disturbance (including unstable self-image or sense of Self)
- Impulsivity
- Recurrent suicidal behaviour or self-harm
- Affective instability
- Chronic feelings of emptiness
- Inappropriate anger
- Transient paranoid ideation or dissociation related to stress
To learn more about the distinct differences between bipolar disorder and borderline personality disorder or to find detailed information on diagnosing and treating these two mental health conditions in young people, visit the We Treat page on our website. If you want to read further you can also check out our blog Bipolar vs Borderline Personality Disorder
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Sources
[1] DelBello, M.P. and Strakowski, S.M. (2009) Bipolar Disorder. Encyclopaedia of Neuroscience.
[2] Rick D. Kellerman MD. (2021) Depressive, Bipolar, and Related Mood Disorders. Conn’s Current Therapy, 2021.
[3] Hilty, D.M. et. al., (2006) A Review of Bipolar Disorder in Adults. Psychiatry, Sept; 3(9): 43-55. PMID: 20975827
[4]Rock, P.L. (2013) The common bipolar phenotype in young people. International Journal of Bipolar Disorders. Oct, 1: 19. doi: 10.1186/2194-7511-1-19
[5] Rick D. Kellerman MD. (2021) Depressive, Bipolar, and Related Mood Disorders. Conn’s Current Therapy, 2021.
[6] National Institute of Mental Health. (2022) Borderline Personality Disorder. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
[7] Ferguson, S. (2021) All about borderline personality disorder. PsychCentral. May 23. https://psychcentral.com/disorders/borderline-personality-disorder
[8] Koenigsberg, H.W. and Siever, L.J. (2009) Borderline Personality Disorder. Encyclopaedia of Neuroscience.
[9] Hooley, J.M. and Masland, S.R. (2016) Borderline Personality Disorder. Encyclopaedia of Mental Health (Second Edition).
[10] British Psychological Society (UK) (2009) Borderline Personality Disorder: Treatment and Management. YOUNG PEOPLE WITH BORDERLINE PERSONALITY DISORDER. NICE Clinical Guidelines, No. 78. National Collaborating Centre for Mental Health (UK).
[11] Chanen A. M. (2015). Borderline Personality Disorder in Young People: Are We There Yet?. Journal of clinical psychology, 71(8), 778–791. https://doi.org/10.1002/jclp.22205
