Bipolar disorder, also known as manic-depressive illness, has complex manifestations that are easily confused with other mental disorders (including borderline personality disorder), with over 80% of patients failing to receive a correct diagnosis.
How can we differentiate between bipolar disorder and borderline personality disorder? Before answering this question, let’s first get to know borderline personality disorder.
Borderline Personality Disorder: Core Features
Borderline personality disorder is one of the most common personality disorders, falling between normalcy and bipolar disorder, schizophrenia, and mental dysfunction. The prevalence in the general population ranges from 0.5% to 5.9%, with little gender difference.
Most of the time, patients appear no different from others, even displaying an active social life. Initially, many people may find them warm and charming, but as interactions deepen, their deadly “instability” often becomes unbearable.
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1. Love and Hate in an Instant
Patients with borderline personality disorder have extremely unstable emotions, unpredictable mood swings. Some patients describe, “One moment I’m overjoyed, the next second I’m emotionally shattered, hysterical. From good to bad in just a few minutes, completely out of control.”
Similarly, in the realm of love, they are either in love or in hate, with no middle ground. Despite deeply loving their partner, they might idealize the relationship to an extreme; however, a trivial matter or unmet expectation can evoke intense hatred, quickly cooling off their emotions and pushing the other person away mercilessly.
2. Fragile Hearts
Patients with borderline personality disorder lack a sense of security, fear abandonment intensely, and excessively rely on close relationships.
At times, the slightest hint of indifference from others might trigger a huge fear and anger of being abandoned in the patient, leading to outlandish behaviors like repeatedly telling the other party how sad they are, demanding many things to feel at peace, or resorting to constant calls, going to the other person’s place, or even using self-harm or suicide as threats.
However, when given enough love and care, they may doubt the sincerity of the other person, use intense words to force them to leave, then feel extremely remorseful afterward, yearning for the person to come back into their life.
The desire for intimacy mixed with the desire for separation is the best description of the relationship between individuals with borderline personality disorder and their intimate partners.
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3. Oscillation Between Confidence and Low Self-esteem
Patients easily fall into a binary, black-and-white thinking pattern, fluctuating from overestimating themselves to feeling worthless, often struggling to identify who they are and not recognizing their self-worth, lacking a stable and independent personality.
4. Uncontrollable Anger
They often have frequent outbursts of anger, with the intensity of their anger not necessarily proportional to the triggering event. Even minor issues can lead to extreme anger, resulting in inappropriate responses like physically assaulting the other person.
5. Impulsive Self-harming Behaviors
Due to emotional instability and difficulty maintaining long-lasting friendships, patients with borderline personality disorder tend to feel empty, finding life meaningless, and fearing isolation.
As a result, some individuals cope through impulsive behaviors like excessive consumption, substance abuse, binge eating, seeking immediate emotional outlets, potentially engaging in sexual activities hastily with acquaintances, only to switch partners shortly after.
Some patients resort to repetitive self-harm or even suicide attempts. Research indicates that over 75% of patients have had thoughts of self-harm or suicide, with 10% ultimately choosing to end their lives.
6. Minor Psychotic Symptoms
Under stressful conditions, individuals with borderline personality disorder may experience depression, anxiety, personality disintegration, and other dissociative symptoms (e.g., auditory hallucinations, paranoid thoughts, sudden detachment from the world, feeling detached from themselves).
Borderline vs. Bipolar: Key Differentiation
After reading the above descriptions, attentive readers may notice the similarities in symptoms between moments of heightened emotions, grandiosity, extreme lows in mood, feelings of emptiness, loneliness, aggression, self-harm, and suicide. Aren’t these characteristics of bipolar disorder as well?
Indeed, these two disorders share many symptoms, often co-occurring, making differential diagnosis challenging and prone to misdiagnosis in clinical practice. We can attempt to differentiate based on the following aspects.
1. Etiology
While the exact causes of both disorders remain unclear, evidence suggests that genetics play a significant role in bipolar disorder, which can be preliminarily distinguished by inquiring about family history.
On the other hand, psychosocial factors are more critical in borderline personality disorder. Early life traumas (such as abuse, neglect, insecure attachments, frequent family conflicts, etc.) seem to be key in the formation of the disorder.
2. Clinical Presentations
(1) Emotional Instability
Patients with borderline personality disorder experience rapid mood shifts, easily triggered fluctuations that typically last for a few hours or even shorter, rarely exceeding a few days. These emotional swings, often triggered by life events and interpersonal stress, vary from pleasant to angry.
In contrast, the emotional fluctuations in patients with bipolar disorder usually range from depression to excitement, occurring cyclically over longer durations (often for days, weeks, or months), generally arising spontaneously with weaker associations to environmental factors.
(2) Impulsive Behaviors
The development of personality is a slow, long-term process and symptoms may not pinpoint a specific onset. Borderline personality disorder exhibits a wide range of impulsive behaviors, such as verbal aggressiveness, hostility, physical violence, substance abuse, or self-harm activities.
In manic episodes of bipolar disorder, impulsive behavior may occur but typically has clear onset limits, progressing gradually and then subsiding. Emotional instability and impulsivity generally dissipate during the remission phase. Suicidal attempts are more common during depressive episodes.
(3) Interpersonal Issues
Rapid bonding, excessive reliance, fear of abandonment are characteristics of borderline personality disorder, leading to unstable and short-lived interpersonal relationships. While individuals with bipolar disorder may encounter relationship challenges, they usually do not display extreme dependency, fear of abandonment, or identity crises – the struggle to understand who they are.
3. Medication Response
Mood stabilizers (e.g., lithium carbonate) are effective in treating bipolar disorder. Although medication can alleviate symptoms in borderline personality disorder, there is currently no specific drug therapy available; therefore, psychotherapy remains the primary treatment strategy.
Living with Borderline Personality Disorder: Tips for Interaction
Some describe living with an individual with borderline personality disorder as a blend of an angel and a devil, often causing those around them great distress or feeling emotionally manipulated. Dr. Zhang Liping of Affiliated Yifu Hospital, Nanjing Medical University, provides several suggestions:
1. Understand that the behaviors and emotional responses are symptoms of the patient, not your fault. Do not absorb this information like a sponge, try to overcome negative emotions quickly.
2. Establish clear and stable boundaries, a crucial key to interaction. Clearly express what behavior you can accept, what you cannot, and maintain consistency in your actions. When faced with unreasonable demands, politely decline instead of blindly yielding.
3. Treat emotions like a wild tiger – evade, not confront. When faced with anger or accusations, hit the pause button, and discuss the matter once the other party has calmed down.
4. Encourage and support them to undergo professional psychotherapy. In situations where they threaten or attempt extreme actions, stay calm and promptly seek help from mental health professionals.
References:
[1] Lu L. Shen’s Fishery Psychiatry (6th ed.). Beijing: People’s Health Publishing House. 2018.
[2] Yao Y. Dark Psychology: Newly Revised Series. Tianjin: Tianjin Boji New Media Technology Co., Ltd. 2020.
