Mood swings during stressful times are natural, but those living with a mood disorder like bipolar (BP) or personality disorder like borderline (BPD) have extreme, erratic, and sometimes irrational changes in their mental state. A lot of symptoms overlap, but these are different disorders and have very different treatments. Medication, for example, is a critical component for those with bipolar, but for borderline the first recommended treatment is usually some form of therapy.
Mood and personality disorders can produce similar symptoms, like severe depression and rapid mood changes. However, mood disorders affect someone’s emotional state temporarily during “episodes”, not their core personality. It’s more about how someone interprets and experiences their strong emotions than who they are as a person. Another difference is that mood disorders can sometimes cause psychotic symptoms that completely keep people from functioning in their daily life. The social harm with personality disorders is caused by character traits that make people behave in destructive ways.
There are many types of personality disorders, classified into clusters:
Cluster A – Odd or eccentric behavior. Examples are schizoid personality disorder, paranoid personality disorder and schizotypal personality disorder.
Cluster B – Dramatic, emotional, or erratic behavior. Examples are antisocial personality disorder, borderline personality disorder and narcissistic personality disorder.
Cluster C – Anxious fearful behavior. Examples are avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder. [1]
Borderline personality disorder and bipolar disorder are often confused because they can present in similar ways, such as experiencing highs and lows. One difference between BPD and BP (other than the confusing acronyms) is that people with borderline personality disorder can be triggered by any event – typically related to abandonment – and experience highs and lows related to their triggers throughout the day. They tend to be inflexible and unable to respond to the changes and demands of life. This loss of emotional control can increase impulsivity, affect how a person feels about themselves, and negatively impact their relationships with others. [2] In contrast, someone with bipolar disorder experiences mania and depression, intermittently, and often for long periods of time. Approximately 1.4% of the United States adult population has borderline personality disorder and approximately 2.8% has bipolar disorder. [3]
Those with BPD are more likely to have had some type of trauma as a child than people with bipolar disorder, although trauma does not cause borderline personality disorder. [4] And, though both often produce addictions, suicidal thoughts, and anxiety, those with BPD are more likely to suffer from eating disorders and body dysmorphia. [5] Self-harm, such as cutting to help deal with strong emotions, is also more common in BPD than in bipolar – 75% of those experiencing BPD have physically injured themselves in some way. [6]
Overall, people with borderline personality disorder typically have insecure attachments and a hard time accurately reading other’s emotions and social signals, resulting in feeling insecure even if the other person is truly just being neutral. Occupational relationships can also be affected, resulting in a tumultuous career.
The cause of borderline personality disorder is unknown, but some research suggests links to:
- Genetics and social environments
- Childhood abuse and trauma such as sexual, physical, and emotional abuse.
- Real or perceived fear of abandonment in childhood or teenage years.
- Being a victim of emotional, physical, or sexual abuse.
- Being exposed to long-term fear or distress as a child.
- Being neglected by 1 or both parents.
- Growing up with another family member who had a serious mental health condition, such as mental illness or a drink or drug misuse problem [7]
For bipolar, people experience phases of illness; the main phases being highs of hypomania/mania and lows of depression. There are several types of bipolar disorder. Bipolar I and II are the most common. People with bipolar I experience mania while people with bipolar II experience a milder form of mania called hypomania. It is important to note, though, that bipolar II includes the lows of depression and is not always a milder condition. Less common is schizoaffective disorder, which is a combination of schizophrenia and bipolar.
Comorbidity (the presence of two or more conditions) is common in bipolar: more than 50% of people with bipolar I and II experience anxiety and more than 60% choose to self-medicate through substance abuse, which can trigger other latent disorders to manifest. [8]
Symptoms of hypomania/mania include inflated self-esteem, decreased need for sleep, increased talkativeness, goal-directed activity, racing thoughts and engaging in activities with potentially damaging consequences. Hypomania may not always interfere with everyday functioning, and many people enjoy being hypomanic, but that means they may resist treatment during this phase. Both forms of mania can have serious consequences. In addition to hospitalizations and arrests, [9] the highs can significantly harm people and their relationships.
It’s important to be able to identify the dangerous lows of depressive bipolar episodes. Common symptoms of depression for people with bipolar I and II include low mood, loss of interest in activities, fatigue, feelings of worthlessness or guilt, difficulty thinking or concentrating and recurrent suicidal ideation. Some people may also experience a “mixed state” that combines the features of mania and depression, sometimes producing delusions. Approximately 53% of people with bipolar I experience psychosis at some time if their life. [10] An estimated 40% of people with bipolar experience anosognosia or lack of awareness of symptoms, which prevents them from taking medication. [11] People with bipolar disorder face high rates of suicide that exceed those of other major psychiatric disorders – up to 19% die by suicide and up to 50% will make a non-fatal suicide attempt. [12]
Though there’s no cure, the intensity of both BP and BPD can ease with age and long-term treatment. Options include the combination of psychotherapy and medication. Forms of psychotherapy often used to treat these disorders include:
Dialectical Behavior Therapy (DBT): This treatment method was created for people with BPD. DBT involves mindfulness, awareness of the present situation, and awareness of one’s emotional state. It helps people develop skills for controlling intense emotions, reducing risky/destructive behavior, and improving relationships.
Cognitive Behavioral Therapy (CBT): A treatment that can help one recognize and change inaccurate core beliefs of oneself that lead to problems interacting with others. It can reduce mood swings, anxieties, and other behaviors leading to self-harm or suicide.
Despite the negative effects of mood and personality disorders, treatments are available that can help manage and decrease symptoms so individuals can lead a happy, fulfilling life.
Some Recommended Free Resources:
- Borderline Personality Disorder: This brochure offers basic information about borderline personality disorder, including signs and symptoms, treatment, and finding help.
- Depression and Self-Injury: This Breaking Taboo infographic help to illustrate fact from fiction.
- 5 Action Steps for Helping Someone in Emotional Pain: This infographic presents five steps for helping someone in emotional pain to prevent suicide.
- My Friend is Suicidal: This Breaking Taboo article presents a first-hand story along with methods for helping someone close to you.
- Warning Signs of Suicide: This infographic presents behaviors and feelings that may be warnings signs that someone is thinking about suicide.
- Digital Shareables on Borderline Personality Disorder: These digital resources, including graphics and messages, can be used to spread the word about borderline personality disorder and help promote awareness and education in your community.
- CBT Explained: An Overview & Summary of CBT (Incl. History)
~ Melinda
Melinda is from the Boston area and still has a passion for lobster and the ocean although she currently resides in Atlanta, Georgia with her husband and cat. Mindy draws from both professional and personal experience for inspiration. In her professional life, she has worked in the publishing industry, non-profit world, and most memorable to her, at a shelter for homeless adults. In her personal life, Mindy has been living with Bipolar I disorder since 2008 and draws on that experience in her writing, with the goal to end each article with something proactive and positive, with action steps for how to find yourself in a better place. She writes in memory of her brother, Roy, her first editor.
[References:
1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540749/
[2] https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
[3]
https://www.nami.org/mhstats#:~:text=Annual%20prevalence%20among%20U.S.%20adults,Bor
derline%20Personality%20Disorder%3A%201.4%25
[4] https://www.scientificamerican.com/article/borderline-personality-disorder-may-be-rooted-
in-trauma/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839025/
[6] https://www.borderlinepersonalitydisorder.org/wp-content/uploads/2011/12/If-Only-We-Had-
Known.pdf
[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973430/
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094705/
[9] https://pubmed.ncbi.nlm.nih.gov/15003073/
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807194/
[11] https://www.webmd.com/schizophrenia/what-is-anosognosia
[12]
https://journals.lww.com/jaanp/fulltext/2020/10000/is_it_depression_or_is_it_bipolar_depression
_.12.aspx
