Because some of the diagnostic criterion overlaps, it is easy to confuse bipolar disorder with borderline personality disorder (BPD). In fact, BPD is co-diagnosed (comorbid) with mood disorders, such as bipolar, about 50% of the time (Adams et al., 2001).
The term "manic-depression" was first introduced in 1899 by Emile Kraepelin (Butcher, Mineka, and Hooley, 2004). The clinical picture he described resulted in behaviors and moods that vacillated between extremes of depression and elation, or euphoria. Over time, clinicians began to refer to the disorder as "bipolar disorder," although "manic depression" is still commonly used.
BPD was originally believed to be a biological cousin to schizophrenia. In essence, the condition was identified as a type of "border" between neurotic and psychotic disorders (Paris, 1999). According to Paris, biological connections between BPD and schizophrenia are no longer considered to be related to schizophrenia or other psychotic disorders.
Diagnosing the Problem
Many studies have found links between BPD and a large number of traumatic events during childhood. In contrast, bipolar disorders are more often linked to genetics (Butcher, Minkeka, & Hooley, 2004).
Bipolar I and II are considered "major clinical syndromes" and diagnosed on Axis I of the DSM diagnostic classification system. BPD is listed on Axis II as a personality disorder. Axis II disorders, which also include mental retardation, have traditionally been thought of as more resistant to change with a poor prognosis. According to APA (2000), BPD patients often have a separate additional Axis I diagnosis such as a mood or anxiety disorder. Thus, BPD clients often have a "dual diagnosis".
Depression
While bipolar disorder is characterized by cyclical states of depression, a diagnosis of BPD alone does not typically share that feature. Since BPD is often characterized by impulsiveness and erratic behaviors, symptoms may mimic depression and be confused with mood disorders such as bipolar. However, someone with BPD alone may not suffer from depression (APA, 2000).
Violent Behavior
Other features of BPD are centered around instability of self-image, extremely unstable personal relationships, fears of abandonment and unstable and dramatic mood shifts (APA, 2000). While the mood shifts are common to both BPD and bipolar, according to APA (2000), self-mutilation (such as cutting) and repeated suicide attempts are more characteristic of individuals diagnosed with BPD. If a bipolar patient exhibits violent tendencies, she is likely to have a dual diagnosis of BPD and bipolar disorder.
Treatment
Since bipolar is classified as a mood disorder, it is not surprising that persons diagnosed with a bipolar disorder are more likely to respond successfully to antidepressant medications (Gitlin, 2002). Alternatively, BPD tends to be treated with individual, group and family counseling (Butcher, Minkeka, & Hooley, 2004).
References
- Abnormal Psychology; James Butcher, Susan Mineka, Jill Hooley; 2004
- Diagnostic and Statistical Manual of Mental Disorders; American Psychological Association; 2000
- Oxford Textbook of Psychopathology; J.Paris; 1999
- Comprehensive Handbook of Psychopathology; H. Adams, J.Bernat, & K. Luscher; 2001
- Handbook of Depression; Gitlin; 2002
