In Part I of this two-part series, I discuss the differences between bipolar and borderline personality disorder in terms of diagnosis. In this part, I focus on differences in treatments for the two conditions.

Treating Bipolar Disorder

Bipolar disorder has been considered a biological illness for many years, and the research has focused largely on medications. A standard repertoire of medications is used to treat bipolar:

• To treat acute mania and help maintain mood stability, the old standbys include lithium, anti-seizure medications (including Depakote), and atypical antipsychotics (including Zyprexa).
• Antidepressants are more complicated and difficult to use, and their role in treatment of bipolar disorder is not clear cut. A strong body of research supports the treatment of classic Bipolar I with medicine, but the data on Bipolar II or the broader spectrum that is still evolving and the responses to medication seem to be less consistent.

In terms of non-medication treatment, the focus is on the following:

• Educational and supportive interventions with a focus on family and establishing support systems.
• Working to reduce stress that can trigger mood cycles.

A program called Interpersonal and Social Rhythm Therapy (IPSRT), which we discuss in Bipolar Disorder For Dummies is well studied and targets sleep/wake and general daily rhythms along with interpersonal stress and demands. IPSRT seems to reduce the frequency and severity of symptoms when used in tandem with medication.

What’s most important to note about bipolar as contrasted to borderline personality disorder is that bipolar is generally considered more biological than psychological and tends to respond more fully and consistently to medication treatment. Many (though certainly not all) people with bipolar disorder can achieve remission of symptoms – elimination or reduction of mood cycle episodes – with medication treatment.

Treating Borderline Personality Disorder

The treatment of borderline personality disorder has a history of conflicting approaches and less clear data. Traditionally, borderline personality disorder has been seen as more psychological than biological, but more recently awareness of the neurobiological components of this very difficult-to-treat condition has increased.

The treatment research has focused more on therapy models than on medication, and the core symptoms of the disorder have not shown consistent or robust responses to any family of medications.

Currently a few competing models of therapy intervention for borderline personality disorder are available:

• Dialectical Behavioral Therapy (DBT) is the most well know and well studied. DBT is a type of cognitive behavioral therapy (CBT) that focuses on training in a number of core emotional and interpersonal skills that are consistently impaired in individuals with borderline personality disorder. Family/support networks are commonly involved in this treatment approach, which differs from traditional therapy approaches to borderline personality disorder.
• An alternative treatment referred to as mentalization is also being studied with some good effects. This is more of a hybrid between cognitive behavioral and psychodynamic therapy. Psychoanalysis/psychodynamic treatment for borderline disorder has a long history, but not a strong database, which may simply be because the studies haven’t been done yet.

In the medication corner, some studies have been done on the use of mood stabilizers in the treatment of borderline personality disorder – focusing on the core symptoms of mood reactivity. However, medications don’t have a strong track record in this disorder.

Medication is most commonly used in borderline personality disorder to treat associated conditions, including depression, anxiety, rage attacks, and eating disorders. Antidepressants/anti-anxiety medicines are commonly used in these scenarios, and the results can be quite positive, but the core personality symptoms are not typically resolved with these medications.

Overlapping Treatments

Some treatment approaches for bipolar disorder and borderline personality disorder overlap:

• Mood stabilizers, which are core treatment for bipolar, are often used in borderline, but with less clear benefit.
• Antidepressants are used in both conditions, and with caution in both situations, because of the risks of creating agitation or even manic-like symptoms as a side effect in both populations.
• Comprehensive therapeutic approaches that include emotional and regulatory skills training and that involve the family and support network have been found to be helpful in both groups of patients, although the specific treatment protocols for each condition are different – at least for now.

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  gbr at 6:38 pm on September 2nd, 2010

I live in England and have to rely on the NHS has I can not afford to go Private…… the system is failing me, due to high demand for its services (ie therapy’s)I can not take medications for various reasons (ie anti depressants trigger mania, Mood stabilizers trigger my eating disorder, because they cause a sensational craving to eat constantly, anti anxiety medication (Diazipan) is difficult to use without leading to addiction)I don’t have a supportive family and have to look after 2 children, I have Borderline Personality disorder….What can I do??? The C.A.T I had, is being undone because i’ve been left to my own devices for a few months and have to wait another couple of months to start Art Psychotherapy.. Im back to square one so to speak, in spite of having an over view to what is happening to me and why….Im becoming very despondent and destructive

  Ronie at 1:56 am on September 3rd, 2010

Ok so you went though how BPD and Bipolar are different and how they have some slight similarities… I have been diagnosed with both: Bipolar NOS and BPD. So how does all this translate to someone in my situation? I do thank you for these two articles. I think it shed some light for me. I think that when I’m going though what I think is a mixed episode is actually depression with the mood shifts of BPD. Maybe? So back to my original concern: What does this information mean for someone in my particular situation?

  Patti at 1:17 am on September 7th, 2010

Thanks for the information. I have been diagnosed with Borderline Personality Disorder and Bipolar Disorder at different times, altho the consensus seems to be that I have Borderline PD. As you stated, symptoms can overlap, and many people are misdiagnosed. (Altho I do know some people who have both disorders.) I found the link to this blog on one of my “mood disorders” sites, and I will definitely have to thank the friend who posted it–the information is very helpful and I think will help a lot of people who are confused about these two disorders.

  Marianne at 10:50 pm on May 13th, 2011

Sadly, most individuals struggling with personality disorders do not have their diagnoses properly documented due to the insurance industries reluctance/refusal to provide coverage since personality disorders are not typically biologically based “illnesses” – just like marital therapy is not typically covered because it is not and illness. Clinicians have historically relied upon the “garbage can” diagnoses to ensure reimbursement from the health insurance industry. I am hopeful the recent enactment of the Mental Health Parity Law will persuade clinicians to document psychiatric diagnoses more accurately and transparently. Until this happens it will remain impossible to accurately study the differences between these and other mental health conditions.

Links to This Article

From Psych Central's Bipolar Beat:
Bipolar Borderline Personality Disorder Differences Diagnosis | Bipolar Beat | Candida Fink, MD | Bipolar Beat (September 7, 2010)

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“Borderline Personality and Bipolar Differences Part II: Treatment”

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    Last reviewed: 2 Sep 2010