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.
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.