Bipolar disorder versus borderline personality disorder what's the
difference or how do you tell the difference? That's what I'm gonna talk
about today. This is actually based on a viewer question. If you're new to my
channel, I'm Dr. Tracey Marks a psychiatrist and I published weekly videos on mental
health education and self-improvement. So if you don't want to miss an episode,
click Subscribe and the notification button so you'll know when the new the
next videos coming out. The viewer question is from paper parade and she
says can you explain the difference between a borderline with depression and
bipolar? I'm gonna focus on the difference between bipolar disorder and
borderline personality disorder because depression is actually a part of bipolar
disorder. There's a big difference between the personality disorders and
the psychiatric illnesses like depression, anxiety, schizophrenia, bipolar
disorder. Personality or your personality is your hardwiring and the illnesses are
your state at the time. Another analogy would be comparing your personality to
the climate of a region and a disorder like depression would be the weather
that you're having at the moment. I grew up in Florida which is a warm climate
and we basically had two seasons: hot and not hot. But then we'd have hurricanes
that could rip through and completely disrupt the environment. But once
hurricane season passed, we'd still be left with a warm climate. The climate
affects how the weather manifests at the time likewise your personality makeup
affects how your illness manifests. So going back to the geographical example,
Russia has a very cold climate and this affects the type of storms that you see
there. So you get blizzards in cold climates and sandstorms and desert
climates and tropical storms in tropical climates. So if a person with
say narcissistic personality disorder gets depressed, it's going to look
different from the person with dependent personality disorder who becomes
depressed. The narcissistic person because of their self-centeredness may
look more angry and self-loathing whereas the dependent
person because of their neediness can become more pitiful and helpless when
they get too depressed. Now these are just broad stroke examples. So back to
borderline personality disorder, this is actually a really big topic but I'm only
going to briefly define the disorder for you and I'm going to use our Diagnostic
and Statistical Manual of Mental Disorders the fifth edition and I'm
going to read the definition. So borderline personality is defined by the
following: a pattern of unstable relationships self-image and emotional
expression marked by impulsivity, beginning in early adulthood and present
in a variety of contexts as indicated by five or more of the following. It's
important that you realize that it's five or more of these characteristics so
what you don't want to do is take out one and say oh I have that does that
mean I have borderline personality disorder? No unless you have several of
these things. Number one is frantic efforts to avoid real or imagined
abandonment. An example of this is the person who may seem to read into things
too easily. Things that you say are interpreted to mean that you're done
with them or that you're abandoning them in some way. Number two: a pattern of
unstable in intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation. In this
kind of relationship, the person with borderline personality disorder may at
one point think that you're the best thing ever and you can do nothing wrong
and in the next moment or the next day you're the worst thing ever, the exact
opposite. Number three is an identity disturbance You have a markedly
persistent or unstable self-image or sense of self. This kind of identity
disturbance occurs at a deep level and not to be confused with whether you're
not sure if you're meant to be a teacher or an astronaut. This is a confusion
about core identity issues like your gender or your sexuality or even your
spirituality. Now I tiptoe around this because I don't
want you to walk away thinking that anyone who wants to change their gender
has borderline personality disorder in fact as I mentioned before an important
thing to remember with this is that the diagnosis is based on a grouping of
symptoms of the things that I've listed. So you need five of them and it's not
that anyone who's angry say has borderline personality disorder. Anyone
who's ever cut themselves must be borderline. It's about having multiple
things that fall into this category and having it present a problem for you in
many ways not just in one relationship. Number four is impulsivity in at least
two areas that are potentially self damaging. Some examples of this could be
reckless spending or reckless sexuality drug abuse or binge eating. Number five
would be recurrent suicidal behavior, gestures or threats or even
self-mutilating behavior. And this would be things like cutting yourself or
taking over doses of pills even though you don't really want to die you're just
responding to internal distress and that's why you're doing these things.
Number six would be an unstable, reactive mood and this would be things like
episodic low mood, irritability or anxiety that usually lasts a few hours
or a few days. And this is one of the key differences between borderline
personality and bipolar disorder and I'll expand on that after I get through
the criteria. Number seven is chronic feelings of emptiness. And this is one of
the reasons people with borderline personality disorder cut themselves it's
a coping mechanism to help them feel real. Some people will
cut themselves though to relieve tension. Number eight is inappropriate, intense
anger or difficulty controlling anger. And this can look like temper tantrums,
constant anger or physical fights. Number nine and the last one is transient
stress-related, paranoid ideation or severe dissociative symptoms. Clinicians
sometimes call these micro psychotic episodes. They're not full-blown
psychosis but they're close and if you don't know what
psychosis is I'll have a link for you in the corner that on a video where I have
talked about or defined psychosis but let me explain what dissociation is.
Dissociation happens when a person disconnects with their present situation
and this disconnection can be from the current environment or from their
thoughts or even from themselves and an example of this is a person who's been
subjected to repeated physical or sexual abuse and one of the ways they cope to
deal with the act at the time is just to mentally pull away as if it's not really
happening to them. And that's one of the ways that they can deal with getting
through it. Well with borderline personality disorder, dissociation
happens a lot in different circumstances. So that's the criteria for borderline
personality disorder. It's a lot of stuff and so it's not a matter of taking one
of these things out and saying I must be borderline because I cut myself, you need
to have at least five of these nine things that I just listed going on at
the same time or in general that's the kinds of things that you do or feel. So
back to borderline personality disorder and bipolar disorder they look very
similar because you can have the mood swings and impulsivity, but in the case
with borderline personality disorder you're more likely to have mood swings
that can shift from hour to hour over the course of the day. With bipolar
disorder the group of symptoms, not just low or high moods but
the group of symptoms that make up an episode need to last at least two weeks
if you're in the depressed state and one week if you're in the manic state. So you
aren't shifting in and out of states hour to hour. Also the sense of fear of
abandonment and unstable identity are things that have more to do with your
hardwiring and it's also influenced by your environment as well. It kind of goes
to the nature versus nurture Theory how much of who you are is based on genes
versus how you were raised in your formative years. And these issues are not
part of bipolar disorder. Think of mania as like a hurricane that swoops in and
swoops out and leaves the hot climate behind.
And some other examples of the practical differences is that bipolar disorder
does not make you do manipulative things. Manipulative behavior has to do with
your personality. Also people with who are manic or depressed at the time don't
engage in self-harm only because of their mood state. So if you get depressed,
the coping skills that you employ at the time have to do with your personality
and it's not the depression itself. So the depression may push you into doing
something that is self harming but it's your personality type or your
personality coping skills that reacts to the depression with self-harm.
The treatment for borderline personality disorder and bipolar disorder are very
different but they can overlap. The primary treatment for borderline
personality disorder is a psychotherapy called dialectical behavioral therapy or
DBT. It's an offshoot of cognitive behavior therapy that was developed
specifically for borderline personality disorder and when it's implemented by
someone trained in DBT it's very effective and it's usually a combination
of group and individual sessions. The primary treatment for bipolar disorder
is medication management. Sometimes the with the depressive episodes if they're
mild to moderate they can respond well enough to cognitive behavioral therapy.
But manic episodes usually require medication. People with borderline
personality disorder can still have a mood disorder, so you can have both
problems. So if a person with borderline personality disorder also becomes
depressed, then they may require medication to get through the depression.
Also sometimes the swinging moods that you can have with borderline personality
disorder can respond well to mood stabilizers even though it's not
considered bipolar disorder. So mood stabilizers are mood stabilizers and
they can help people with borderline personality disorder who have a lot of
mood shifts or intense anger but the reason you'd be using the the
mood stabilizer is to treat the mood instability that goes along with the
personality disorder and it doesn't mean automatically that you must have bipolar
disorder. So this can get confusing, there's a lot of nuances to this. That's
why the best treatment is really should be determined by a clinician who's
evaluated you. But the gist of it is that there is an overlap between borderline
personality disorder and bipolar disorder. Sometimes people with
borderline personality disorder would need the same kind of medication that a
person with bipolar disorder would need however bipolar disorder tends to be
more episodic like bad weather whereas borderline personality disorder
has a fairly consistent set of behaviors that go up and down in intensity and
that tend to hang around for a long time. That's it for this topic if you're new
to my channel it may seem a little disjointed with needing to go to other
videos to get more information and that is kind of by design because I don't
want to make these videos so epic in length that with all these definitions
and going through all these criteria and then it makes it hard, I mean it's hard
enough to go through the criteria just for one disorder. You see you had to read
through that long list, but I think the best way to get a good grasp on any of
these topics is to chunk it out in little pieces at a time. So that's why
I've developed playlists to help you for the various illnesses to kind of help
you get through them in a little bit by little bit and as I continue to make
more videos I'll continue to develop the playlist in a way that you can start
with one and just go through and have a more complete understanding of the
various psychiatric issues. Thanks so much for watching. Please share this
video with someone if you think they would benefit from it and feel free to
drop me a comment even if it's just to say hello. See you next time