Hi, I'm Dr. Tracey Marks,
a psychiatrist and I make mental health education videos.
Can you have bipolar disorder
and borderline personality disorder at the same time?
I've been asked this question several times,
and the answer is yes.
In fact, some people will refer to this as borderpolar.
And this isn't an official term,
but it's one coined by professionals in the field,
psychiatrists and therapists.
It's kind of like an inside term
used by people who keep up with the research on this issue.
So now you have some inside lingo.
I've explained in a previous video
the difference between borderline personality disorder,
which I'll call BPD, and bipolar disorder,
and you can watch this video for a longer explanation.
In that video, I considered borderline personality disorder
as your hard-wiring,
similar to the climate of the area where you live.
I compared bipolar disorder to a storm that comes in
and lasts for a period of time and then goes away.
The climate, or your hard-wiring
affects the kinds of storms that you have.
One of the key places that BPD and bipolar disorder overlap
is in the mood instability.
With BPD, you get rapidly shifting mood states
that last hours or a day,
whereas episodes of mania or depression
last for a minimum of four days for hypomania
and two weeks for depression.
Some experts have debated whether or not BPD
should really be part of the bipolar spectrum.
I talk about bipolar spectrum in this video.
But the latest reviews on this issue
have concluded that they're very distinct entities.
But what the latest research has shown
is that 20% of people have both disorders,
so 20% of people with bipolar disorder also have BPD,
and 20% of people with BPD also have bipolar disorder.
Now in medicine, 20% is still a low frequency,
it's less than half.
But even so, people who have both of these things
going on at the same time tend to have more severe illness.
They tend to have more mood episodes,
which means less time feeling stable
despite being on a good medication regiment.
They have an earlier age of onset of bipolar disorder,
more suicidality, either in attempts or thoughts,
more aggression and hostility,
more substance misuse,
more comorbid diagnoses.
This means co-occurring illnesses like PTSD and OCD.
People with both disorders tend to have
more unemployment and hospitalizations.
So what does it look like if you have both?
You have your episodes of depression and mania
that can come and go,
but then you can still have this level of distress,
sadness, or dissatisfaction with life
that doesn't seem to change,
even when your depression or mania have passed.
In fact, it may be hard to tell
if your depression or mania have passed
if you're still feeling emotionally unstable.
That can lead to overmedication.
Another thing you have to remember is that with BPD,
you get the fears of being rejected or abandoned
by people that you care about,
and this wreaks havoc on your relationships
as you test people or sabotage the relationship
to keep them from leaving you.
And this is behavior that you can have
even when you're not in a depression or mania.
Then add in the impulsivity and poor judgment of hypomania
that can cause you to make really bad decisions,
even worse than you would have made
if you had pure mania without the personality issues.
The feelings of emptiness really ramp up
if you crash into a depression,
and this is one of the reasons
why there tends to be more suicidality with borderpolar
than with either BPD or bipolar alone.
Using self-harm as a coping mechanism
is not really a feature of bipolar disorder,
but this can really get out of control
in a borderpolar person who's either depressed or manic.
So it can get complicated to recognize
the interplay of both problems.
For the clinician, a clue is probably
in how you are behaving in your relationships over time,
and we call this getting a longitudinal history.
The behavior that happens
within a depression or manic episode
tend to be more of a slice in time look
versus longstanding patterns of behavior
that you engage in over the course of your life,
even when you weren't depressed or manic.
That's something that your doctor
or therapist would consider
in determining whether you have both disorders.
Why does this matter?
It matters with the treatment you get.
The primary treatment for bipolar disorder
is medication first and therapy second.
Helpful therapies are social rhythm
and interpersonal therapy, cognitive behavior therapy,
psychodynamic therapy, and dialectical behavior therapy.
For borderline personality disorder,
the primary treatment is therapy first
and maybe medication if there's something else to treat,
like depression, anxiety, or ADHD, just to name a few.
The gold standard therapy
for borderline personality disorder
is dialectical behavior therapy.
So if you have both disorders,
you really need medication and DBT
or some other comparable therapy
for your borderline personality disorder.
Medication alone is probably not going to be enough,
and I think that's why we see more people with borderpolar
having poor treatment outcomes.
If you try and address the unstable view of self
and the relationship instability with medication,
you're not gonna get far.
Then the instability leads to more depressed
or angry emotions, emptiness,
hopelessness, suicidal thoughts,
and then really poor coping mechanisms like self-harm.
So that's borderpolar or the combination
of bipolar disorder and borderline personality disorder.
And this isn't the only combination
of disorders you can have.
You can have any personality disorder
along with bipolar disorder, anxiety,
unipolar depression, or even schizophrenia.
This combination has earned its own name
because of the similarities between the two disorders.
Thanks for watching.
I'll see ya next time.