BPD vs. Bipolar: 6 Key Distinctions for Better Treatment

An Important Note About Diagnosis

It’s natural to recognize parts of yourself when reading about these conditions. However, experiences of mental health conditions can overlap: What looks like bipolar disorder might be BPD,³ or vice versa. Sometimes people even experience both conditions together (also known as comorbidity).

Only a qualified mental health professional give you a proper diagnosis because they’ll look at your full history, not just current symptoms. They’ll want to understand your mood patterns over time, how your emotions typically shift, and what tends to trigger changes in how you feel.

If you’re concerned about your well-being, start by talking with your therapist or primary care doctor. They can refer you to a mental health specialist who has experience diagnosing and treating mood disorders. During your evaluation, be open about what you’re experiencing. The more information you share, the better equipped your provider will be to understand your situation and recommend effective treatment.

3. Daily Impact: How Each Condition Affects Functioning

Mood Patterns and Episodes

With bipolar disorder, moods typically shift between 2 primary states. During manic episodes, you might feel extremely energetic, need less sleep, talk faster, and take more risks than usual. During depressive episodes, you might have trouble getting out of bed, lose interest in activities you usually enjoy, and feel overwhelmed by sadness or hopelessness. These episodes often last weeks or months.

BPD’s emotional instability can entail more frequent and intense shifts: Happiness might suddenly turn to anger, or confidence might quickly become self-doubt. These changes are often connected to what’s happening in your life, especially in close relationships. You might feel things more deeply than others seem to, making both positive and negative emotions seem overwhelming.

Self-Image and Identity

People with bipolar disorder usually maintain a stable sense of who they are, though their self-confidence might change during manic or depressive episodes. During mania, they might feel invincible; during depression, they might feel worthless.

With BPD, your sense of self might feel less consistent. You might struggle to clearly understand who you are, what you value, or what you want in life. This can make it hard to set long-term goals or make decisions that feel true to yourself.

Relationships and Social Connections

In bipolar disorder, mood episodes can strain relationships. During mania, you might make impulsive decisions or become overly involved in others’ lives. During depression, you might withdraw from friends and family.

With BPD, relationships often feel unstable and intense. You might worry deeply about abandonment while also struggling to trust others. This can lead to a pattern of unstable relationships that become strained by conflicts or misunderstandings.

4. Root Causes: Biological vs. Environmental Factors

Let’s talk about what might contribute to these conditions. 

With bipolar disorder, genetics play a big role—if you have a family history of bipolar, you might be more likely to experience it yourself. Your brain’s structure and chemistry are key players too. While environmental factors like major stress or trauma can trigger symptoms, biological factors tend to be the stronger influence.

BPD often develops because of early life experiences,⁴ especially in your relationships with parents or caregivers. While genes play some role, the environment you grow up in usually matters more—things like childhood trauma, having unreliable parents, or dealing with long-term stress. People typically start noticing BPD symptoms as young adults, when the ways they learned to handle emotions and relationships start causing more problems in their lives.

For both conditions, understanding these causes helps guide treatment approaches. Bipolar disorder often responds well to medications that help stabilize brain chemistry, while BPD typically improves with therapy that helps you build new relationship skills and coping strategies.

5. Evidence-Based Approaches: Tailored Treatment Strategies for Each Condition

Even though bipolar disorder and BPD are different conditions, both have effective treatments that can help you feel better and manage symptoms. Let’s look at what works best for each:

For Bipolar Disorder

Mood stabilizers are usually the foundation of bipolar treatment. These medications help prevent extreme mood swings and make episodes less intense when they do occur. Your doctor might also recommend other medications, such as antipsychotics or antidepressants, to help with specific symptoms like depression or trouble sleeping.

Therapy is essential, too. A good therapist can help you:

• Stick to your treatment plan
• Spot early warning signs of mood episodes
• Develop strategies to manage stress
• Keep your relationships healthy during tough times

Lifestyle changes make a big difference. Regular sleep schedules, stress management, and avoiding alcohol and drugs can help prevent mood episodes. Many people find that tracking their moods, either with an app or in a journal, helps them notice patterns and stay more stable over time.

In some cases, people with bipolar might require inpatient treatment or hospitalization—especially if they’re at risk of self-harm or struggling to manage their emotions safely. A structured setting can offer stabilization, therapy, and support to help get symptoms under control.

For Borderline Personality Disorder

The most effective treatment for BPD is usually therapy, especially dialectical behavior therapy (DBT). DBT teaches practical skills for:

• Managing intense emotions
• Improving relationships
• Making decisions when emotions are high
• Dealing with stress without using self-destructive behaviors

Other types of psychotherapy, such as cognitive behavioral therapy (CBT), mentalization-based therapy (MBT), or schema therapy⁵ can also help. These approaches help understand your emotions and ways of thinking, and teach healthy emotional regulation and coping strategies.

Support groups can also be valuable. Connecting with others who understand what you’re going through helps you feel less alone. Some people also find that medication helps with specific symptoms like anxiety or depression, though it’s not usually the main treatment.

6. Dual Diagnosis: When Both Conditions Occur Together

Sometimes people experience both bipolar disorder and BPD⁶ at the same time. In fact, it’s somewhat common for these conditions to overlap—one study on the relationship between bipolar and BPD⁷ found:

• 20% of patients with BPD had bipolar disorder
• 20% of bipolar II patients had BPD
• 10% of bipolar I patients had BPD

This makes sense because both conditions affect how you feel emotions and relate to others, though in different ways. What makes this tricky is that the symptoms of bipolar and BPD⁸ are sometimes confused since they can seem similar on the surface.

Both conditions can include:

• Very strong emotions
• Problems with relationships
• Risky behavior during tough times
• Changes in how you feel about yourself

This is why getting a thorough evaluation from a mental health professional is so important. They can figure out if you’re dealing with one condition, both, or something else entirely. This helps make sure you get the right kind of help.

If you do have both conditions, they can be treated together. Your treatment team might combine approaches, like using medication to help with bipolar symptoms while doing therapy to build BPD coping skills. The key is having healthcare providers who communicate well with each other—and with you—about what’s working.

Safety Planning: Managing Crisis Moments

Life with bipolar disorder or BPD can have really tough moments, and both conditions are associated with suicidal behavior.⁹ Having a plan for these times is just as important as regular treatment.

A safety plan is like a roadmap for hard days. It includes:

• Activities that help you feel better
• People you can call when you’re struggling
• Ways to make your environment safer
• Professional support contacts
• Reasons to keep going

It’s a good idea to create this plan with your therapist or doctor when you’re feeling okay, so it’s ready when you need it.

If you’re contemplating self-harm or having suicidal thoughts, or if you need immediate support, 24/7 help is always available:

• Call or text 988 to reach the Suicide and Crisis Lifeline
• Text HOME to 741741 to reach the Crisis Text Line
• Call 911 if you’re in immediate danger

You can also visit the National Education Alliance for Borderline Personality Disorder (NEABPD) website for a comprehensive list of BPD support resources.¹⁰

Recovery From Bipolar and BPD: Building a Life Beyond Symptoms

Living with bipolar disorder or BPD can be challenging, but with the right support and treatment, many people with these conditions live fulfilling lives and achieve their goals. Everyone’s path looks different, and that’s okay.

Success often comes from:

• Finding healthcare providers you trust and feel comfortable with
• Building a support network of family, friends, and loved ones, as well as support groups
• Learning what triggers your symptoms and how to manage them
• Making small changes that add up to better stability over time
• Being patient with yourself as you learn and grow

Recovery isn’t about being “perfect” or never having symptoms. It’s about learning to manage challenges and improve your quality of life over time. Some people find their symptoms get much better with treatment, while others learn to thrive even with ongoing symptoms.

If you’re just learning about these conditions, take it one step at a time. Focus first on finding a mental health provider who can provide an assessment and explain your treatment options. Every step forward, no matter how small, matters.