Can You Have Borderline Personality Disorder and Bipolar Disorder?
Living with mental health challenges can be confusing, especially when symptoms overlap or change over time. If you or someone you care about has been diagnosed with borderline personality disorder (BPD), or bipolar disorder, or shows signs of both, you might wonder: can someone have both conditions at once?
The answer is yes. While BPD and bipolar disorder are separate diagnoses with different causes and treatments, about one in five people with one may also meet the criteria for the other. Understanding how these disorders intersect is key to getting the right diagnosis and support.
Understanding Both Disorders Individually
Borderline Personality Disorder (BPD)
Borderline personality disorder (BPD) is a mental health condition marked by ongoing patterns of instability in relationships, self-image, emotions, and impulsive behavior. It affects about 2.7% of the general population but is more commonly seen in mental health settings. People with BPD often struggle with intense fear of abandonment, unstable relationships, a shifting sense of identity, impulsive or risky behaviors, emotional ups and downs, and chronic feelings of emptiness. Other symptoms can include inappropriate anger, self-harm or suicidal behavior, and feeling disconnected from reality during stress.
To be diagnosed with BPD, a person must meet at least five of the nine criteria outlined in the DSM-5. Symptoms usually begin in early adulthood, though they may appear in adolescence. While BPD can be intense and disruptive, some symptoms may lessen over time, especially by a person’s 30s or 40s, though flare-ups can still occur.
Bipolar Disorder
Bipolar disorder is a mood disorder characterized by dramatic shifts in mood, energy, and activity levels. These shifts are far more severe than normal ups and downs and can significantly impair daily functioning. Bipolar disorder affects approximately 1.5% of the population. There are several types of bipolar disorder:
- Bipolar I Disorder: Defined by manic episodes lasting at least 7 days (or severe enough to require hospitalization) and depressive episodes typically lasting 2 weeks. Manic episodes may be so severe that they can include psychotic features.
- Bipolar II Disorder: Characterized by patterns of depressive episodes and hypomanic episodes (less severe than full mania).
- Cyclothymic Disorder: Periods of hypomanic and depressive symptoms lasting for at least 2 years, but not meeting full criteria for hypomanic or depressive episodes.
Bipolar disorder typically appears between ages 20-30, with women often showing symptoms around age 21 and men around age 23. More than 90% of people who experience a single manic episode will continue to have mood episodes throughout their lives, and about 60% will experience a major depressive episode immediately following a manic episode.
The Overlap – Similarities and Differences
Similarities Between BPD and Bipolar Disorder
It’s not surprising that these conditions are often confused or misdiagnosed, as they share several key symptoms:
- Mood instability: Both conditions involve significant mood changes
- Impulsive behavior: Risk-taking and poor decision-making during symptomatic periods
- Suicidal thoughts and behaviors: Increased risk in both disorders
- Relationship difficulties: Both conditions can strain interpersonal connections
- Substance abuse risk: Higher rates of substance use disorders in both populations
- Genetic components: Both have heritable aspects and often run in families
Key Differences That Distinguish the Disorders
Despite their similarities, important differences help distinguish these conditions:
| Feature | Borderline Personality Disorder | Bipolar Disorder |
|---|---|---|
| Mood changes | Last hours to days | Last days to months |
| Triggers | Often linked to relationships | Often caused by stress or come without a clear reason |
| Sleep patterns | Can vary, but not a key sign | Less sleep during mania, more during depression |
| Self-image | Often unstable and changes a lot | Changes depending on mood episodes |
| Fear of abandonment | Very common and central to the disorder | Not a main symptom |
| Treatment focus | Mainly treated with talk therapy | Mainly treated with medication |
Perhaps the most significant difference is the pattern and timing of mood shifts. In BPD, emotional changes are often rapid, intense, and triggered by interpersonal stress—they may last hours or days. In bipolar disorder, mood episodes are typically longer, lasting weeks or months, and may occur without obvious external triggers.
Dual Diagnosis – “Borderpolar”
The term “borderpolar” is an informal way to describe individuals diagnosed with both borderline personality disorder (BPD) and bipolar disorder. Although not an official medical term, it highlights the unique challenges of this dual diagnosis. Research shows that about 20 percent of people with either condition also meet the criteria for the other. While some have debated whether BPD falls within the bipolar spectrum, most experts agree that they are separate but often co-occurring disorders that require tailored treatment approaches.
Diagnosis and Assessment
Challenges in Differential Diagnosis
Diagnosing borderline personality disorder and bipolar disorder can be difficult, especially when both are present. Studies show that misdiagnosis is common, with up to 40 percent of people with BPD first diagnosed with bipolar disorder, and vice versa. This confusion often happens because the two conditions share symptoms like mood swings, impulsivity, intense emotions, and suicidal thoughts. Sometimes, one disorder can hide the signs of the other, and not all clinicians are equally familiar with both, making accurate diagnosis even harder.
Diagnostic Process
Proper diagnosis requires a comprehensive approach:
- Thorough psychiatric evaluation: Detailed history-taking with attention to symptom patterns, triggers, and duration
- Longitudinal observation: Monitoring symptoms over time to identify patterns
- Structured clinical interviews: Using validated diagnostic tools like the SCID or DIB-R
- Mood charting: Tracking mood shifts and potential triggers
- Family history assessment: Noting patterns of mental health conditions in relatives
- Collateral information: Input from family members or close friends (with patient permission)
When assessing for a possible dual diagnosis of BPD and bipolar disorder, clinicians focus on the timing and duration of mood episodes, whether mood shifts are triggered by relationships or occur on their own, the presence of true manic symptoms, family history of either condition and how the person has responded to past treatments.
Treatment Approaches for Dual Diagnosis
Effective treatment for co-occurring BPD and bipolar disorder requires addressing both conditions simultaneously with an integrated approach.
Psychotherapy Options
Psychotherapy forms the cornerstone of treatment for BPD and plays an important supportive role in bipolar disorder management. For dual diagnosis, several approaches have shown promise:
- Dialectical Behavior Therapy (DBT): Considered the gold standard for BPD, DBT helps build skills in emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness—all valuable for managing both conditions.
- Cognitive Behavioral Therapy (CBT): Effective for both disorders, CBT helps identify and change negative thought patterns and develop coping strategies.
- Schema-Focused Therapy: Addresses early maladaptive schemas and coping styles that maintain symptoms.
- Systems Training for Emotional Predictability and Problem Solving (STEPPS): A group treatment that combines cognitive-behavioral elements with skills training.
- Family therapy: Educates families about both conditions and improves communication patterns.
Medication Strategies
Medication management for dual diagnosis requires careful consideration:
- Mood stabilizers: Lithium, valproate, lamotrigine, and carbamazepine can help stabilize mood in bipolar disorder and may help with affective instability in BPD.
- Atypical antipsychotics: Can help manage both acute mania in bipolar disorder and cognitive-perceptual symptoms in BPD.
- Antidepressants: Used cautiously due to the potential for triggering mania or hypomania; may help with depressive symptoms.
- Anti-anxiety medications: Used judiciously for short-term management of severe anxiety, with careful monitoring for dependency.
Medication alone is typically insufficient for BPD but is essential for bipolar disorder. The combination of appropriate medication and psychotherapy offers the best chance for symptom improvement in dual-diagnosis cases.
Intensive Treatment Options
Due to the severity of symptoms often seen in dual diagnosis, more intensive levels of care may be needed:
- Partial hospitalization programs: Structured daytime treatment while living at home
- Intensive outpatient programs: Several therapy sessions per week
- Residential treatment: For those needing 24-hour support
- Inpatient hospitalization: For acute crisis, suicidality, or severe symptom exacerbation
Living Well with Both Conditions
Despite the challenges of managing both BPD and bipolar disorder, recovery and a fulfilling life are possible with proper treatment and support.
Self-Management Strategies
Individuals with both conditions can benefit from:
- Consistent routine: Regular sleep, meal, and activity schedules help stabilize mood
- Stress management: Techniques like mindfulness, deep breathing, and progressive muscle relaxation
- Mood tracking: Identifying patterns and triggers to intervene early
- Building a support network: Connecting with understanding friends, family, and support groups
- Developing a crisis plan: Knowing what to do when symptoms worsen
- Medication adherence: Taking medications as prescribed, even when feeling well
- Avoiding substance use: Alcohol and drugs can worsen symptoms and interfere with treatment
Recovery and Prognosis
Although both BPD and bipolar disorder are long-term conditions, symptoms can improve greatly with the right treatment. BPD often becomes less intense over time, especially with therapy, and many people see major progress by their 30s or 40s. Many bipolar patients can manage their symptoms effectively through a combination of medication and healthy lifestyle habits, which helps them maintain more stable periods. When both disorders are present, recovery may take longer and require more support, but with accurate diagnosis, proper treatment, and ongoing care, improvement is very possible.
Special Considerations
Substance Use and Dual Diagnosis
Substance use disorders are more common in people with BPD or bipolar disorder, and the risk is even higher when both conditions are present. Substance use can worsen symptoms, reduce the effectiveness of medication, trigger mood episodes, and make treatment more difficult. For those with a dual diagnosis, integrated care that treats both mental health and substance use at the same time is essential for recovery.
Trauma and Its Connection
Trauma, especially in childhood, is strongly linked to both BPD and bipolar disorder. Many people with BPD report histories of abuse or neglect, and early trauma can play a role in emotional regulation difficulties. Trauma-focused therapies can be helpful, but it’s important to first establish safety and stability before directly addressing traumatic experiences.
Suicide Risk and Prevention
Having both BPD and bipolar disorder greatly increases the risk of suicide, making careful monitoring and prevention essential. Warning signs that need immediate attention include talking about wanting to die, feeling hopeless, searching for ways to end one’s life, increased substance use, reckless behavior, social withdrawal, and extreme mood swings.
Conclusion
Living with both borderline personality disorder and bipolar disorder can be overwhelming, but understanding the differences, similarities, and treatment options is a powerful first step toward healing. With the right diagnosis and a personalized, integrated treatment plan, individuals can manage their symptoms, build healthier relationships, and lead fulfilling lives. While the journey may require extra support and patience, recovery is possible.
If you or a loved one is struggling with symptoms of BPD, bipolar disorder, or both, Rego Park Counseling is here to help. Our experienced team provides compassionate, evidence-based care tailored to your unique needs. Contact us today to schedule a confidential consultation and take the first step toward lasting support and meaningful change.
FAQs
Can you have borderline and bipolar at the same time?
Yes, you can have both borderline personality disorder and bipolar disorder simultaneously, which occurs in approximately 20% of bipolar disorder patients and is sometimes informally referred to as “borderpolar” by mental health professionals.
What is the hardest mental illness to live with?
There’s no definitive “hardest” mental illness as the experience varies greatly between individuals, but conditions that combine mood instability with interpersonal difficulties—such as bipolar disorder combined with personality disorders—are often considered among the most challenging due to their comprehensive impact on daily functioning.
Can someone with BPD be happy?
Yes, people with borderline personality disorder treated with evidence-based approaches like dialectical behavioral therapy and appropriate support systems can absolutely experience happiness and build fulfilling lives, despite the emotional challenges they face.
Is it possible to have both BPD and DPD?
Yes, it’s possible to have both BPD and Dependent Personality Disorder concurrently, as personality disorders often overlap with anxiety disorders and other conditions, though understanding the specific risk factors involved helps in creating effective treatment plans.
How is BPD different from major depressive disorder?
While both conditions can involve intense sadness, BPD is characterized by rapidly shifting emotions, fear of abandonment, and unstable relationships, whereas major depressive disorder involves persistent depressed mood and loss of interest lasting at least two weeks, with different treatment approaches required for each.