The Borderline personality disorder and the bipolar disorder They are often confused, especially in diagnosis.
In a recent article by Fink (2014) we try once again to take stock of the differences, often not so evident, between the two disorders.
It is possible to identify some overlaps between the symptoms, but the psychopathological nucleus differs on some clear elements, even if some authors argue that they are both part of a continuum and some clinicians consider the borderline disorder like a bipolar disorder “with ultra -pord cycles” (Gunderson, 2006).
The borderline disorder It is a personological disorder and is therefore a persistent condition, present from the early adulthood for the entire duration of life, which influences the entire development of the emotional and behavioral structure of a person.
The bipolar disorder Instead, it is a set of symptoms of the mood of mood that occur in acute or subacuta form in one or more moments of life, but are not part of the central structure of the personality.
In addition, the symptoms superimposable as the difficulty in regulating impulsiveness and emotion, in borderline disorder are constant throughout the patient’s life span, while in bipolar disorder they are symptoms present in an episodic way and distance themselves from the usual character matrix of the person.
Let’s see specifically the superimposable symptoms.
The mood tone oscillations In borderline disorder they are more frequent and shorter, often triggered by an external event and described as an excessive emotional response than the proportions of the triggering event (a loss, a perceived refusal, a frustration).
During these episodes, which usually last a few hours or at most a few days, the person can experience strong emotions such as anger or sadness, or different degrees of irritability or anxiety. The oscillations of the mood in bipolar disorder are, however, more discontinuous and lasting and can present themselves unexpectedly.
For example, a depressive episode, to be such, must persist for at least two weeks and a obsessive episode for at least a week.
Irritability or anger They may be present both in depressive and maniacal (or hypomaniacal) episodes but are not part of the personality of the subject. The same applies to impulsive behaviors, which in borderline disorder are part of the personological nucleus and are expressed in the difficulty of managing potentially harmful behaviors, while in bipolar disorder are present only in manic or hypomaniacal periods.
For i Psychotic symptomsanother category that often leads to the overlap in diagnosis, in borderline disorder patients may have paranoid ideation or experimenting dissociative states, however maintaining the awareness that something “strange” is happening and rarely developing structured delusions or hallucinations. In bipolar disorder, however, real hallucinations and/or delusions are possible in every type of episode.
Finally, the diagnosis of borderline disorder requires the satisfaction of at least 5 of the 9 criteria in the DSM, and only 3 of them have a possible overlap with the bipolar disorder.
These differences are fundamental for the setting of the treatment, which obviously also differs.
Bipolar disorder, which for years has been considered mainly a biological disorder, is effectively treated with mood tone stabilizers or atypical antipsychotics. Like any mood disorder, it also benefits from effective psychotherapeutic treatments such as cognitive-behavioral therapy.
The research on borderline disorder suggests that psychotherapy is the treatment of election for the psychopathological nucleus of this disorder.
There Behavioral dialectical therapy (DBT) is one of the most studied and effective and finds its focus in the training of emotional and interpersonal skills that allow you to deal with problematic emotional states.
Today also other forms of cognitive behavioral therapy, such as the Therapy scheme or interpersonal metacognitive therapy, are integrated in order to maximize the effectiveness of the treatments.
Clinicians may have difficulty presenting a diagnosis of borderline disorderconsidering it worse or synonymous with an inauspicious prognosis, but patients and their families can instead judge useful to be informed about it.
Just as for bipolar disorder, an accurate diagnosis often determines a better prognosis and access to adequate treatments.
Resource
To download for free
- First chapter of the volume “overcoming the borderline personality disorder. Practical guide for family members, partners and clinicals” published by Centro Studi Erickson
Texts for deepening suggested
- Porr, V. (2020). Overcome the borderline personality disorder. Practical guide for family, partners and clinicals. Trento: Erickson Study Center
