Then in December 2019, Godfrey received an additional diagnosis: borderline personality disorder (BPD). According to People, Godfrey felt relieved to finally have an answer for symptoms — such as relationship instability, feelings of worthlessness or emptiness, and issues with controlling impulsiveness and temper — which persisted despite the treatment she was receiving at the time. Godfrey told People that cognitive behavioral therapy (CBT), medication, and a strong personal support system have helped her become “happy and healthy.” Godfrey shares her story to help others with similar mental health issues and advocate for accessible treatment.
Borderpolar, Explained
So what is borderpolar? First, borderpolar is a term, not a diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders. It’s a shorthand description for individuals like Godfrey who have been diagnosed with both bipolar disorder and BPD. Despite it being unofficial, borderpolar has gained traction in the medical field, says Mark Zimmerman, MD, a professor of psychiatry and human behavior at Brown University and the director of outpatient psychiatry and the partial hospital program at Rhode Island Hospital in Providence. (Dr. Zimmerman is often credited with helping coin the term.) The reason for the growing interest? It’s not uncommon for health professionals to see people who have been diagnosed with both bipolar disorder and BPD. According to research published in Dialogues in Clinical Neuroscience that Zimmerman co-authored, an estimated 20 percent of people diagnosed with one of these conditions have the other, too. In some cases, however, accidental misdiagnosis can happen, especially with BPD. For instance, someone with BPD may receive additional diagnoses, such as bipolar disorder, before receiving the correct diagnosis of BPD. In fact, one study published in the Journal of Psychiatric Research showed that 40 percent of people who were correctly diagnosed with BPD were initially misdiagnosed with bipolar disorder type 2. Accidental misdiagnosis sometimes happens because bipolar disorder and BPD have some overlapping symptoms. Because of this, doctors often need to observe symptoms over time across multiple visits to make the correct diagnosis.
What Is Bipolar Disorder?
To recognize the signs of borderpolar, it’s important to know the similarities and differences between bipolar disorder and BPD. Bipolar disorder causes extreme mood swings, ranging from euphoric emotional highs to deep depressive lows. Symptoms vary by the type of mood episodes an individual experiences. According to the Mayo Clinic, manic episodes and hypomanic episodes (less severe versions of manic episodes) cause a person to feel abnormally happy, upbeat, irritable, or energetic. Other signs of manic and hypomanic episodes include:
Abnormal talkativenessGrandiosity, or an exaggerated sense of self-confidenceDecreased need for sleepRisky or impulsive behavior, such as shopping sprees, gambling, or unsafe sexRacing thoughts
In contrast, a depressive episode is marked by deep sadness, emptiness, or hopelessness, experts at the Mayo Clinic report. Other signs of a depressive bipolar episode are:
FatigueInability to sleep or oversleepingLoss of interest in activities that an individual used to find enjoyableRestlessness or slowed movementsSignificant, unintentional weight gain or weight lossSuicidal thoughts or behaviors
What Is Borderline Personality Disorder?
BPD affects the way an individual views themselves and others, leading to difficulties managing their emotions and behaviors, and trouble maintaining stable, healthy relationships. The signs of BPD, per the Mayo Clinic, are:
Bouts of paranoia related to stress and loss of touch with realityExtreme fear of abandonment or rejection and problems coping with being aloneHabitually having unstable, intense, or explosive relationshipsIntense and inappropriate anger, including loss of temper and physical fightsImpulsive or risky behaviors such as gambling, drug abuse, or unsafe sexPersistent feelings of emptinessQuick changes in self-image, including viewing oneself as bad or as if they don’t existSabotaging one’s own successes, such as quitting a new jobSuicidal thoughts or behaviors
Borderline Personality Disorder and Bipolar Disorder: How They’re Alike and How They Differ
Researchers have aimed to pinpoint how these conditions differ from one other since their symptoms overlap, says Zimmerman. Both disorders, he says, are associated with:
Engaging in risky or impulsive behaviors, such as gambling or reckless sexExtreme mood changesImpaired ability to function in daily lifeFrequently seeking psychiatric helpLow self-esteem (most apparent with depressive episodes among people with bipolar disorder)Substance use disordersSuicidal thoughts or behaviors
Where they differ, Zimmerman says, is when and why certain behaviors occur. For instance, people with BPD tend to engage in risky behaviors such as gambling or unsafe sex as a means of coping with sadness, anger, or emotional pain. However, people with bipolar disorder most often engage in these behaviors if they’re having a manic or hypomanic episode but not during a depressive episode when they’re feeling sad or empty. “If an individual with bipolar disorder engages in those behaviors only in the context of a manic or hypomanic episode, I would not count that as an indicator of BPD,” Zimmerman explains. “But if the person engages in the behavior in those contexts of mania and also when they’re upset because, for example, a relationship is not going well or they’re upset for some other reason, and the behavior is their usual way of managing or regulating their negative emotional state, then I would view that as being more consistent with a feature of BPD.” How long one’s extreme mood fluctuations last is another key difference between bipolar disorder and BPD. According to the American Psychiatric Association (APA), mood swings related to bipolar disorder happen in the form of episodes, which occur in distinct intervals of days to weeks at a time. However, mood swings related to BPD tend to be quicker, lasting several hours to a few days, per Mayo Clinic.
Why Is Borderpolar Hard to Recognize?
It’s unlikely you’ll be diagnosed with both bipolar disorder and BPD at the same time. Being diagnosed with one disorder before the other, as in Godfrey’s case, is a common experience for people with borderpolar. In other cases, individuals who have only one of these conditions are sometimes misdiagnosed with the other first. Again, this is because bipolar disorder and BPD share similar symptoms. As a result, one disorder often masks the other, making it difficult for doctors to recognize both at the same time, says neuropsychologist Sanam Hafeez, PsyD, the director of Comprehensive Consultation Psychological Services and a faculty member in Columbia University’s PhD program in clinical psychology in New York City. Furthermore, bipolar disorder is often diagnosed first among people with both conditions. This makes BPD more challenging to detect since its symptoms are often mistakenly attributed to bipolar disorder, adds Dr. Hafeez. “However, with time and treatment for one disorder, the presence of the other can become clearer,” Hafeez says.
How Is Borderpolar Treated?
It can be tricky to treat, but it’s definitely not impossible, says Hafeez. Although the term “borderpolar” reflects the combination of bipolar disorder and BPD, if someone does have both conditions, they need to be treated as separate health conditions. The good news is that with proper treatment, people with the coexisting conditions live successful, happy, and fulfilling lives.
Treatment for Bipolar Disorder
People with bipolar disorder are prescribed medications such as mood stabilizers to reduce the frequency, intensity, and persistence of bipolar disorder symptoms, as well as the risk of future mood episodes, Zimmerman says. Psychotherapy is another common treatment for bipolar disorder, according to the APA. Therapies that can be particularly helpful for people with bipolar disorder, per the National Alliance on Mental Illness, are:
CBT In CBT, people with bipolar disorder learn to identify triggers for mood episodes and learn to manage those episodes with healthy thinking and behavioral patterns.Interpersonal and social rhythm therapy (IPSRT) IPSRT teaches individuals to reduce their exposure to stressful triggers and help regulate their symptoms by establishing daily routines, such as eating meals at regular times, going to bed, and waking up at the same time each day.
Hospitalization is sometimes necessary to treat people with bipolar disorder who have manic episodes, says Hafeez. “Manic episodes that go along with bipolar disorder combined with the suicidal tendencies sparked by BPD can cause a person to attempt to take their life and are very dangerous,” she warns.
Treatment for Borderline Personality Disorder
The first-line treatment for BPD is psychotherapy (aka talk therapy), according to experts at the National Institute of Mental Health (NIMH). Dialectical behavioral therapy, the most common psychotherapy for BPD, helps individuals learn how to manage intense emotions, better their relationships, and decrease any self-destructive behaviors. Currently, no medications are approved by the Food and Drug Administration to treat BPD. But sometimes doctors prescribe medication to help manage certain symptoms of BPD, such as mood swings or depression, per the NIMH.
Additional Ways to Cope
Self-care is anything you do to better your health and wellness, and it plays a key role in keeping bipolar and BPD symptoms in check. Steps you might take:
Go to sleep and wake up at the same times every day. Maintaining a consistent sleep schedule helps manage the symptoms of both disorders.Eat a healthy diet rich in fruits and vegetables.Exercise.Try mindful meditation to help manage stress.Use a mood journal or a mood tracking app to write down your symptoms and show them to your doctor as needed.Learn about bipolar disorder and BPD so you can recognize symptoms and triggers in yourself and make informed choices about your treatment.Understand your risk for comorbid mental health disorders. People with bipolar disorder or BPD have an increased risk of other comorbid conditions, including substance use disorders, anxiety disorders, and eating disorders, Zimmerman says.Avoid drugs and alcohol. These substances can worsen both bipolar and BPD symptoms.
