Borderline personality disorder (BPD) is a mental health disorder characterized by intense mood swings, impulsive behaviors, fear of abandonment, and unstable personal relationships. People with BPD often engage in self-harming behaviors like cutting or suicidal threats or attempts. They may also have other mental health issues like depression, anxiety, eating disorders, and substance abuse.
Because the symptoms of BPD can look like other mental health disorders, it is often misdiagnosed. Getting an accurate diagnosis is important so that the person can receive the right treatment. Here we will discuss what BPD is commonly mistaken for.
Depression
Depression and BPD share some similar symptoms like sadness, emptiness, anger, and suicidal thoughts or behaviors. The main difference is that in depression these feelings persist over weeks, months or years. In BPD, mood swings between depression, irritability, and anxiety can happen over the course of a day or even a few hours.
People with BPD tend to have very unstable interpersonal relationships characterized by intense idealization and devaluation. They fear abandonment and can react strongly when relationships end. These relationship patterns are typically not seen in depression.
How depression is treated vs BPD
Depression is commonly treated with antidepressant medication and psychotherapy like cognitive behavioral therapy (CBT). While these may be used for BPD as well, dialectical behavior therapy (DBT) is considered the gold standard. DBT helps people learn distress tolerance, emotion regulation, and interpersonal effectiveness skills.
Bipolar Disorder
Bipolar disorder causes extreme mood episodes from very high (mania) to very low (depression). BPD also involves intense mood swings, so it may look similar to bipolar, especially bipolar II which has more depression than mania.
Some key differences:
- In bipolar disorder, the mood episodes last for days or weeks. BPD mood swings happen much faster over hours or days.
- BPD causes a wider range of moods like anger, irritability, and anxiety in addition to depression. Bipolar depression tends to be more one-dimensional.
- People with bipolar often have periods of normal mood in between episodes. BPD mood issues are more chronic.
- BPD causes significant relationship issues which is not typical of bipolar disorder.
Bipolar treatment vs BPD treatment
Bipolar disorder is treated with mood stabilizers like lithium as well as antipsychotic meds in some cases. These drugs are not very effective for BPD. Again, DBT psychotherapy tends to be the best treatment for BPD.
Generalized Anxiety Disorder (GAD)
GAD involves frequent and excessive worrying that is very difficult to control. BPD can cause anxiety as well, so they may look similar at first glance. However, there are some clear differences.
In GAD:
- The anxiety persists steadily over time.
- The main focus is on worrying and feeling tense.
- Relationships are not significantly impacted.
In BPD:
- The anxiety comes and goes in response to interpersonal stress.
- There are drastic mood swings between anxiety, anger, sadness, etc.
- Unstable relationships and fear of abandonment are prominent.
GAD treatment vs BPD treatment
GAD is commonly treated with anti-anxiety meds like SSRIs or benzodiazepines and CBT therapy. Like the other disorders, BPD requires therapy like DBT that focuses on emotion regulation and relationships rather than just anxiety reduction.
Post-Traumatic Stress Disorder (PTSD)
PTSD involves re-experiencing traumatic events through flashbacks, nightmares or intrusive thoughts. Being exposed to trauma is common in people with BPD. However, there are some differences between the two:
- In PTSD, symptoms are a direct response to a traumatic event. BPD is pervasive instability in mood, relationships, and identity.
- PTSD does not involve the extreme emotional swings found in BPD.
- Impulsiveness and reckless behaviors are characteristic of BPD but not PTSD.
PTSD treatment vs BPD treatment
PTSD psychotherapy focuses on processing trauma memories and managing fear and anxiety about the events. BPD treatment uses DBT to build life skills for handling emotions, relationships, and impulsive behaviors in day-to-day life.
Eating Disorders
Eating disorders like anorexia, bulimia, and binge eating involve extreme thoughts and behaviors around food, weight, and body image. People with BPD often have issues with body image as well and may develop disordered eating habits.
However, there are some differences:
- Eating disorders cause specific thoughts and behaviors focused on food, weight, calories etc. BPD is associated with more general impulsiveness and emotional instability.
- People with eating disorders are often isolated and withdrawn. Those with BPD fear abandonment and desperately try to avoid rejection.
Eating disorder treatment vs BPD treatment
Eating disorders are treated by helping the person normalize their eating patterns, manage false beliefs about body image, and address the underlying emotional issues. BPD treatment is broader and focuses on building skills for emotional and interpersonal regulation in all areas of life.
Conclusion
Borderline personality disorder is complex and often looks like other mental health conditions like depression, bipolar disorder, anxiety disorders, PTSD, and eating disorders. While it may share some similar symptoms with these, there are important differences in the pervasive instability of moods, relationships, impulsivity, and sense of self that set BPD apart.
Getting an accurate diagnosis of BPD is important because it requires specialized psychotherapy treatment like DBT. Medications may be used to treat co-occurring depression or anxiety, but they do not address the core BPD issues. Ongoing DBT skills training can teach people how to handle their emotions, control impulses, and improve relationships.
| Disorder | How it’s different from BPD | Treatment approach |
|---|---|---|
| Depression | – More persistent low mood – Lack of relationship issues |
Antidepressants, CBT |
| Bipolar Disorder | – Distinct manic highs – Mood episodes last weeks – Normal periods between episodes |
Mood stabilizers, antipsychotics |
| Generalized Anxiety Disorder | – Constant worrying – More focus on anxiety – Minimal relationship disruption |
Anti-anxiety meds, CBT |
| PTSD | – Direct response to trauma – Lack of emotional volatility – Less impulsiveness |
Trauma processing psychotherapy |
| Eating Disorders | – Specific thoughts/behaviors about food/weight – Social isolation |
Normalize eating, address emotional issues |