Raise your hand if you knew that bipolar disorder and borderline personality disorder have significant similarities 🙋🏾♀️
Even after eight years of working as a psych NP, I recently realized how tough it can be to distinguish bipolar vs borderline personality disorder. The overlap between these two disorders is more significant than most providers expect.
Why Does It Matter?
Accurate diagnosis is critical. If you’re unsure whether it’s bipolar disorder or borderline personality disorder, you may end up recommending the wrong treatment path. And when treatment doesn’t align with the underlying disorder, patients often don’t get better.
Different Diagnoses, Different Treatments
Here’s a simplified breakdown:
- Bipolar disorder is primarily treated with medications. (If you want a deeper dive into pharmacologic treatment, check out our Mental Disorders Crash Course.)
- Borderline personality disorder is not typically treated with medications. The gold standard is therapy, especially Dialectical Behavioral Therapy (DBT). In these cases, your role as a PMHNP may involve referring your patient to a DBT-trained therapist rather than managing symptoms with meds.
Shared Symptoms Add to the Confusion
So what makes bipolar vs borderline so confusing?
Both may present with:
- Depression
- Impulsivity
- Suicidality
- Hyperactivity
- Brief psychotic symptoms
But the patterns of these symptoms are different. For example, mood swings in bipolar disorder tend to occur over longer periods (days to weeks), while those in borderline personality disorder may change rapidly throughout the day. The timing, triggers, and duration of emotional shifts are important clinical clues.
For a deeper overview of how bipolar disorder is diagnosed, check out this Mayo Clinic resource on bipolar disorder.
Strengthen Boundaries for Clearer Diagnosis
When you’re navigating bipolar vs borderline, clinical clarity isn’t just about symptom recognition—it’s also about relationship dynamics. Patients with borderline personality disorder often test interpersonal boundaries, which can cloud your objectivity and increase diagnostic uncertainty.
This blog post on setting boundaries with BPD patients offers practical tips to help you stay grounded in your clinical role. Strong boundaries aren’t just helpful—they’re diagnostic tools that keep you focused on what’s therapeutic vs. reactive.
Get More Free Training
If you want to dig deeper into differentiating mental health diagnoses and build more confidence in your assessments, diagnosis, and treatment I created a free training you can sign up for free here:
👉 Free Master Mental Health training
