Borderline Personality Disorder (BPD) and Bipolar Disorder (BD)

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In general terms:

  • Bipolar I:
    • is characterized by at least one manic episode, followed by a hypomanic or a major depressive episode.
    • is also sometimes characterized by “psychotic breaks,”
    • typically causes greater destruction in the patient’s life than bipolar II.
  • Bipolar II:
    • is characterized by at least one major depressive episode lasting at least two weeks and at least one hypomanic episode lasting at least four days (NOTE: for bipolar II, the patient must not have experienced a manic episode).
  • BPD is a personality disorder, and (like all personality disorders) the effects of BPD are pervasive and effect virtually all relationships in the patient’s life
  • On the other hand, a patient suffering from BD typically has more control over who sees them with a dysregulated mood.
  • BPD is an ego syntonic disorder, meaning the distorted thoughts and emotions that fuel the symptoms of borderline feel like a natural part of the patient’s gross mind
  • Bipolar Disorder is an ego dystonic disorder, meaning the patient is at least partially aware that some of their thoughts and mood states and behaviors are problematic or even dangerous.

Additional Differences Between BPD and Bipolar Disorder

The ego syntonic nature of BPD makes it a seriously treatment resistant disorder, which in part explains why the “good outcome rate” for BD is superior to that of BPD.

The primary reason treatment for BPD fails is noncooperation and noncompliance with treatment on the part of the patient, while patients in treatment for BD are typically far more aware of their symptoms and typically  collaborate with their doctors.

As Dr. Parker Wilson recently said, BPD is “a disease that tells someone they don’t have a disease,” and thus the patient angrily blames their afflicted thoughts and emotions on the people, places, and things around them.

Both BPD and BD are treated with mindfulness based interventions:

  • For BPD the gold standard of care is dialectical behavior therapy (DBT).
  • For BD I and II the gold standard of care is mindfulness based cognitive therapy (MBCT) in combination with other cognitive and existential humanistic psychotherapies 

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