There is considerable overlap between borderline personality disorder (BPD) and bipolar disorder (also known as manic-depressive disorder), and quite a bit of misdiagnosis. The core characteristic of bipolar disorder is mood shifts that swing from extremely low (depression) to extremely high (mania). Manic episodes are periods of extreme energy, euphoria, or irritability that persist continuously for several days to several weeks and lead to extremely erratic or high-risk behaviors. Sometimes individuals with bipolar disorder shift between these extremes within a few days (called “ultra-rapid cycling” or “ultradian” bipolar disorder) and sometimes episodes are separated by many months or years. A person affected by bipolar II disorder has hypomanic episodes (less-intense elevated moods) but not full-blown manic episodes. Individuals with bipolar disorder tend to have high levels of conflict in intimate relationships, and researchers have found that they tend to cope ineffectively with critical and intrusive comments from others, for example by attacking back. People with BPD may also experience large mood swings, emotional sensitivity, and interpersonal conflict, but research suggests that they are more likely to have problems with anger, aggression, and nonsuicidal self-injury, and less likely to have extended periods of extreme euphoric energy. Study have reported that fewer than half the patients previously diagnosed with bipolar disorder by a mental health professional received a diagnosis of bipolar disorder when assessed with a standardized and validated psychiatric diagnostic interview. Most often, patients get a diagnosis of bipolar disorder when a diagnosed of BPD is warranted. This problem is even worse for adolescents because many mental health professionals believe, falsely, that they are not permitted to diagnose adolescents with BPD. Therefore, it is smart to ensure that you receive an accurate diagnosis because the recommended medications sometimes cause serious physical side effects.
A handful of studies have found that adding skills-focused problem-solving Cognitive Behavioral Therapy to standard medication treatment substantially reduces depressive and manic episodes. These treatments are very similar to DBT. One such therapy, Family-Focused Therapy (FFT), utilizes communication skills training and other strategies to improve relationships with family members and relationship partners. In one study, adding FFT to medications reduced 2-year relapse rates to 28%, and reduced psychiatric hospitalization to 12%. In contrast, 60% of the bipolar patients who received medications and minimal psychotherapy relapsed and returned to the hospital in the same 2-year period. All effective psychotherapies for bipolar studies get the patient to maintain consistent times for daily routines for all major activities including sleep, exercise, and eating. Studies have found that manic episodes are often triggered by life events that change sleep-wake habits (e.g., changing time zones due to air travel). Going to bed and waking at the same times, even during weekends, is considered the most important routine, in addition to medications, to reduce biological vulnerability to stress. FFT has many similarities to Dialectical Behavior Therapy. DBT also focus on improving interpersonal skills and problem-solving, and reducing biological vulnerability to stress. There is currently no evidence that bipolar disorders and BPD need different psychotherapies. Although many research studies have confirmed that medications are an effective part of the treatment of bipolar disorder, over the course of a year depressive and manic episodes recur for about half of bipolar I patients on these medications, and only about one-fourth have long periods of minimal symptoms and high functioning.
We utilize these treatment books by David Miklowitz: