Can there be a Dual Diagnosis of Bipolar Disorder and Personality Disorder?

Mental health has been gaining prominence in recent times as people are opening up about various conditions that affect their daily lives. There are many new mental conditions that have come to fore and new research has further revealed many aspects of mental disorders that were unknown before. Often people suffering from one mental disorder tend to wonder if it is possible for them to be afflicted with another mental condition at the same time. Indeed it is. Recent research has revealed that people suffering from borderline personality disorder (BPD) frequently also suffer from other psychiatric disorders. This is known as a co-occurring or comorbid disorder.

Borderlines are particularly vulnerable to such kinds of co-occurring disorder due to their genetic makeup. Most often, people having borderline personality disorder also get diagnosed with bipolar disorder. While bipolar disorder is characterized by a whole range of rapid mood swings, borderline personality disorder (BPD) is a personality disorder that is characterized by unstable behavior, mood, and self-image. Let us take a look at both these conditions and how a dual diagnosis is very much possible.

What is Borderline Personality Disorder?

Let’s briefly discuss the main aspects of borderline personality disorder (BPD) in order to understand how it is possible for many people to have a dual diagnosis of both borderline personality disorder (BPD) and bipolar disorder. Borderline personality disorder (BPD) is a condition that borders between neurosis and psychosis. It is characterized by a prevalent pattern of instability in behavior, interpersonal relationships, moods, and self-image. This is in contrast to the distinct episodes of mood swings between mania and depression in people having bipolar disorder. People having BPD experience overly strong emotional responses when faced with upsetting events and also try to hurt themselves. People having borderline personality disorder (BPD) are at a higher risk of having other mental issues as well and they are also prone to having eating disorders, addictions, anxiety, panic attacks, etc.

What is Bipolar Disorder?

Bipolar depression is characterized by chronic episodes of mood fluctuations between mania (full of energy and excitement) and depression. These mood swings tend to impact the person’s ability to function through their daily activities. Each alternating period of depression and mania can last from a matter of days to several months. Sometimes, there are episodes having ‘mixed features’, in which symptoms of mania and depression occur at the same time. People suffering from bipolar disorder need lifelong treatment in order to manage their symptoms.

Can there be a Dual Diagnosis of Bipolar Disorder and Personality Disorder?

Can there be a Dual Diagnosis of Bipolar Disorder and Personality Disorder?

Arriving at the correct diagnosis of psychiatric conditions can be tricky. When people suffer from co-occurring disorders, what tends to happen is that the doctor diagnoses the comorbid disorder accurately, but often tends to miss the borderline diagnosis. It then becomes quite difficult to treat one disorder if the borderline personality disorder is not treated correctly and in a timely manner. On the other hand, in order to treat borderline personality disorder, the other comorbid disorder needs to be treated correctly as well. Therefore, unless until both borderline personality disorder and bipolar disorder are treated together, the treatment for either will not show any effect. Apart from bipolar disorder, conditions that most commonly co-occur with borderline personality disorder include substance abuse, post-traumatic stress disorder (PTSD), bulimia or other eating disorders, anxiety disorders, and attention deficit hyperactivity disorder (ADHD).

Many of the symptoms of borderline personality disorder and bipolar disorder tend to overlap, particularly with type 1 bipolar disorder, which is characterized by intense mania episodes. Some of the symptoms that are shared between these two conditions include:

  • Impulsive behavior or actions
  • Suicidal behavior
  • Extreme emotional reactions

There is another school of thought which says that borderline personality disorder is actually a part of the bipolar spectrum itself. However, a majority of researchers treat these two disorders as being separate.

The other issue is that often these two conditions are mistaken for one another. As per a recent review on the relationship between bipolar disorder and borderline personality disorder, it was discovered that nearly 20 percent of people suffering from type 2 bipolar disorder were diagnosed to have borderline personality disorder, while ten percent of people having type 1 bipolar disorder were given a diagnosis of borderline personality disorder.

According to experts, these two disorders have to be looked at on the whole. This will ultimately help in determining whether you have one of the conditions with tendencies of the other, or if you have both the conditions at the same time.

Symptoms of Having both Disorders

Both borderline personality disorder and bipolar disorder have a set of similar symptoms and some symptoms that are different. When an individual suffers from both borderline personality disorder and bipolar disorder, they will experience symptoms that are characteristic of each disorder.

Symptoms that are specific to borderline personality disorder include:

  • Signs of self-harm, such as burning, hitting, cutting, etc.
  • Emotional changes on a daily basis, particularly related to family and work
  • Feelings of boredom or emptiness
  • Intense or uncontrollable outbursts of anger, followed by feelings of guilt
  • Symptoms that are specific to bipolar disorder include:
  • Changes in sleep quality and quantity
  • Symptoms of depression while undergoing manic episodes (these are also termed as a mixed episode)
  • Episode of mania causing extremely euphoric feelings

Impact of Borderline Personality Disorder on Bipolar Disorder

People diagnosed with both the conditions tend to have a worse course of illness. It has been observed that people who get a dual diagnosis generally have a history of substance abuse and may have had symptoms of ADHD in their childhood. Having bipolar disorder already and then being diagnosed with borderline personality disorder puts a person at a much higher risk of suicide.

How is a Dual Diagnosis of Bipolar Disorder and Borderline Personality Disorder Done?

People who are suffering from both borderline personality disorder and bipolar disorder will generally receive one diagnosis before the other. This happens because the symptoms of both these disorders can mask the other, and sometimes can overlap as well. In a case where an individual suffers from both borderline personality disorder and bipolar disorder, then usually it is seen that bipolar disorder gets diagnosed further as the symptoms can change. Due to this, it becomes more difficult to diagnose and detect symptoms of borderline personality disorder. As the treatment for bipolar disorder continues, over a period of time the symptoms of borderline personality disorder may also become clear enough for a separate diagnosis to be made.

Therefore when you visit your doctor, explain your symptoms if you are under the impression that you might be showing signs of both bipolar disorder and borderline personality disorder. Your doctor will then conduct their own assessment to understand the nature and severity of your symptoms and which condition they fall under. Doctors today use the latest edition of Diagnostic and Statistical Manual (DSM-5) for arriving at a diagnosis. They review each symptom on a standalone basis and then determine which disorder they fall under. Your history of mental health is also taken into consideration to provide insight that can help in distinguishing borderline personality disorder from bipolar disorder. For example, if you have a family history of someone having either borderline personality disorder or bipolar disorder or both, then you are at a higher risk of having the same.

Treatment Course after a Dual Diagnosis of Bipolar Disorder and Borderline Personality Disorder

You may be having both bipolar disorder and borderline personality disorder, but the treatment of each of these disorders is different as the symptoms vary from one another. Bipolar disorder will require several types of treatment, such as:

  • Medications such as mood stabilizers, antidepressants, anti-anxiety medications, antipsychotics, etc. are used to treat bipolar disorder.
  • Psychotherapy including family or group therapy
  • Sleep medications if you are suffering from insomnia
  • Alternative treatments such as electroconvulsive therapy

Meanwhile, borderline personality disorder is treated primarily through therapy. Your doctor may also suggest the following:

  • Dialectic behavior therapy
  • Cognitive behavioral therapy
  • Schema-focused therapy

STEPPS – Systems Training for Emotional Predictability and Problem Solving

Doctors do not generally prefer to recommend medications for treating borderline personality disorder as medication can at times worsen the symptoms, particularly increasing the risk of suicidal tendencies. However, at times your doctor may prescribe certain medication to treat some specific symptoms such as depression or mood swings. In severe cases, hospitalization may be required in both disorders as the manic episodes of bipolar disorder combined with suicidal tendencies in borderline personality disorder may lead to a person trying to commit suicide or seriously harm themselves.

Once you are diagnosed with both conditions, it is important that you avoid consuming alcohol or indulge in substance abuse. Keep in mind that both these conditions tend to boost a person’s risk of turning towards substance abuse. Drug abuse is only going to worsen your symptoms.

Outlook for a Dual Diagnosis of Bipolar Disorder and Borderline Personality Disorder

Having two conditions will no doubt increase the intensity of your symptoms. Many people with both bipolar disorder and borderline personality disorder may need to undergo intense inpatient care, while others may get better with outpatient care itself, without requiring hospitalization. The outlook for a dual diagnosis depends primarily on the severity and intensity of symptoms of both these disorders. It is also possible that one condition causes more severe symptoms as compared to the other. As both BPD and bipolar disorder are long-term conditions with no cure, it is important to work together with your mental health doctors to develop a treatment plan that is best suited for you. The correct treatment plan also ensures that there is an improvement in your symptoms.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 2, 2019

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