What is borderline personality disorder? How is it different from bipolar disorder?

What is Borderline Personality Disorder?

Borderline Personality Disorder is the name for a specific pattern of issues that are caused by the interaction of parenting, childhood experiences, and the child's temperament. BPD begins in early childhood and shapes the growing child's personality. It is fully formed by the time the person reaches adulthood. It typically manifests in adulthood as:

  • Difficulty with emotional regulation.
  • Inability to self-soothe.
  • Extreme fears of abandonment.
  • Fear of being engulfed by the emotional need of other people.
  • Unstable relationships.
  • Identity problems.
  • Lack of Whole Object Relations-the ability to see oneself and others in a stable, integrated, and realistic way.
  • Lack of Object Constancy-the ability to stay positively connected to someone when they feel hurt, angry, or disappointed with the person.
  • Difficulty being alone.
  • Yearning for unconditional love and reparenting.
  • Impulsive and often destructive ways of trying to manage negative emotions.

How does Borderline Personality Disorder begin?

Dr. Margaret Mahler (1897–1985) a psychiatrist and child development researcher and Dr. James F. Masterson (1926–2010), the well known Object Relations theorist and authority on Borderline Disorders of the Self, theorized that Borderline Personality Disorder begins developing at around age two.

Separation and Individuation-At that age, children can be quite challenging to their mother or other primary caretaker. They are beginning to experiment with independence, but still feel very needy. This period is colloquially called "The Terrible Twos" because children say "no," and are easily frustrated, and may have tantrums; but they also need their mother to be a stable source of love and attention on an as needed basis. (Mahler calls this period the "Rapprochement Subphase of Separation and Individuation" and dates it at about 14–24 months).

The Role of Abandonment: Children are particularly sensitive at this stage to anything that is experienced as abandonment. This can be intentional abandonment, such as when the mother leaves the child with the father and goes off with a boyfriend-or unavoidable abandonment, such as the mother becoming ill and needing to be hospitalized away from the child. Early traumatic abandonment sets the stage for later abandonment fears.

The Role of Abuse: Many people who develop Borderline Personality Disorder report being physically or sexually abused by parents, relatives, or friends of the family.

Becoming a Parent's Parent: Some people with BPD report that their role in the family was to take care of their mother's emotional needs. This creates a conflict between the child's need for parental support and permission to grow up and become an independent person and the child's sense of responsibility towards the mother.

Lack of Training and Support for Independence: Many people with BPD report that they felt very unprepared for adulthood by their childhood. They say that they feel like a child in an adult body.

What is the best treatment for BPD?

Appropriate psychotherapy is the best treatment. In general most people respond well to Dialectical Behavior Therapy (DBT) which is perfect for low functioning people with severe Borderline problems) or Masterson's approach which is best for moderate to high functioning individuals.

Medication may be prescribed to diminish symptoms, but it does not "cure" BPD. Most people with BPD do very well with appropriate psychotherapy.

What is Bipolar Disorder?

This is a serious, usually chronic, mental disorder characterized by disregulated moods. It is believed to have a strong genetic component (about 85%) and also be affected by stress and abuse. It is not a personality disorder and so far as we know does not have its origins in early childhood. It often shows up in the mid 20's.

There are three main subtypes of Bipolar Disorder:

  1. Mania-The person is hyper energetic, has a greatly diminished need for sleep, has exaggerated moods of happiness or irritability, makes impulsive poor decisions, has pressured speech and difficulty listening to what other people are saying, and may over spend and act out sexually. This can become a psychotic episode in which the person loses touch with reality.
  2. Depression-The person feels extremely sad, hopeless, and may even be suicidal.
  3. Hypomania-This is a less extreme form of mania that many people enjoy. The person has an elevated mood, confidence, and may have increased creativity. For some people, hypomania is the prelude to a manic episode with all the problems that brings.

What is the treatment for Bipolar Disorder?

Appropriate medication is necessary to stabilize the mood swings. Psychoeducation about the disorder and psychotherapy can be useful once the person is stabilized by medication.

How does BPD differ from Bipolar Disorder?

Some main differences:

  • Type of Disorder

These are two different categories of disorders. BPD is a personality disorder, while Bipolar is a more serious chronic mental disorder.

  • Treatment

BPD: BPD responds well to appropriate psychotherapy, usually does not require medication or a psychiatrist, and is considered highly treatable with a good prognosis. There can be full recovery.

Bipolar Disorder: Bipolar Disorder requires a psychiatrist to prescribe appropriate medication and monitor its effects. Psychiatric hospitalization may be necessary. Psychotherapy and psychoeducation and support groups are useful to minimize recurrences.

  • Cause

BPD: BPD is believed to be an outgrowth of the child's family experiences and their temperament. Usually early childhood abandonment trauma and abuse play a major role in the development of BPD.

Bipolar Disorder: The cause of Bipolar Disorder is not fully known. There appears to be a strong genetic component that is exacerbated by stress and traumatic experiences.

  • Depression

BPD-There are two common triggers for Borderline Depression: (1)This is often triggered by abandonment experiences or the fear of abandonment. (2) Being expected to act independently and fulfill adult responsibilities. Life events can shorten the depression. For example, Borderline depression may quickly lift if the person falls in love.

Bipolar Disorder-This is triggered by a chemical imbalance that may be exacerbated by stress. Positive life events do not usually affect the person's mood.

Punchline: BPD and Bipolar only appear to be similar to people who have not seen someone go into a full blown manic episode. Both disorders are characterized by emotional disregulation, but the causes and severity of the disregulation, how it affects the person's life, and the treatments are quite different. By the way, some unlucky individuals have both BPD and Bipolar Disorder.

A2A

Elinor Greenberg, PhD, CGP

In private practice in NYC and the author of the book: Borderline, Narcissistic, and Schizoid Adaptations.

www.elinorgreenberg.com


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