Borderline or emotionally unstable personality disorder (BPD/EUPD) versus bipolar affective disorder (BPAD)

I often see people who have been mistakenly diagnosed with BPAD when they in fact have borderline or emotionally unstable personality disorder or traits of this disorder (BPD/EUPD).

The difficulty in making a diagnosis between bipolar affective disorder and borderline personality disorder is understandable, given symptoms from both disorders can be mistaken for one another. In my experience one of the main areas of confusion is with properly assessing the difference between the mood changes that someone with BPAD has compared to someone with BPD/EUPD. Mood changes in BPAD often last weeks or months, for example, pervasive periods of low mood which last months and episodes of mood elation which can last weeks. The above changes in mood are also accompanied by several other symptoms, for example, significant decreases or increases in energy and sleep.

People with BPD/EUPD often experience very rapid changes in mood, from high, to low, to angry sometimes within minutes or day to day. There is often no identifiable cause for what triggers or leads to resolution of these rapid changes in mood.

Making the correct diagnosis is critical because the treatments are very different for BPAD and BPD/EUPD. In my experience getting it wrong can lead to years of unsuccessful treatment and outcomes. This particularly applies to people incorrectly diagnosed with BPAD, when in fact they have BPD/EUPD. I often see people with BPD/EUPD because various medications they have tried, often over years, has failed to produce any significant beneficial effect. While I do not provide psychological therapy to treat BPD/EUPD making the correct diagnosis allows me to signpost that person to experienced psychologists who can provide the correct treatment. In some cases people have asked me to detoxify them from their psychiatric medication and I have extensive experience in this area.