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Borderline Personality Disorder and Bipolar Disorder

What is the Difference and Why Does it Matter?

Paris, Joel MD*; Black, Donald W. MD

The Journal of Nervous and Mental Disease: January 2015 - Volume 203 - Issue 1 - p 3–7
doi: 10.1097/NMD.0000000000000225
Review Article

Borderline personality disorder (BPD) and bipolar disorder (types I and II) are frequently confused because of their symptomatic overlap. Although affective instability is a prominent feature of each, the pattern is entirely different. BPD is characterized by transient mood shifts that occur in response to interpersonal stressors, whereas bipolar disorder is associated with sustained mood changes. These disorders can be further distinguished by comparing their phenomenology, etiology, family history, biological studies, outcome, and response to medication. Their distinction is of great clinical importance because misdiagnosis can deprive the patient of potentially effective treatment, whether it is psychotherapy for BPD or medication for bipolar disorder. On the basis of a comprehensive literature review, guidelines for differential diagnosis are suggested, and priorities for further research are recommended.

*Department of Psychiatry, Jewish General Hospital and McGill University School of Medicine Montreal, Quebec, Canada; and †Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa.

Send reprint requests to Joel Paris, MD, Institute of Community and Family Psychiatry, 4333 cote Ste Catherine, Montreal, Quebec, H3T1E4, Canada. E-mail:

© 2015 by Lippincott Williams & Wilkins