Understanding Borderline Personality

Borderline personality disorder can look like other disorders

/ Author:  / Reviewed by: Robert Carlson, M.D

Many of the symptoms of borderline personality disorder (BPD) overlap with other mental health issues. It is important to make sure your doctor knows all your symptoms.

Robert S. Biskin, MD, and Joel Paris, MD, of the department of psychiatry at Sir Mortimer B. Davis Jewish General Hospital in Montréal, Canada, reviewed research on BPD.

They looked at some of the ways that BPD can look like other disorders. Here are the highlights:

How is BPD diagnosed?

BPD has symptoms in four main areas – mood, impulse control, relationships and thought processes.

To be diagnosed, a person must meet five out of nine symptoms of BPD.  The symptoms include:

• Avoiding abandonment
• Unstable relationships
• Identity problems
• Impulse control problems
• Repeated suicidal or self-harming behaviors
• Mood problems
• Problems controlling anger
• Feeling empty over long periods of time
• Paranoia or psychotic symptoms that last for short time period

Only an experienced professional can diagnose BPD by talking with you about your symptoms.

Mood symptoms may look like depression or bipolar disorder.

Mood swings in BPD can mimic mood problems seen in bipolar disorder and depression.

However, the mood symptoms of BPD change much more quickly than those seen in bipolar disorder. In bipolar, mood changes last for days or weeks. In BPD, they last a few hours but no more than a few days.

Suicide or self-harm is a common reason for people with BPD to visit the hospital. However, unlike depression, the mood that led to self-harm may lift as quickly as it arrived.

Also, mood swings for people with BPD are usually brought on by life events and stress. In bipolar or depression, the mood changes last even when life events improve.

Impulse control symptoms may look like addiction or bipolar.

Impulse control is the way you stop yourself from doing something you know is dangerous, unhealthy, or has an unwanted result.

People with BPD often have trouble controlling their impulses. They may use drugs, have many sex partners, spend money they don’t have, gamble a lot and binge eat.

These behaviors often look like addiction or eating disorders. Outside the context of other BPD symptoms, these behaviors may be misdiagnosed.

Risk-taking behavior is also common for people with bipolar disorder when they are in a manic state. However, for bipolar disorder, the risk-taking happens when they are feeling high from the mania.

People with BPD will engage in risk-taking throughout their lifetime in ways that are not based on mood symptoms.

Cognitive symptoms may look like schizophrenia or PTSD.

Cognitive symptoms in BPD include changes to the way a person sees the world. They may see the world or themselves in an altered way that is unsettling.

About half of people with BPD will have brief periods of psychotic symptoms.

These usually show up as paranoia or hallucinations, both of which are common to schizophrenia.

The psychotic symptoms in BPD are short-lived and are usually based in reality.  In BPD, these symptoms may show up as real life events that are just interpreted in a strange way.

This is different from schizophrenia, which has long-lasting symptoms that are often not based in reality.

Other common cognitive symptoms in BPD are the feeling that the self or the body are not your own and the feeling that the world is unreal or bizarre.

These feelings can also show up in post-traumatic stress disorder (PTSD). But in PTSD they are not usually accompanied by risk-taking and unstable relationships.

What does this all mean?

Because so many of the symptoms overlap with other conditions, BPD can be hard for a doctor to detect.

Sometimes, patients get diagnosed with more than one other disorder, like depression, bipolar disorder and psychosis, when they really have BPD.

To make sure that you are getting the right diagnosis and the right treatments, be sure to keep a discussion going with your psychiatrist.

Telling your doctor or psychiatrist about all your symptoms is important – even if they seem unrelated.

Having a clear picture of all the behaviors or thoughts that cause you discomfort is the only way your psychiatrist can be sure you get the treatments you need.

Drs. Biskin and Paris also recommend that all doctors should inform and teach patients about a diagnosis of BPD.

Patients should also seek help in learning more about their diagnosis.

The authors gave the following resources for patients:

National Institute of Mental Health: www.nimh.nih.gov/health/topics/borderline-personality-disorder /index.shtml
Borderline Personality Disorder Resource Center: http://bpdresourcecenter.org/
National Education Alliance for Borderline Personality Disorder: www.borderlinepersonalitydisorder.com/index.html

This review paper was published in September in the Canadian Medical Association Journal. The authors declare no competing interests.

Review Date: 
September 15, 2012