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Bipolar Illness Versus Borderline Personality: Red Skies Versus Red Apples

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Borderline Personality and Mood Disorders

Abstract

Major sexual trauma that derails personality development in early childhood has important consequences and can produce a clinical picture of complex PTSD symptoms that we call borderline personality. This is a truth, but it is a falsehood if this picture is allowed to deny and ignore our most treatable common psychiatric disease: bipolar illness. We demonstrate in this review that these conditions are two completely different entities: bipolar illness, in its entire spectrum ranging from severe mania to mild hypomania, is a medical disease almost completely genetic in etiology; borderline personality is a clinical picture with a primarily psychosocial etiology, based mainly on sexual trauma and pathogenesis. They share some clinical features—like mood lability and impulsivity and hypersexuality—which are nonspecific, and they differ in key specific ways: sexual abuse and parasuicidal self-harm are much more common in borderline personality, while psychomotor activation, without sexual abuse or parasuicidal self-harm, along with a strong genetic heritability, is basically diagnostic of bipolar illness. The similarities between these conditions are superficial—like red apples and red skies; the differences are profound. We also discuss mood temperaments and bipolar spectrum concepts and demonstrate their validity, how they are part of the overall disease of manic-depressive illness, and how they clearly differ from the clinical picture of borderline personality. Historical, conceptual, and empirical reviews of the literature are provided, along with case examples.

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Authors and Affiliations

  1. Department of Psychiatry, Mood Disorders Program, Tufts Medical Center, 800 Washington Street, Box 1007, Boston, MA, 02111, USA

    S. Nassir Ghaemi MD, MPH & Sergio Barroilhet MD, PhD

  2. Tufts University School of Medicine, Boston, MA, USA

    S. Nassir Ghaemi MD, MPH & Sergio Barroilhet MD, PhD

  3. Escuela de Psicología, Universidad de los Andes, Monseñor Álvaro del Portillo N°12.455, Santiago, RM, 7620001, Chile

    Sergio Barroilhet MD, PhD

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  1. S. Nassir Ghaemi MD, MPH
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Correspondence to S. Nassir Ghaemi MD, MPH .

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Editors and Affiliations

  1. McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA

    Lois W. Choi-Kain

  2. McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA

    John G. Gunderson

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Ghaemi, S.N., Barroilhet, S. (2015). Bipolar Illness Versus Borderline Personality: Red Skies Versus Red Apples. In: Choi-Kain, L., Gunderson, J. (eds) Borderline Personality and Mood Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1314-5_6

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