Struggling with your mental health is a challenge in of itself, and when you have overlapping symptoms across different conditions, it can be even more frustrating trying to figure out the best treatment approach. Two mental health conditions that are often confused and misdiagnosed are borderline personality disorder (BPD) and depression. While the two share similarities, they’re both different in their own ways, including the type of support that’s needed.
Keep reading for a full breakdown on BPD vs. depression.
What is Borderline Personality Disorder?
Borderline personality disorder is a condition that presents extreme patterns of instability in emotions, relationships, self-image, and behavior. It affects between 0.7% and 2.7% of the general population and typically emerges in early adulthood. People with BPD experience the world in extremes, such as all good or all bad. There is no in-between or stability.
Symptoms of BPD
BPD symptoms can be categorized into four sections:
- Emotional instability
- Distorted thinking or perception
- Impulsivity
- Unstable and intense relationships
Examples of symptoms that fall under these categories include:
- Frantic efforts to avoid real or imagined abandonment
- Idealizing someone one minute and devaluing them the next
- A distorted and unstable sense of self
- Risky behavior (e.g., reckless driving, substance abuse, or impulsive spending)
- Self-harm or suicidal thoughts during emotional crises
- Rapid mood swings that last hours or days
- Chronic feelings of emptiness
- Explosive anger or difficulty controlling it
- Feeling disconnected from oneself or reality, known as dissociation
While these behaviors may appear to be attention-seeking or a form of manipulation, they actually reflect deep emotional pain and an extreme fear of being alone or abandoned.
What is Depression?
Depression is one of the most common mental health conditions worldwide and affects how you feel, think, and function. Unlike BPD, depression brings a persistent low mood, reduced motivation, and a numb, joyless outlook on life.
According to the World Health Organization, there are different patterns seen in depressive episodes:
- Single Episode Depressive Disorder: Your first and only major depressive episode
- Recurrent Depressive Disorder: Multiple depressive episodes over time
- Bipolar Disorder: Includes depressive episodes that alternate with manic or hypomanic ones
Specific types of depressive disorders include:
- Persistent depressive disorder (PDD)
- Disruptive mood dysregulation disorder (DMDD)
- Premenstrual dysphoric disorder (PMDD)
- Postpartum depression
- Seasonal affective disorder
- Depression due to a medical condition
Symptoms of Depression
To meet the clinical threshold for a depression diagnosis, a person must have symptoms that persist most of the day, nearly every day, for at least two weeks, along with a noticeable decline in functioning. Common symptoms include:
- Persistent sadness, irritability, or hopelessness
- Loss of interest or pleasure in once enjoyable activities
- Changes in appetite or weight
- Insomnia or oversleeping
- Fatigue or lack of energy
- Restlessness or slowed speech/movement
- Feelings of worthlessness or guilt
- Difficulty concentrating, remembering, or making decisions
- Thoughts of death or suicide
Differences Between BPD and Depression
Despite similarities on the surface, BPD and depression are very different disorders with different causes, experiences, and treatment methods. Here’s a closer look:
Emotional Patterns
One sign of BPD is emotional intensity that can look something like going from deep despair to anger or joy in a matter of minutes or hours. Depression, on the other hand, usually brings a consistent low mood that doesn’t fluctuate much, even when things appear to be okay.
Research shows that while both BPD and depression involve unhealthy emotional regulation, depressed individuals ruminate more, whereas those with BPD struggle with distraction and overwhelming emotions that don’t get better even with coping skills.
Relationship Volatility
It’s common for people with BPD to have intense and unstable relationships. A recent study found that those with BPD described their relationships as filled with fear, insecurity, and unpredictability. As a result, they develop strategies, such as pushing people away, to avoid abandonment.
In depression, relationships usually suffer from withdrawal and isolation rather than a fear of abandonment. A person may pull away from loved ones because they feel like a burden or they don’t feel optimistic towards connecting with others in general. Another study found that depressed individuals perceive less intimacy and more conflict in relationships over time.
Self-Esteem and Identity
A hallmark sign of BPD is an unstable or distorted sense of self. People may feel like they don’t know who they are and change their values, appearance, or goals depending on who they’re around. This is sometimes called the “chameleon effect” where the person disguises themselves as someone they think others want.
Sadly, identity disturbance in BPD is a long-term risk factor for suicidal behaviors. A study found that those with more unstable self-identity were almost three times more likely to have attempted suicide.
Conversely, even though identity is usually more stable in depression, it’s clouded by self-loathing, guilt, and low self-worth. In other words, a depressed person knows who they are, but they believe who they are isn’t enough.
Suicidal Thoughts and Self-Harm
Both BPD and depression carry a risk of suicidal ideation, but the motivation and presentation are different.
In BPD, suicidal behaviors or self-harm may be triggered by interpersonal conflicts or emotional distress, such as feeling abandoned or misunderstood. These actions can be one’s way of expressing their emotional pain, regaining control, or stopping perceived rejection. In depression, suicidal ideation is more persistent (if present) and tied to the belief that nothing will ever get better.
Regardless of diagnosis, any talk of suicide or self-harm needs immediate professional intervention.
Can You Have Both BPD and Depression?
Yes. In fact, it’s very common. Studies show that 83-85% of people with BPD also experience episodes of major depression. That means someone may experience the emotional reactivity and interpersonal instability of BPD alongside the numbness, fatigue, and hopelessness of depression.
Treatment Options for BPD vs. Depression
Fortunately, BPD and depression are both treatable. For BPD, the standard is Dialectical Behavior Therapy (DBT), which is a skills-based therapy that focuses on emotional regulation, distress tolerance, mindfulness, and improving relationships. There are no specific medications approved for BPD, but some people may benefit from anxiety and/or mood stabilizing medications.
For depression, evidence-based therapies include cognitive behavior therapy (CBT) and interpersonal therapy (IPT), both of which help challenge negative thinking patterns and improve functioning within relationships. Antidepressant medications may also be helpful in managing depressive symptoms.
Alternatively, transcranial magnetic stimulation (TMS), a non-invasive brain stimulation procedure, may be considered, especially in treatment-resistant cases. Already approved for treating depression, TMS is sometimes used off-label for treating BPD. One study found that repetitive TMS, or rTMS, helped to relieve symptoms like anxiety, depression, and impulsivity.
Gain Stability and Control with Cura Behavioral Health
Whether you’re struggling with BPD, depression, or both, Cura Behavioral Health is here to help. We offer compassionate, evidence-based care, including psychotherapy and TMS, that is personalized to your unique situation. Our team specializes in helping clients manage mood swings, rebuild their self-worth, and regain control of their lives. To learn more about your options, give us a call today.
Sources:
- Borderline Personality Disorder – StatPearls
- Depressive disorder (depression) – World Health Organization
- Daily Emotion Regulation in Major Depression and Borderline Personality Disorder – Clinical Psychological Science
- How people diagnosed with borderline personality disorder experience relationships to oneself and to others. A qualitative in-depth study – International Journal of Qualitative Studies on Health and Well-being
- Longitudinal Associations Between Depressive Symptoms and Quality of Romantic Relationships in Late Adolescence – Journal of Youth and Adolescence
- Symptom Overlap Between Depression and Borderline Personality Disorder: A Network Analysis – Personality Mental Health
- Momentary Interpersonal Processes of Suicidal Surges in Borderline Personality Disorder – Psychological Medicine
- Treating depression in patients with borderline personality disorder: clinical clues on the use of antidepressants – Annals of General Psychiatry
- Brain Connectivity and Symptom Changes After Transcranial Magnetic Stimulation in Patients With Borderline Personality Disorder – Frontiers in Psychiatry
