Symptoms of mental health conditions often overlap with one another, which can cause confusion when determining which condition (or conditions) you may have. Of course, official diagnoses can only come from mental health professionals (or general healthcare providers), but it’s still important to understand the symptoms of suspected conditions, and their possible overlap with comorbidities—conditions that exist simultaneously in one individual.

Three mental health conditions that are often confused are attention-deficit/hyperactivity disorder (ADHD), borderline personality disorder (BPD) and bipolar disorder.¹ However, there are distinct differences between them.

The main difference between ADHD and borderline personality disorder and Bipolar disorder is frequency and severity in which the overlapping symptoms interfere with the affected individual’s quality of life.

Bipolar disorder vs. BPD vs. ADHD

It’s important to note that while the three conditions discussed below have many similarities, they vary drastically in how common they are. It’s estimated that approximately 1.6% of American adults have BPD², 4% have ADHD, and fewer than 0.001% are bipolar.

For reference, over 7% of American adults suffer from depression.³

Many people struggling with one mental health condition often struggle with additional comorbid conditions. In other words, it’s likely that many individuals represented in ADHD statistics are also represented for bipolar and/or BPD statistics, and vice versa.

Borderline personality disorder (BPD)

Personality disorders are characterized by the strong effects they have on how someone may think and feel about themselves and others. BPD was added to the third edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders) in 1980, but remains a controversial diagnosis.

Some practitioners even avoid diagnosing BPD completely.^4,5

What are the main symptoms of borderline personality disorder?

• Frequent mood swings and irritability
• Risky behaviors (promiscuity, reckless driving, drug use, gambling)
• Dissociation, sometimes causing paranoia
• Severe emotional dysregulation and angry outbursts, sometimes resulting in physical violence⁶
• Frequently feeling “empty”
• Inappropriate social behavior (excessive sarcasm, bitterness, vulgar language, personal insults)
• Impulsivity
• Rejection sensitivity
• Unstable self-image⁷ (inflated sense of self importance or dissociative feelings)
• Self-harm, suicidal thoughts, or suicide attempts
• Extreme fear of abandonment, often resulting in a fear of being alone

BPD symptoms typically appear in early adulthood. Whether the symptoms worsen or improve over time depends on the individual; however, it’s recognized as a highly treatable condition.⁸

Bipolar disorder

Bipolar disorder, formerly known as manic depression, is a mental health condition that causes extreme mood swings; from the highest highs (mania) to the lowest lows (depression). Hypomania is also possible, which is a less extreme version of mania.

Bipolar symptoms: depressive

• A loss of interest in previously-loved activities
• Lack of energy
• Difficulty sleeping or sleeping too much
• Suicidal thoughts
• Feelings of hopelessness and sadness
• Feelings of guilt⁹
• Difficulty focusing
• Forgetfulness
• Low motivation

Bipolar symptoms: manic (or hypomanic)

• Feelings of euphoria and extreme happiness
• Inflated sense of self-importance
• Easily distracted
• High energy
• Extreme irritability
• Risky behaviors
• Feeling "full of great ideas"⁹
• Insomnia, or avoiding sleep completely

Mood swing frequencies vary from patient to patient. Bipolar disorder is a lifelong disorder; however, treatments such as medication and psychotherapy (psychological counseling) have proven to be useful.

Types of bipolar disorder

Bipolar I disorder (type 1)

Individual experiences one or more manic episodes, preceded or followed by hypomanic or major depressive episodes.

Bipolar II disorder (type 2)

Individual experiences one or more depressive episodes and one or more hypomanic episodes – but no manic episodes.

Cyclothymic disorder

Two or more years of periods of hypomania and depressive symptoms (verbal and nonverbal). 

ADHD

Attention-deficit/hyperactivity disorder — or ADHD (formerly known as ADD) — is a mental health condition that affects both adults and children. It can cause problems in multiple areas of life such as at home, work, school, or in relationships.¹⁰ Symptoms usually commence in early childhood and persist through adulthood.

There are 3 ADHD subtypes: 

• Predominantly hyperactive-impulsive (HI)
• Predominantly inattentive (PI)
• Combined (C) 

Inattentive ADHD symptoms

• Difficulty focusing
• Low motivation
• Easily distracted
• Brain fog; lack of energy
• Difficulty following directions
• Appearing to not listen; daydreaming
• Forgetfulness
• Emotional dysregulation¹¹
• Rejection sensitivity

Hyperactive symptoms

• Hyperactivity; high energy
• Impulsivity
• Restlessness
• Impatience
• Angry outbursts
• Risky behaviors
• Mildly inappropriate social behavior (speaking loudly and/or quickly; interrupting others)

Combined presentation

The most common subtype — combined — presents symptoms from both the inattentive and hyperactive subtypes. 

Distinguishing between bipolar disorder, BPD, and ADHD

Note: symptoms from both the hyperactive and inattentive ADHD subtypes are included; manic symptoms and depressive symptoms are both included for bipolar symptoms.
This diagram was reviewed by Inflow's clinical director, Dr. George Sachs (PsyD.)

Misdiagnoses for mental health conditions are incredibly common, so it’s important to share as much relevant information as possible with your doctor. Distinguishing between ADHD, bipolar, and borderline personality disorder requires careful examination of symptoms, as well as other crucial factors, such as:

• Age at onset of symptoms
• The extent of difficulties or interference in daily life due to symptoms
• Current or past treatments for personality or mood disorders, including their effectiveness
• Family history of mental health conditions and treatments

Causes, treatment, and coping mechanisms

What causes or worsen symptoms?

Various factors have the potential to cause and/or exacerbate the severity of mental health conditions, including:

• Genetics or hereditary factors
• Traumatic experiences
• Burnout, stress, or feelings of overwhelm
• Overstimulation or understimulation 
• Distracting, irritating, or triggering external stimuli
• Medication, alcohol, and other substances

Treatment options: medication and therapy

Doctors may prescribe medications to alleviate symptoms, but meds must be taken regularly to remain effective. It’s important to discuss medication with your doctor, as trial-and-error periods are common when determining which drug works best for unique patients.

Additionally, cognitive behavioral therapy (CBT) is a popular and effective way to manage a variety of mental health conditions, specifically ADHD and bipolar disorder.¹² For borderline personality disorder, dialectical behavior therapy (DBT) is a more common therapeutic approach.¹³

Coping strategies, tools, and mental health resources

Alternatively, there are many coping mechanisms that can temporarily reduce symptom severity. Some examples include:

• Noise-canceling headphones
• Mindful meditation, such as the R.A.I.N. method
• Stimulating games with symbols, numbers, or colors
• ADHD coaches
• Puzzles
• Sensory toys or rings
• ADHD management apps
• Stimming (self-stimulating behavior, such as snapping, tapping, bouncing one’s foot, humming, etc.)

Final thoughts

Talk to your doctor about the best treatment options for your unique symptom presentation. It’s crucial to get a professional evaluation in order to receive a proper diagnosis, therapy, and support — especially since conditions like ADHD, bipolar, and borderline personality disorder have so many similarities!

We wish you the best of luck in your mental health journey!