Is My Depression Actually Borderline Personality Disorder? When Misdiagnosis Hinders Healing

The Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) defines BPD as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.” Individuals suffering from this disorder have difficulty regulating their emotions, often causing them to experience feelings such as anger, happiness, and sadness to degrees that are far past the point of healthy functioning. The end result is a life of unstable relationships, impulsiveness and a self-image that becomes distorted due to an inability to maintain a stable perception of who you are. However, being misdiagnosed with depression can make you feel as if all of these feelings and experiences are just byproducts of depression, when in reality they may signal something more complex—raising the question of borderline personality disorder vs depression.

Individuals suffering from BPD often describe chronic feelings of emptiness, can find themselves fluctuating between extreme depression and anxiety, and might either threaten to or engage in suicidal or self-harming behavior. All of these symptoms can also present themselves in those suffering from Major Depressive Disorder (MDD), the most common type of mental illness—and given the relatively recent recognition of BPD as a diagnosable disorder (back in 1980), many people are incorrectly diagnosed with depression when they actually have BPD. In addition, some individuals that suffer from BPD have other co-occurring mental disorders with overlapping symptoms, ultimately making the diagnosis process even more complex and preventing many people from getting the proper treatment that they need to heal and grow.

BPD stems from an inability to properly regulate emotions, especially in situations where you’re dealing with family members or those that you’re close with. BPD creates waves of intense anger, depression, and anxiety, all on a daily or weekly basis—and for many individuals suffering from this disorder, their reaction is to distance themselves from their emotions. However, when you distance yourself from what you feel, you unintentionally exacerbate feelings of emptiness and depression, sometimes so much so that they seem to be indicative of depression as opposed to BPD. In order to properly treat BPD, you must recognize and acknowledge your irrational emotions, patterns of impulsiveness, and the toll that they are taking on your life and relationships.

“The biggest problem with treating BPD as depression is the fact that there is no acknowledgment of the key differences in emotional regulation. This distinction between BPD vs depression is crucial for receiving the right care. In fact, depressed patients often have the opposite problem—they feel only one emotion all the time. While living with BPD is like constantly riding a roller coaster of emotion and turmoil, depression is like living in a painting with only one color. Although individuals with BPD at times do feel intensely depressed and down, this is just one of the many fluctuating emotions that dominate their life.

Medication-based treatments for BPD typically utilize selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants that are also used to treat depression. However, depression is also treated with the numerous other classes of antidepressants such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants, all of which are not preferred medications for treating BPD. In fact, many antidepressants can cause mood swings as a side effect, which can amplify the flurry of emotions that you are already feeling due to BPD, highlighting the necessity of proper diagnosis and receiving the appropriate antidepressant medication. Furthermore, people that suffer from anxiety along with their depression are typically treated with benzodiazepines such as Xanax, which can actually reduce inhibitions and increase impulsivity, exacerbating symptoms of BPD.