How depression and borderline personality disorder differ and overlap

Borderline personality disorder (BPD) and major depressive disorder (MDD), often referred to as depression, frequently co-occur. Research shows that approximately 71% to 83% of people with BPD will experience depression at some point in their lives.  

BPD and depression share some common features related to mood and emotional regulation. This can make it difficult to tell which condition a person is living with or whether they have both at the same time. 

Understanding the similarities and differences between depression and BPD can help you better understand your experience and your mental health. It can also help you advocate for yourself with your providers so that they can provide an accurate diagnosis and the right care for your needs.

How to tell the difference between BPD and depression symptoms

BPD is characterized by intense emotions, mood swings, and a fear of abandonment. It can also lead to a pattern of instability in relationships and increase a person’s risk of self-harm. People living with BPD often have a fluctuating sense of values and personal identity. They may also appear impulsive and have difficulty regulating their feelings, especially anger.

Depression is a mood disorder characterized by periods of low energy, a loss of motivation, and pervasive feelings of sadness and hopelessness. It can cause people to disengage from relationships and activities they used to enjoy. Like BPD, depression can lead to thoughts of death, suicidal ideation, or suicide attempts.* Depending on the type of depression a person has, these intervals can persist for varying amounts of time and change in intensity.

Depression and BPD co-occur frequently, and the majority of people with BPD will experience depression at some point. Both conditions can have a serious impact on mood and emotional regulation. However, one key distinction to be aware of is that depression often presents differently in people with BPD. 

Most people with depression say they experience feelings of guilt or sadness. Alternatively, people with BPD and co-occurring depression are more likely to report a sense of emptiness, shame, or anger. They may also feel like there’s something inherently “bad” about them, and they might be more likely to feel bored, lonely, or restless. This distinction might seem subtle. But sadness can take many forms, and being able to describe your experience can help you communicate with your provider.

*If you or a loved one is experiencing suicidal thoughts or thoughts about harming themselves or others, please call or text 988 on any phone for the Suicide & Crisis lifeline, contact a local crisis line, or head to the emergency room immediately. 

Any of these resources will ensure that the person in crisis receives support right away. For more information on getting help, go to 988lifeline.org. If you’re experiencing a life-threatening emergency or you need immediate help, please call 911. 

Co-occurring BPD and depression

More research is needed to help us understand the relationship between BPD and depression. While these conditions co-occur at high rates, a person can feel sad or experience a depressive episode without meeting the full diagnostic criteria for clinical depression. 

Given the emotional toll that untreated BPD can take, it’s easy to see how it might cause periods of low mood from time to time. However, to be diagnosed with depression, a person’s symptoms must persist and maintain their intensity for specific amounts of time. It’s also important to consider that, while depression isn’t a predictor of BPD, BPD is a significant predictor of depression.

Can BPD be misdiagnosed as depression?

While experts have made considerable strides in our understanding of mental health, it’s not an exact science. When conditions that share similar symptoms occur together, misdiagnosis is possible. An incorrect diagnosis can, unfortunately, keep a person from getting the care they need. This can be particularly dangerous in the case of BPD and depression because having both conditions has been shown to lead to less favorable treatment outcomes and an increased risk of relapse and suicide attempts. 

If you believe that you may have been misdiagnosed, know that you’re not alone and help is available. Most mental health professionals want to ensure that the people they serve receive the right care for their needs. So if you’re already working with a provider, don’t be afraid to speak up about your concerns. And if you’re currently without support, consider seeking a new therapist to meet with either in person or online.

Treatment options for co-occurring depression and BPD

Treatment for BPD and co-occurring depression will likely include a combination of therapy, self-management strategies, and lifestyle changes. But it’s important to note that treating depressive symptoms alone won’t alleviate BPD symptoms. By contrast, BPD treatment has been shown to reduce symptoms of depression. 

So, for treatment to be effective, your provider will likely emphasize BPD-focused interventions, like dialectical behavior therapy (DBT), cognitive behavior therapy (CBT), mindfulness, interpersonal psychotherapy, or mentalisation-based treatment. The exact approaches your therapist uses will be based on your unique preferences, strengths, and challenges.

In addition, while medication may be used to treat standalone depression, it may not be as effective when depression occurs with BPD. Currently, there are no medications available for treating BPD alone. You can talk to your provider about whether adding medication to your treatment plan is the right option for you.

Find care with Rula

Living with BPD and depression can be a confusing experience. You might not be sure which condition is causing your mood symptoms or how to accurately describe your experience. Fortunately, you don’t need to know your exact diagnosis to ask for help. 

With Rula, you can connect with a mental health professional who can listen to your concerns, provide a professional evaluation, and ensure that you get the right support for your needs. No matter the mental health issue you’re facing, we invite you to use our therapist-matching program today to find an in-network provider and schedule your first appointment.

Get started with Rula today