How do we distinguish between bipolar mood disorder, cyclothymic temperament, and borderline personality disorder? This may be among the most important questions in clinical psychiatry and psychotherapy.

The ability to accurately distinguish between these conditions frequently leads to treatment success; misdiagnosis can result in major failures. For instance, bipolar disorder is often well-treated with medication. Lithium therapy can lead to remission of symptoms and prevention of future episodes in appropriately selected patients (Ghaemi, 2024). In contrast, medication does not treat the core symptoms of borderline personality disorder. Misdiagnosis of borderline personality disorder as a mood disorder often results in multiple failed medication trials and prolonged suffering and impairment.

Much diagnostic confusion results from significant symptomatic overlap, particularly in the area of mood........

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