Reframing the Borderline Personality Disorder Diagnosis
When defining borderline personality disorder (BPD), most resources will present you with the Diagnostic and Statistical Manual (DSM) criteria, but I wish to reframe the borderline personality disorder diagnosis. Not only is the DSM flat-out wrong about certain aspects of BPD (such as its understanding of people with BPD as lacking empathy), but it reduces a complex experience of being human to a diagnosis packed with bias. Let's reframe borderline personality disorder and think about the diagnosis differently.
The Medical Model and Diagnosis of BPD
Diagnoses such as borderline personality disorder have a specific function within the medical establishment. They standardize care and (dis)qualify you for insurance coverage. However, not only is BPD not covered by many insurance plans, but it can't be standardized. The medical and scientific communities lack essential information that would be necessary for BPD to be pathophysiologized (define the functional and/or physical changes that accompany an illness). The medical model isn't sufficient to understand and accommodate people with BPD.
Reframing the Borderline Diagnosis
Instead of trying to make something up to satisfy insurance companies and then packaging it as Truth, why don't we shift away from the medical model and communicate about our conditions with the people that matter to us using our own language. Let's respect our individuality in "being" borderline while also recognizing that everyone is on a BPD spectrum. To have BPD is to be human, and to be human is to have borderline traits, to a degree. This understanding will not only undermine society's notion that people with BPD are evil or sub-human (identifying with "the other" effectively removes stigma); it will undermine the BPD individual's notion that they are worthless (getting to the core of any problem that existed in the first place).
Empathy and understanding BPD as somewhat universal will bridge the gap between people with and without the diagnosis and decrease animosity in both directions, preventing the dehumanization of patients by healthcare providers and allowing families to better incorporate BPD members. The individualization part is important, too, because we all suffer in different ways for different reasons. To exercise the same treatment over everyone with a diagnosis does not address the reasons for one's suffering or allow the BPD person the agency necessary for self-empowerment, self-awareness, and real healing.
Framing the Borderline Personality Disorder Diagnosis
A portrait of someone with the BPD diagnosis might look like the following:
Think of someone who is highly sensitive living in a cruel world. Not only does the cruel world not value sensitivity, but it inflicts trauma. Think of that someone experiencing pain and responding in genius ways such as dissociative coping. Think of people interpreting this protective response as angry and manipulative. Think of the punishment. Think of the isolation, violence, and hate. Think of a system, devoted to helping other people who are different, offering nothing but rejection. Think of feelings of helplessness, hopelessness, and worthlessness, of wanting to die. Think of self-harm as dissociative coping but also as exposure therapy for the fear of death.
Now, be that person (if you weren't already), and think of a community which values your sensitivity and understands your response to pain. Think of its appreciation of you in the form of acceptance, love, and devotion. Think of enjoying life and wanting to be present for it.
Let's be that person by being that community.
Hofert, M. (2015, November 4). Reframing the Borderline Personality Disorder Diagnosis, HealthyPlace. Retrieved on 2023, October 3 from https://www.healthyplace.com/blogs/borderline/2015/11/reframing-borderline-personality-disorder
Author: Mary Hofert Flaherty
I have lived with bipolar disorder for fifty years and was only recently given the diagnosis of features of BPD. I'm very sensitive but don't consider that an altogether bad thing. Sensitivity is what has made me a compassionate person. I've spent the last twelve year supporting people with mood disorders, founding a Christian support group called Living Room (Christian, because churches were doing such a poor job of giving support.) I've only recently retired from the groups and carry on writing for those living with mental illness. Sensitivity has helped my creativity. I'm a published author and award-winning photographer. But sensitivity does become a problem - and very painful - when I feel rejection. I'm trying to overcome that.
just before I read this article I read an article, a pin on Pinterest, that left me hurt and angry. The kind that make us BPD sufferers out to be monsters. This article makes me want to cry, for the caring and sensitivity it shows. I am 63 years old and was not diagnosed until six years ago, along with bipolar mixed. I am also OCD and have anxiety. I am an introvert and I crave peace and quiet, no chaos. Unfortunately during the past six years I have been terribly betrayed by the mental health profession and it made me vulnerable to emotional and financial abuse by a family member. I lost my husband three years ago, many of my belongings were sold so I could move in with the family member. A year ago I was kicked out and shortly thereafter found out about the money of mine that was stolen. I am living with my brother and family who are wonderful to me. The family member who abused me and stole my money has no remorse. She blames me for everything. Even blames me for blaming her for causing my unhappiness. I remain devastated. I have to return home, to the state I lived in. I have a granddaughter who is my reason for going on. I want to be with her.
The emotional turmoil and financial issues this has created are irreparable.
Last year I was given a BPD with dissociative features diagnosis by a psychiatrist paid for by my employer Corrective Services NSW. My doctor had diagnosed Complex-PTSD prior to this and saw it as different. The reason I was referred by work to the psychiatrist was that I worked as a teacher in a prison and had disclosed that I had dissociated and split into 2 child parts while at work. During this time I was sexually assaulted by a powerful inmate who knew I wasn't in my body. he was a senior police officer serving time for child sex offences. Corrective Services wanted to keep what happened quiet as the work environment wasn't safe and the inmate was high profile. Once I was given a BPD diagnosis everything was blamed on that and it was used as a reason to refuse to investigate, which I requested. It was the worst discrimination I have ever faced. The inmate was part of an International paedophile's ring eMULE Even after pleading guilty to child sex offences he was awarded a lifelong police pension It built up while he was in prison and he was a millionaire when he was released. Yet a simple BPD diagnosis took my power away. I am only now speaking up as I live with PTSD and flashbacks that destroy my quality of life.
I absolutely agree. The sensitivity of those with BPD is nearly debilitating. And it's true that as humans we all have BPD traits and characteristics. It isn't until those traits begin to consume and contort us that we are labeled, packaged and sorted as evil, heartless, callous and cruel. Nevermind the pain, the despair, the tempest we battle within. Society has declared you forfeit.
Ms. Flaherty, thanks so much for your writing and standing up for those labeled "borderline". I'm getting a lot out of reading your articles, please keep up the good work!!
Dr. Jones, if only more therapists were like you! I know from personal experience that most psychologists/psychiatrists (pretty much anyone in the mental health field) absolutely loathe anyone even SUSPECTED of BPD. I once had a psychiatrist (who never figured out I was borderline, lol, what a genius!!) who told me seriously that if he even suspected that a patient was borderline, he THREW THEM OUT OF HIS OFFICE--PERMANENTLY!!!! I couldn't believe my ears--ppl like him are not fit to be therapists. If he can't handle BPD, he could refer the patient to a more "qualified" therapist or do a million other helpful things. But no--he ENJOYED telling me how brutally he cut off "borderlines". He was a total bastard--like so many therapists who hate anyone with BPD. Thank God for kind, compassionate, caring therapists like you!
I have BPD and would like to emphasize the agonizing internal pain we feel in every conscious moment. I am a very "sensitive" person; my heart goes out to anyone and everyone who has experienced any form of abuse, neglect or any other trauma in their lifetime - past or present. This extreme empathy, and not a lack thereof, also and especially is extended to those persons and animals of any kind who are unable to survive on their own. It knows no boundaries and haunts me until I am reminded of a new horror in the world we live in. I hold the REALISTIC view that our world is filled with evil, hardship for most people on the globe, leadership at all levels driven by greed and self-indulgence and a huge amount of emotional pain we all must live with in some shape or form from the time of said trauma until we take our last breath. I try not to watch the news because the horrific events of the day seem even worse than those we heard in recent days past. I have TOO MUCH empathy for those who suffer and wish I could resolve the pain of the world. Of course, I can not.
As for therapists, the best understand us on a fundamental level and then we fill in the details of our own personal tragedies. It is the pervasive pain the BPD feels inside along with the smallest stressors occurring in their lives that causes them to unravel, act out, try to commit suicide or self-harm. We are a challenging and difficult population to treat for many reasons. Some therapists begin to burn out, some begin to dislike us, some begin to feel inadequate because we aren't responding to their efforts to help us and some just want to refer us out to anyone else. Whenever we perceive frustration, impatience or any other negative emotion from our therapist, we feel rejected and misunderstood. Of course, anything we perceive in this way starts our internal dialogue that no one likes us, we don't like ourselves, etc. The end result is an increase in the emotional, permeating, gut wrenching pain we feel inside. It defines who we are, reminds us of how very sick we are and forces us to keep fighting the pain and misery until our life is over.
I've been a counselor for 9 years. All of them being spent counseling victims of abuse (every kind imaginable). My knowledge of BPD has only increased in the past few months as I had a client who came in with a previous diagnosis of BPD. In my self-education & research on the disorder, I'm realizing the multitude of previous clients I've seen who unknowingly (undiagnosed) have BPD. I have thoroughly enjoyed working with these particular clients. In fact, I find that many of their personalities & struggles are not much different from my own. In fact, I may be similarly undiagnosed. I have my suspicions. ;) I am able to convey great acceptance & empathy to them which definitely has great therapeutic value. I genuinely enjoy connecting with these clients & make great headway in sessions with them. The sensitivity of these clients is precious & what makes them so exceptional. I find myself often thinking that if the world had mor BPDs, it would be a much better place.
As a therapist, I agree with your thoughts on BPD. Sadly, even among therapists, persons diagnosed with BPD are often spoke about in condescending tones and with rolling eyes ("Oh, she's a BPD - you know how THEY are"). Our culture is very intolerant of those who are "highly sensitive", and continue to expect everyone to respond in a predetermined framework to trauma. If the response is different than the "norm", compassion and empathy are often withheld, which often compounds their already present negative self-view.
Thank you for your comment and validation! While I've met some pretty awful therapists, I've also met some really supportive amazing ones, like you. It's going to take people working on this stigma from all angles to bring justice to the issue. And, in the end, we're all going to benefit from a more compassionate world that accepts diversity of experience. Keep on keeping on! And please do share my website (www.quitecontraryadvocacy.com) with those who could benefit from it!