Do you know someone with Borderline Personality Disorder (BPD)? Are you diagnosed with it yourself? How did the person (or you) accept or deal with the diagnosis? As a therapist who has worked with both adults and adolescents with borderline traits, I have seen my fair share of denial, resentment, and even outright rage expressed in sessions when the word BPD comes up. I had a previous adolescent client ask me to stop using the term BPD while discussing her challenges because “I don’t believe I have that. If I don’t believe I have that, then neither should you.” Stunned by this attempt at controlling a professional, I offered to emphasize only the symptoms and leave the label behind, at least during the hour of psychotherapy.
This article will explore some of the fears that clients may have about being labeled with BPD.
While I am not an expert on Borderline Personality Disorder, I have had my fair share of male and female adolescent and adult clients who exhibit BPD traits and behaviors. These experiences have given me a taste of just how difficult the disorder can be (for everyone involved). Family members, caregivers, healthcare professionals, mental health professionals, and even friends are often emotionally overwhelmed by the individual suffering from BPD. Sufferers with BPD symptoms can come across as controlling, overwhelming, as an exaggerator, and even trouble maker who triangulates and creates chaos. While some behaviors do come off this way and may certainly occur, it is possible that the individual truly is unaware of how their emotionally intense reactions to stressors and others create strained and stormy relationships. Because of lack of insight and denial of the diagnosis, relational problems, therapeutic barriers, and personal suffering may never be resolved. Treatment for BPD can take a lifetime.
When I work with clients who have BPD I highlight the importance of being mindful of the 4 major areas of concern for those with the diagnosis:
- Dysphoric affect: a profound state of unease, affective instability or labile emotions, and feelings of emptiness and loneliness.
- Cognitive disturbance: Identify confusion that is serious, lack of identity, and a fragmented sense of self. Not knowing who you are and struggling with creating a “whole self.”
- Troubled relationships: stormy relationships, drama, and confusion. Some individuals exhibit extreme reactions to breakups.
- Impulsivity: little to no care for ones safety which may include promiscuous behaviors, reckless driving, substance abuse, overeating, and reactivity.
Despite explaining these 4 domains, some may continue to refuse the diagnosis. I learned over time in my work, also with much research and consultation with other professionals, that there is typically a reason for fearing the BPD diagnosis which includes:
- Stigma: Lets face it. BPD can seem like the only diagnosis (besides psychotic disorders) that results in social, familial, and occupational stigma that will never go away. As discussed in a previous article on this topic, BPD is largely misunderstood by society which makes the diagnosis even more difficult to accept once it is given to a patient or client. Sadly, those who are diagnosed with the disorder have heard negative comments and have experienced negative thoughts about BPD. A previous client of mine reported that she would rather be diagnosed with bipolar disorder than to receive the diagnosis of BPD. When I asked why she reported “because so many people will think I am a vicious person with no self-control.” While emotion dysregulation is a hallmark feature of the disorder, many people can learn to control their emotions and have healthier relationships with the right combination of therapy (appropriate therapy) and medication.
- Self-concept: Being diagnosed with BPD will result in a change of self-concept or self-esteem. It is very easy to view oneself in two extremes: one view may include the idea that the sufferer is “sick” and therefore should not be held responsible for their behaviors and attitudes toward others while the other extreme would be that the individual does not have BPD at all and should not pursue treatment. I have had both experiences with clients and these kind of clients are often difficult to treat because there is very little to no accountability or acceptance.
- Relational distress or fear(s): BPD, as noted above, often includes a myriad of emotional and relational challenges. As a result, most individuals would prefer to keep their diagnosis a secrete or not even accept the diagnosis for fear that others around them will react negatively. Some individuals with BPD would rather keep the diagnosis a secrete while dating or spending time with extended family. Of course, you do not have to share the diagnosis with everyone but there should be at least 1-2 people who should know. This can be a great source of support when it is needed.
- “Family order” concerns: Family members can be competitive. Some individuals, and not only with BPD, would rather not share their emotional and psychological challenges for fear of becoming the “black sheep” within the family. Some individuals struggle with the BPD diagnosis because of the stigma it creates within families.
- Healthcare discrimination: I have heard many clients, readers, and advocates complain about the challenges their mental health diagnosis creates when seeking medical attention. Some people fear that a “severe” and complicated mental health diagnosis such as BPD can create stigma among medical professionals who are providing medication management and general healthcare services. My experience with clients has been that most general practitioners do not have access to mental health records unless the patient provides consent for that information to be shared between the mental health therapist and medical doctor.
- Employment concerns: Some individuals also fear that supervisors or superiors can find out information by speaking with family members, friends, co-workers, or even medical and mental health professionals. Because of HIPAA (Health Insurance Portability and Accountability Act of 1996), no one is able to retrieve such information without consent (written) by the patient or client. A lot of people worry about their EAP (Employee Assistance Program) benefits that offer therapy services. I cannot deny the fact that some employees have been “burned” by their employer by sharing their BPD diagnosis with supervisors or even colleagues. Some even believe their supervisor gained access to their records.
- Other mental health diagnoses: One of the things I tend to do when meeting a client for the first time is obtain written consent to speak with other mental health professionals including neurologists and sometimes even medical doctors. Why? Because collaboration is extremely important in my work and I can often create a more accurate therapeutic picture if I know what other professionals have said about my client’s overall health. Unfortunately, some clients have expressed concern that their diagnosis may change if collaboration with their psychiatrist or another healthcare provider occurs. My experience has been that if a client does not like what another mental health professional says about them that they will go to another “to get” the diagnosis they can live with. Sadly, this is a BPD trait that makes treatment difficult.
- Challenges with medication: Another fear for individuals with BPD includes medication management and medication type. Medication management can become a challenge if the individual is suicidal or extremely depressed. If you are depressed, you will most likely not take your medication as you should. If you are suicidal, you may consider overdosing on the medication prescribed. As far as medication type, some individuals fear having to take strong medications that make them feel tired or drugged, have names that make them feel “unstable,” or that have stigmatizing names such as Haldol or Zyprexa.
- Social ranking: Although families can be very competitive, friends and colleagues can also be competitive. It can be a challenge for individuals with BPD to accept the diagnosis because of how they view themselves in comparison to others. A former client once said to me “why would I accept this diagnosis if a lot of my friends and colleagues experience similar symptoms but only have depression or anxiety?”
- Symptom similarity to movies: Sadly, a lot of popular movies portray illnesses such as borderline personality disorder, multiple personality disorder, depression with psychotic features, autism spectrum disorders, etc. There are some movies who portray, with a high level of accuracy, the symptoms of BPD such as Thirteen, Mommy Dearest, and Young Adult. However, there are other movies that simply exaggerate symptoms and perpetuate unhealthy views of BPD. As a result, a lot of people try to avoid and deny the diagnosis of BPD because of incorrect or exaggerated portrays of symptoms in cinema.
What has been your experience with the diagnosis of BPD (as yourself, a friend, the patient or client, etc)? Do you find that BPD is one of the diagnoses that are difficult to accept?
While it is very important to do your own research, maintain an open mind, and sometimes seek a second opinion, acceptance is often the only real way to heal.
As always, looking forward to your perspective.
I wish you well