Borderline Personality Disorder requires a diagnosis by a trained mental health professional like a psychiatrist or therapist. But few other psychiatric diagnoses are more stigmatized, misdiagnosed, and outright avoided by mental health professionals, despite the cost to their patients’ well-being. This creates an extra challenge for those suffering with BPD who are in desperate need of appropriate treatment but can’t receive it without a qualifying diagnosis. Not only can this attitude towards a BPD diagnosis interfere with patients receiving the proper treatment, social security disability benefits, and support, but it also continues to spread the already exaggerated public stigma against BPD both inside and outside of the medical community.
1. Why Clinicians Avoid Diagnosing BPD
Multiple reasons are cited for the general reluctance of many clinicians to label someone as having Borderline Personality Disorder, but the one I personally encounter the most is the incorrect assumption that they will be the bearer of the bad news: “you can’t get better.” They simply want to avoid telling their patients that they are doomed.
“Clinical research shows that most people in treatment for Borderline Personality Disorder do end up in remission or with substantially reduced symptoms”
An alarming amount of therapists and psychiatrists do not believe there is an effective treatment for BPD, and will also share that incorrect assumption with their patients who are often devastated by the idea that there is no hope, no help, and no point in trying.
However, clinical research shows that most people in treatment for Borderline Personality Disorder do end up in remission or with substantially reduced symptoms. In other words, there is no reason to resist telling a patient their diagnosis for fear of the loss of hope. The evidence shows that hope is definitely worth having, and can save lives.
2. Why clinicians stigmatize the BPD diagnosis
Here we see another way that lack of current, relevant information and reliable research has contributed to difficulties in receiving the proper diagnosis by a mental health professional. Stigma towards Borderline Personality Disorder often comes from the assumptions that those with this illness have a “personality problem” instead of a biological, neurological, medical illness.
Behaviors linked to abnormal brain functioning are misconstrued as manipulative behaviors, attention-seeking behaviors, or an outright rebellious attitude instead of a malfunction in neurological structures and communication, despite clinical evidence to the contrary.
3. Why clinicians misdiagnose BPD
“…a depressive episode and the emotional dysregulation in BPD can seem almost identical, perhaps one of the reasons BPD frequently gets misdiagnosed as Bipolar Disorder.”
Finally, there is the confusion within the medical community about the differences between Borderline Personality Disorder (an Axis II disorder) and other Axis I disorders with symptoms that can overlap. For example, a depressive episode and the emotional dysregulation in BPD can seem almost identical, perhaps one of the reasons BPD frequently gets misdiagnosed as Bipolar Disorder.
It takes a qualified and well-learned clinician to be able to distinguish between symptoms and sets of symptoms, especially complex sets of symptoms over time as seen in BPD.
All of this is not meant to encourage you to diagnose yourself with Borderline Personality Disorder; you need to see a mental health professional for an official diagnosis. Instead, this information is meant to drive you to find the most experienced and qualified clinician possible in order to get a complete and valid diagnosis you can accept with reasonable assurance.
In the future, we hope to have more standardized medical testing such as brain scans to determine diagnostic criteria.
But until then, a well-trained and well-seasoned clinician who is familiar with the recovery rates and the latest research results can drastically affect your recovery. A treatment team that knows your illness, is empathetic, and knows the best way to help you will increase your chances of successfully surviving a difficult diagnosis like BPD.
