BPD Part 1 – Borderline Personality Disorder – an introduction

BPD is a label given for a set of behaviours combined with a number of personality traits by medical professionals when a person presents with a level of chaotic and sometimes destructive behaviours. The diagnosis carries a significant level of stigma which may lead labelled people finding themselves even more lost and abandoned than they started with. It is unfortunate that BPD is so poorly understood by many health professionals and so poorly supported within the system. Fortunately there are health professionals that are understanding the diagnosis better.

BPD has a few different names. It can be called EUPD (Emotionally Unstable Personality Disorder), CPTSD (Complex Post Traumatic Stress Disorder – although there is a version of CPTSD that isn’t BPD) and PD-Bt (Personality Disorder, Borderline type). None of these labels are a good description of what is going on or how the diagnosed person experiences the label. We’ll get into that a bit later.

Frequently BPD is misdiagnosed as anxiety, depression, bipolar or schizoaffective disorder. People frequently fly under the radar (often at great personal expense and discomfort) until something occurs (often traumatic) or the ability to manage fails and the person comes into the awareness of health services. By the time someone with BPD is elevated to health services the person frequently has at least one or more of these secondary traits and is thus misdiagnosed with the trait as dominant instead of secondary. A good clue that these are secondary to BPD are a failure to actually bring real relief to the person when only using the recommended treatment plans for these conditions and not realising the proper diagnosis should be BPD.

BPD has a great deal of stigma attached to it. There are three primary reasons for this stigma. Firstly, in the counselling side it seems that the secondary traits (or misdiagnosed traits) seem easier to address first, but the standard treatment plan for anxiety and depression via medication and CBT are only mildly effective. This results in frustration for the clinician and a transference of failure to the client. The clinician failed, but can’t find fault in their treatment plan (as it is for the wrong condition). The second stigma comes from the effects of the personality disorder on staff as staff become confused about who they are dealing with and often struggle with infighting as the person’s inner chaos becomes manifest in the staff. If you have found your staff lost and chaotic and find that frustrating, imagine what it is like to live with this every day. Stigmatising the person with the BPD diagnosis is personally cheaper than realising the staff need more training in BPD staff splitting. The third most common reason for stigma is the dramatic violence often associated with BPD. This can take the form of destruction of the environment, destruction of the person’s social connections and or destruction of the person’s self in the form of self harm or suicide.

Project Semicolon is an American nonprofit organization known for its advocacy of mental health wellness and its focus as an anti-suicide initiative.
Attribute: By Kencf0618 – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52641091

Many hospitals and facilities are ill equipped to manage people with BPD and thus try to avoid admitting people with any of the various forms of BPD unless they really have to. Unfortunately and ironically this can feed the abandonment issues that often accompany BPD leading to greater demonstrations of destruction. I very well understand why many hospitals have gone this way and the complexities of addressing this issue. It still sucks. A way to think about it is that BPD requires a certain specialisation to manage well, and not managing well is basically managing poorly. If there was a hospital or department that specialised in BPD, the hospitals would on refer patients there, but very few such hospitals exist and often hospital is just the wrong environment irregardless of specialisation. Consider the optics part of your hospital deciding they could manage your heart condition – this seems foolish, just get transferred to the cardiac ward. However there is no BPD ward, so where should the hospital refer you? Often to private therapy, away from the hospital environment.

Well that all seems kind of scary. Wrong diagnosis, lots of stigma, too hard for hospitals to handle, destructive nature of the diagnosis… While that feeds some of the issues with BPD, this is a more extreme end of BPD that gets the attention and drives the aversion and quite frankly a different recognition and management would ease a great deal of the problems. 

Part of the stigma attached to the diagnosis feeds the misdiagnosis of the condition. As many diagnositians are of the opinion that BPD is chronic and untreatable, they are reluctant to attribute a person’s experience to a condition that has little hope. While these diagnosticians (GP’s, psychiatrists and clinical psychologists) are wrong on this perception, let us pretend for a moment they are right. It is much better to treat someone for anxiety and depression, which have known frequently effective treatment plans, than to diagnose someone with BPD which doesn’t (remember, we are pretending there isn’t here). If you are wrong about BPD diagnosis, you have failed to treat someone who could have got help. If you are right about it being anxiety and depression, you fixed it. With this faulty assumption, the lesser evil is to diagnose with anxiety and depression and get some positive results when wrong than doom the person with a terrible condition. The avoidance of the diagnosticians is understandable. But wrong.

The misdiagnosing of people with anxiety, depression, bipolar or schizoaffective disorder is instead of BPD does great harm to far too many people who could have got effective help earlier. It is important to point out that being diagnosed with any of the above conditions does not mean you have been misdiagnosed. GAD (Generalised anxiety disorder) is a very specific condition, and the subtypes of anxiety disorders are definitely specific conditions that frequently have very effective treatment plans (which should be tailored for each individual). The same is true for the other diagnoses. Being given one of these does not mean you have been misdiagnosed. It just might, especially if you are finding the recommended treatment paths ineffective.

All of that and we haven’t even said what BPD is. Stay tuned for next time to find out – because it is complicated.