Is It Time To Rethink Borderline Personality Disorder?

Published on July 13th, 2021

Updated on March 12th, 2022

The label borderline personality disorder emerged in the 1930s to identify people who seemed to be halfway between psychosis and neurosis. Neurosis was viewed as the treatable distress that accompanies most mental health disorders such as depression and anxiety. Psychosis was viewed as the untreatable severe mental illness associated with delusions, hallucinations, and deficits in functioning and processing.

About Borderline Personality Disorder

Borderline personality disorder was the diagnosis that labeled the individuals between neurosis and psychosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has evolved in the past 60+ years. However, borderline personality disorder did not appear in the manual until the 3^rd version (DSM-III) in 1980. The controversy of the diagnosis continues with the ever-changing knowledge and questions of the diagnose.

The current DSM5 categorizes borderline personality disorder with the following criteria:

Controversy Of Borderline Personality Disorder

One of the challenges of diagnosing mental disorders is the lack of concrete symptoms. There is a basic understanding that depression includes sadness, increased sleep, and suicidal ideation; however, there is no blood test, X-ray, or any other test to prove the diagnosis. This is true with most mental disorders. Though there are some screeners and psychological tests that can help solidify a diagnosis, most are based on the clinical training and perception of the mental health provider.

Most mental health professionals are good at recognizing disorders and determining the best treatment for the client. When the diagnostic criteria for a diagnosis are questionable or lacks measurability, this is much more difficult. This is the case with borderline personality disorder.

One of the biggest challenges of mental disorder diagnoses is the overlap of criteria from other diagnoses. Many of the criteria of diagnoses can be found in several different categories. Borderline personality disorder has overlapping criteria with other disorders such as post-traumatic stress disorder (PTSD). The disorder’s intense and rapidly changing nature also means the criteria do not always fit as the symptoms change with different situations, people, and age.

The Roots

Another challenge with borderline personality disorder is the root cause. With most mental disorders, especially personality disorders, the causes are mostly unknown. There is evidence to indicate genetics, environment, trauma, etc.; however, the answer to what really causes a disorder to manifest for one person and not for another with similar circumstances is unknown. The causes of borderline personality disorder are unknown.

There is a high correlation between childhood trauma and personality disorders, especially borderline personality disorder. People diagnosed with personality disorders have a higher rate of past trauma than those without personality disorders. Some studies have indicated the connection between borderline personality disorder and early childhood trauma is higher than any other personality disorder.

Stigma

People with mental disorders have long been stigmatized and stereotyped. Borderline personality disorder may be one of the most stigmatized disorders, even by mental health professionals. People with borderline personality disorder may be labeled as manipulative, treatment-resistant, difficult, and some professionals refuse to treat people with borderline personality disorder all together.

Rethinking Borderline Personality Disorder

The combination of loose definitions of the disorder, difficult criteria to differentiate, high overlap and trauma exposure, and high levels of stigmatization, people with this diagnosis or suspected diagnosis are already at a disadvantage for treatment.

Rethinking the diagnosis and how the treatment is approached may help the person, and the mental health professional feel more hopeful about treatment. The focus of treatment is often to reduce the unhealthy coping strategies such as impulsive spending or difficulty in relationships. However, with the diagnosis’s pervasive nature, these are merely the symptoms of the deeper problem. Learning to cope with this may be helpful but do not get to the root of the problem. This is like continuing to take ibuprofen from a headache without seeking medical attention for the source of the headaches.

What if the source of borderline personality disorder is viewed as the trauma or insecurity of early life? Instead of focusing on the behaviors that appear to be manipulative and intense, focus on the reason for the behaviors. How did the behaviors keep this person safe in the past? By working with the trauma and helping develop safety, the person has a much better chance of developing healthy coping strategies.

It is challenging to live with borderline personality disorder, and it is challenging to work with people with borderline personality disorders at times. Focusing on the underlying issues and not taking the intense responses personally makes it easier to rethink how to help the person.

There is help for people with borderline personality disorder, including dialectical behavioral therapy (DBT) and trauma therapy. And while the stigma of borderline personality disorder may be challenging to face, it is important to continue to reframe the behaviors and the diagnosis to focus on processing and meeting the unmet needs.