Is It Time To Rethink Borderline Personality Disorder?

Published on July 13th, 2021

Updated on January 4th, 2024

Is It Time To Rethink Borderline Personality Disorder?

The label borderline personality disorder emerged in the 1930s. It was used 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. 

Psychosis was viewed as an untreatable severe mental illness. It is typically associated with delusions, hallucinations, and deficits in functioning and processing.

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About Borderline Personality Disorder

Borderline personality disorder was used to label the individuals between neurosis and psychosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has evolved in the past 60+ years.

The condition did not appear in the manual until the 3rd version (DSM-III) in 1980. Thecontroversy of the diagnosis continues as research develops the condition. 

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

  • Fear of abandonment
  • Impulsivity (such as substance use, sex, and spending)
  • Intense anger outbursts
  • Suicidal ideation/behaviors or self-harm behaviors
  • Unstable relationships
  • Difficulty with self-image
  • Challenges regulating mood

Controversy Of Borderline Personality Disorder

One of the challenges of diagnosing certain mental health disorders is the lack of concrete symptoms. There is a basic understanding of depression. It typically includes sadness, increased sleep, low motivation, irritability, and sometimes, suicidal ideation. However, there is no blood test, X-ray, or any other medical test to prove the diagnosis. 

This is true with most mental health disorders. There are some screenings and psychological tests that can help with diagnosing. However, diagnosing is also based on the provider’s clinical training. A provider must be able to trust their interpretation and rely on their education about diagnosing.

Most mental health professionals are good at recognizing disorders. They are trained to determine the condition and best treatment for the client. 

When the diagnostic criteria for a diagnosis are questionable or lack measurability, this is much more difficult. This is the case with BPD.

One of the biggest challenges of diagnosing mental health disorders is the symptom overlap. Many of the criteria of different conditions are similar to each other. BPD has overlapping criteria with other disorders, like posttraumatic stress disorder (PTSD). 

The disorder’s intense and rapidly changing nature also means the criteria do not always fit. This is because the symptoms change with different situations, people, and ages.

The Roots

Another challenge with BPD is the root cause. With most mental health disorders, especially personality disorders, the causes are mostly unknown. There is evidence that the following factors play a part:

There is a high correlation between childhood trauma and personality disorders, especially BPD. People who are diagnosed with personality disorders have a higher rate of past trauma than those who are not. 

Some studies have shown the connection between BPD and early childhood trauma is higher than other disorders.


People with mental health disorders have long been stigmatized and stereotyped. BPD may be one of the most stigmatized disorders, even by mental health professionals. 

People with BPD may be labeled as manipulative, treatment-resistant, and difficult. Some professionals refuse to treat people with BPD at all.

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Rethinking Borderline Personality Disorder

Rethinking the diagnosis and treatment may boost confidence in the recovery process. The focus of treatment is often to reduce unhealthy coping strategies. 

Such unhealthy strategies include impulsive spending or difficulty in relationships. Considering the condition’s pervasive nature, these are merely the symptoms of the deeper problem. 

A combination of the following puts someone who is diagnosed with BPD at a disadvantage:

Learning to cope may be helpful but does not get to the root of the problem. This is like continuing to take aspirin for a headache without seeking medical attention for the source of the headache.

What if the source of BPD is viewed as trauma or insecurity in 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? Address the trauma and help develop a sense of safety. This can help the person have a better chance of developing healthy coping strategies.

It is challenging to live with BPD, and it is challenging to work with people with BPD 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 BPD. This includes dialectical behavioral therapy (DBT) and trauma therapy. While the stigma of BPD may be challenging to face, it is important to continue to reframe the behaviors. Reframe the diagnosis to focus on processing and meeting the unmet needs.

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