“If they’re borderline, you have to discredit half of what they say.” My jaw dropped as I heard these words from a fellow mental health professional. I had experienced caution expressed by peers regarding the aftermath it can have on someone’s life in legal and medical matters. I found this disturbing.

Borderline personality disorder (BPD) is a complex mental health condition affecting relationships, sense of self, behavior, and mood. It is, for most, intensely painful. Among all diagnoses, BPD is most commonly associated with suicidal behaviors, with as many as one in ten with BPD dying by suicide (Black et al., 2004). At its worse, BPD can derail and endanger lives.

A research study wherein clinicians viewed the same video of an individual discussing panic symptoms showed significantly more reactions when told the individual had BPD than those not given this information (Lam et al., 2016). A study of staff in inpatient settings found less empathy among mental health professionals toward those with a BPD diagnosis (Bodner et al., 2015). Some have suggested it to be a diagnosis often applied to clients a clinician finds "difficult" (Sulzer, 2015). In popular culture, BPD carries a stigma associated with manipulation and abuse.

Highly Treatable

Still, BPD is highly treatable. Mentalization-based therapy, a psychodynamic treatment focused on relationships with self and others, has also shown strong promise, particularly in improving quality of relationships (Bales et al., 2012). Dialectical behavioral therapy (DBT), a therapy focused on a balance of acceptance and change through skills development, is also highly effective in treating BPD. In one study, 81 percent of participants in a DBT program no longer met the criteria for the condition (Zeitler et al., 2020), and the therapy appeared to markedly reduce suicidality (Linehan, 2015).

Accurate diagnosis and compassionate treatment of BPD can save lives.

Stigma Origin

How did BPD accumulate so much stigma? Is it fair? While the origin of the stigma against BPD is difficult to trace, research has guided us to several themes. For decades, BPD held a label of being untreatable. Watching the agony expressed by someone moving through the whirlwind of emptiness, fears of abandonment, and depression that those with BPD experience is likely to leave a clinician feeling powerless if not equipped with the proper tools to treat the condition (Ring and Lawn, 2019). Maybe it is less painful for someone to say that a person is just "being manipulative" than to acknowledge the reality of those depths of pain.

These stereotypes do not hold. The truth is that BPD can foster an almost superhuman level of empathy and compassion (Dinsdale and Crespi, 2013). Manipulation is typically defined as attempting to meet a specific objective. BPD is associated with impulsivity, and most struggling in the thick of the disorder do not appear to be achieving the objectives they wish for. The sometimes extreme behaviors of a person in a crisis can give the illusion of manipulation, but it is not manipulation in the truest sense.

Alternative Dimensional Model of Personality Disorder

In the most recent Diagnostic and Statistical Manual of Mental Disorders, an alternative dimensional model of personality disorder diagnosis has been proposed (Wieder et al., 2007). Such a structure suggests a breakdown between categorizing personality disorders into distinct categories, rather framing these conditions in terms of personality functions such as self-direction and intimacy. Many hope that in addition to providing more precise treatment, such understanding would further de-stigmatize specific personality disorder diagnoses, encouraging more compassionate care.

This alternative dimensional model re-humanizes personality disorders, reminding us that these same personality functions are within all of us.

While not listed as an official diagnosis, complex posttraumatic stress disorder has been proposed as a condition sharing many of the traits of BPD that emphasizes the immense correlation between trauma and these troubles (Forder and Courtois, 2021). Still, not all with BPD report posttraumatic stress.

Whatever we call it, one thing is sure, we need to move toward compassion and to stop shaming those experiencing this often devastating, treatable, and life-threatening diagnosis.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741.