Personal Experience in Labeling Borderline Personality Disorder




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The diagnosis of Borderline Personality Disorder is inherently associated with stigma. Many clinicians refuse to work with clients who have this condition, and the term “borderline” may manifest negative emotions in people, clients and clinicians associated with the mental health field. There’s little argument that working with individuals with Borderline Personality Disorder is extremely difficult.

Some clinicians may react to such clients with eye-rolling dismay, but too many people treat Borderline Personality Disorder as the cause rather than the result of problems underlying this diagnosis. The term itself represents a superficial description of deep-seated problems emerging as relational difficulties that precede the diagnosis of Borderline Personality Disorder.

The condition of Borderline Personality Disorder can be described as a “thick concept”. This phrase conveys a label or a stereotype that symbolizes an amalgamation of characteristics, etiology and causes a term such as “Borderline Personality Disorder” can connote. It is important to recognize the diagnosis signified as Borderline Personality Disorder to be a thick concept, not as a label that conveys the associated prejudices.

I have worked with these types of clients, and I have been regularly appalled at the lack of respect that some clients with BPD have displayed toward me. One individual was particularly angry. His name was Tom, and he was a client of mine while I was working as a counselor in a group home in my late twenties. Tom had a superior IQ and used words that were not in my vocabulary. He was also extremely vulnerable.

I had read in the staff log one evening that he had reported to another staff member that he was planning to hoard his medication in order to make a suicide attempt. Also reported was the fact that he had said: “The staff person doling out the medication does not pay attention (to whether he swallowed his dose of medication) anyway”.

The next time I was distributing medication, I asked Tom to take his medication in my presence. He turned toward me, and he stated harshly: “Are you ethical or what? You just told everyone (the other clients) that I am suicidal!” I told him I was sorry. When I went home that day, I spoke to my husband about the incident. He said: “He told everyone he was suicidal — not you.”

Tom, nevertheless, wrote a letter to the director of the group home, complaining about my behavior in particular. My superiors did not reprimand me but supported me. Still, I remained daunted by the anger exhibited toward me by Tom.

He was an excellent artist, and, when he left that group home, he went to college in the Seattle area on a scholarship. I only saw him once after he left the group home. I was walking down a Seattle street with my sister, and I saw Tom walking toward me. I greeted him, without saying his name for reasons of confidentiality, although I did introduce to him my sister. I treated him in a friendly and polite manner.

He was stunned. He looked at me as though he could not understand, and I knew he did not understand why I would treat him well after the way that he had treated me as his counselor at the group home. My kindness toward him on a street in Seattle was one of my most successful moments during my career as a clinician. My behavior penetrated Tom’s perspective. In spite of his negativity, he realized that I had no ill will toward him. It proved to be an authentic, but deliberate therapeutic moment on a street corner in Seattle.

Terms relating to Borderline Personality Disorder include the following: dependent, histrionic, sociopathic, superficial, defiant, sullen, masochistic and ingratiating. We all know that these descriptive terms are negative, perhaps insulting. Even the words I’ve used here: angry, vulnerable and harsh, may be construed as negative. Diagnoses can amount to name-calling. The persons who are labeled with these terms clearly may feel negatively toward themselves and the people who label them, and this results in negative behavior in people like my ex-client, Tom.

The fundamental attribution error pertains to the presentation of negative behavior in those individuals who are labeled as “borderline”. Often we view other people’s behavior as emanating from their personalities, and we view our own behavior as resulting from situational factors. This has bearing on how individuals with Borderline Personality Disorder may view their own behavior and that of their clinicians.

It is easy to see that the terms mentioned here are accurately descriptive of BPD. However, the authority of clinicians who wield them may influence the creation of these negative qualities in their clients.

I have observed the reality that most diagnoses reinforce themselves in a cyclic way. This may be understood in terms of the process of labeling. The cyclic processes of labeling are complicated. They are not always understood, but they can be understood. It can be angering and frustrating to have insulting terms applied to oneself, and labeling can be enacted with impunity with regard to BPD clients who may feel powerless in terms of her negative treatment, even by well-meaning clinicians.

Essentially, the negative behavior of individuals with BPD is perhaps a reaction that is clearly exacerbated by the somewhat complicated processes of labeling. For this reason, it’s vital for clinicians to scrutinize the environment of their clients in an effort to determine exogenous reasons for the behavior of their clients with BPD, or any other client demonstrating a condition indicating psychopathology.

Image via Rob Byron / Shutterstock.

  • onergk69

    Ann & others,

    I readily agree that, in fact, most clients who exhibit any of the “wild” personality D/O’s inc. borderline, are very challenging to treat via psychotherapy. Clear therapeutic boundaries within psychotherapy are critical to + outcomes. So often, the transference & countertransference becomes quite malignant. I strongly recommend that therapists avail themselves of a clinical consultant in these circumstance.

    In my clinical experience, once the therapeutic alliance is well established, outcomes for these clients can be quite satisfactory!

    Rich

    • Anonymous

      i also agree with you you can say it again……..

  • http://healingfrombpd.org Debbie Corso

    Hello Dr. Reitan,

    I’m so sorry to hear about your negative experiences with patients who have BPD, and I realize that there are many things like this that occur.

    I want to encourage you that many people with Borderline Personality Disorder do have the potential to recover, get well, and utilize therapeutic services to truly change their lives. You get to be a part of that process as a clinician.

    I went through over two years of intensive DBT (Dialectical Behavior Therapy) and no longer meet the criteria for BPD. It is possible.

    I encourage you to see the potential of your most difficult patients, beyond where they are in this moment. Everyone has the possibility within them to grow and change.

    If you’re curious about my personal journey and experiences of overcoming, I share my story at my blog, which is at healingfrombpd .org

    Be well!

    In kindnes,
    Debbie Corso

  • http://teresa@essencehappens.com Teresa Lynne

    I really enjoyed this article and thought you had some unique observations. I particularly enjoyed the comparison of diagnosis with name calling. I have felt the judgmental sting of the label and don’t mind saying how damaging it is. I have always found that while people are fighting stigma the professional community is leading the way in keeping the stigma alive and thriving. As an advocate for myself and fellow recovering souls I have been vocal about the ignorance and maltreatment given by the mental health system and as well I have experienced the love and compassion of those professionals who truly believe in the clients they serve. We are sensitive, passionate, creative beings who did not ask for nor deserve this painful illness and we will not stand for the continued bias against us. Put away your clinical observations and see us as the human beings we are. Deserving of a seat at the table of humanity with everyone else.

    • Lea

      Love what you said Teresa. As clients we are taught to practice looking behind the behaviour of significant others in our early environments, to understand that they were doing the best they could at the time. In time it is empowering, but not everyone succeeds. One reason for this I believe, is because that same courage, willingness, and empathy is not applied to the person suffering intensely?

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  • http://auraviewarning.com/ Aimee

    Wow, I’d never even heard of borderline disorder before (very ignorant of me I know) but after reading this I’m fascinated by it. Will do some research now, thanks for sharing.

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  • Paul

    Wow didn’t know this about BPD. I understand that because clinical terms are used to describe their behaviour , they maybe accurate, but the utterances of these words convey that these people are psychologically inherently flawed. What do you do? Calling someone a sociopath or calling them manipulative whilst accurate, can be hurtful. What can be done? I don’t know.

    I think clinicians should be specific about what is causing their dysfunction ,is it depression , is is psychosis , is it anxiety , is it violence and then specifically target this. I don’t think the goal should be to make a person less manipulative for example , all though I see this as a natural development after successful intervention.

  • Paul

    It seems I myself have jumped to conclusions about BPD , i.e Borderline Personality Disorder = Sociopath

    This is what wikipedia says

    F60.30 Impulsive type
    At least three of the following must be present, one of which must be (2):
    marked tendency to act unexpectedly and without consideration of the consequences;
    marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized;
    liability to outbursts of anger or violence, with inability to control the resulting behavioral explosions;
    difficulty in maintaining any course of action that offers no immediate reward;
    unstable and capricious (impulsive, whimsical) mood.
    F60.31 Borderline type
    At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:
    disturbances in and uncertainty about self-image, aims, and internal preferences;
    liability to become involved in intense and unstable relationships, often leading to emotional crisis;
    excessive efforts to avoid abandonment;
    recurrent threats or acts of self-harm;
    chronic feelings of emptiness.
    demonstrates impulsive behavior, e.g., speeding, substance abuse[42]

    • Paul

      I can now see how hard it is to talk about BPD without conjuring all these negative perceptions. I can see how it can be so stigmatising.

      In my opinion the goal should be very specific in trying to end the dysfunction , whatever it is. Rather than to ‘rebuild’ the person. I suppose we are all flawed in some ways and whilst we can’t deny who we are , we must all find a way to adapt to society and the world around us , so that we can function as best we can.

  • onergk69

    To all,

    BPD is one of at least 10 disordered personalities. About 1 in 8 persons exhibit disordered personalities. Underlying themes across all subtypes is rigidity of character & persisting traits over a long period of time that essentially are self-destructive.

    Sociopathy in a clincal concept & not a personality subtype.

    Personality begins to show itself around age 3. It is forged dynamically in the interaction of genes & environmental influences. Around the 3rd decade of life, it becomes relatively fixed. Clinicians think of it as the consistent part of our
    self-experience in regard to how we feel, think & act.

    Persons w/ PD’s can be quite successful professionally. It is within intimate relationships they they can really struggle.

    Psychotropic medications are typically not very helpful. Individual therapy & group therapy of 40 + sessions result in positive gains.

    Rich

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  • Kathy

    I think I’m working with someone who has BPD – has anyone got any good ideas on how to get through the day without constantly feeling that I’m walking on eggshells. I feel like a prisoner being mentally abused by his temper tantrums, he hasn’t got a clue that he’s behaving so badly and we work in a locked room together in an office that is miles away from our supervisor.

    He has good days but just lately he’s kicking off once at least once a week, he tells me that he’s got his Winter disease back where he feels dizzy and sick sometimes. The problem is that if we speak about things he blames me for upsetting him, but where does that leave me, just keeping quiet and living in madness?

    Help me someone please ……………………

    • Lea

      Your underlying bias will show, which wont help your client to like himself. Firstly, you need to find compassion for what may be behind his behaviour. In order to understand it better, Marsha Linehan is the person to google and take notice off. DBT is the best model of therapy, as CBT is severely invalidating. Too many boundaries will be rejecting to him, however, you need to have your own support. The label is helpful for a while until he works out his triggers and understands he is not alone. But later when he is recovering – he will have to also try and deal with a main perpetuating factor – the invalidating bigger environment. He may survive his early one, but the larger environment will continuously place him back there. This illness is fraught with misunderstanding and inability to see behind the suffering. If these people are capable of true manipulation, they would not have BPD. They are survival seekers, not attention seekers. And we all need acknowledgment for our pain. These people are not trying hard to pretend, they are not hoping their cover will be blown.. they are defensive like trying to fight there way through an army of ignorance, listening to other people’s suffering caused by them. Give them a break. Refer him on if you can’t handle him, he disserves a break from someone who knows what real intrinsic suffering can do.

  • Anonymous

    I cannot believe what I’m reading? I have gone through a number of your blogs on BPD and you seem to cushion repeated stigmastism with “I’m not stigmatising but…”. I really can’t believe that you can be so cruel about these patients, people that have allowed themselves to be vulnerable with you – of course reactions will be a little extreme in these situations?

    The fact is, as a psychiatrists you hold the power of building and breaking stigmas around mental health. It is clear from this post alone that people value and listen to your opinions, but in my eyes you are abusing this responsibility. Because of a few bad experiences, perhaps people making your life a little less easy, you are spreading the stigma and hand in hand, prevent others struggling with BPD, but who may be perfectly cooperative and engage with the support gratefully, from being seen as anything other than the nightmare ‘not worth helping’.

    I’m sure you can shrug this off as an over reaction but I very rarely post online but this upsets me a great deal and only hope you will start using your authority positively and actually start breaking stigma you are hypocritically reinforcing.

    • Bec

      Well said

    • Eliza

      I agree totally. There are 256 ways to fulfill the criteria of BPD. Some share but one trait. As well most of these patients also have at least one other significant diagnosis such as PTSD, depression or an eating disorder. It is a diverse population and to reduce such people to same old cliche terms is naive and unjust.
      People with BPD can only do so much in educating professionals and correcting false myths since, due to the label, our words are seldom taken seroiusly and at face value. If there is change to be made around the stigma, discrimination and even abuse by professionals, it must come in large part from other professionals.
      As a person who has lived with this diagnosis for a long time, I can say in all honesty that the stigma is more painful and has done more damage to my psyche than the symptoms of the disorder itself. Given how excruciating my symptoms are, that says a lot.

  • Bec

    A label I hear a lot of is “manipulative”. It’s difficult to move forward after being branded with a personality disorder. I have not been in hospital for 8 years with this condition – have moved forward and am now working full time after 4 and a half years study at university. When I presented to the emergency department for kidney stones, they treated me like I was still a psych patient – put me out in to the waiting room and gave me ibuprofen (for kidney stones)…for anyone who’s had kidney stones you’ll understand the level of pain I am talking about! But still, the label continues…

    • Eliza

      I am so sorry that happened to you. The ER to me is the worst place I can possibly be. I was there last winter for psych reasons and literally developed PTSD from the horrific “treatment” I got.
      I have heard the term “manipulative” ad nauseum. The thing is, manipulation in the sense they mean involves intent. Do they think they are mindreaders and know what we intend, mean, feel? Luckily, Marsha Linehan and Alex Chapman, two experts on BPD, have debunked this myth. Unfortunately, word clearly has not gotten around.

  • Bec

    It’s the lack of ability to look deeper which is why this disorder is so misunderstood

  • KATHY

    All I keep ready is from people who have the Disorder, but what about those of us who have to work and live with your disruptive and abusive personalities, it’s almost typical of BPD people to only think of yourselves. My life is a living hell working with the man I work with, I can’t imagine how his wife and family survive, I suppose as long as he gets his own way all the time, everything is OK, but I wish he would get medication. I’m leaving my Job now because I want to KEEP MY SANITY. He makes me feel so ill, he nags about how he feels all the while, until I literally feel drained and sick. You’re very dangerous people because you don’t stand out like schizophrenics, you trick Doctors and professionals with your coercive mannerisms. I wish I could put you all together on an Island in the middle of the Sea and watch you al go mad, madder!!!!!! Trying to destroy each other with your mental power games.

Ann Reitan, PsyD

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature. She recently published Illuminating Schizophrenia: Insights into the Uncommon Mind.
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