Personal Experience in Labeling Borderline Personality Disorderby Ann Reitan, PsyD | July 23, 2013
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.
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