Is Labelling People With BPD Oppressive And Prejudiced?

It is unfortunately still the case that in many people’s minds, including those working within the mental health industry, a person who receives a diagnosis of BPD is implicitly (or sometimes explicitly) associated with being a person who is manipulative, attention seeking, beyond help, fundamentally flawed, dangerous, criminally inclined, deliberately difficult and out to cause trouble, not to mention a whole host of other negative qualities.

Indeed, many who have received a diagnosis of a ‘personality disorder’ find it insulting and judgmental as it can carry with it the connotation that the person is intrinsically flawed on a fundamental level that is central to his/her very being and to the very essence of who s/he is. In fact, research suggests that such negative attitudes to people with BPD is one of BPD sufferers’ main triggers.

Such negative attitudes towards those with BPD can lead to victim-blaming and even punitive ‘treatment’.

This is why it is increasingly being argued that BPD as a construct is deeply flawed and unethical and the diagnosis should be abandoned completely.

Indeed, Lamb et al.(2018) argued that labelling people as having BPD is stigmatizing, misleading and masks the nature of the reasons behind the individual’s intense feelings of distress.

Further, a recent study conducted at the University of Liverpool (Allsop et al. 2019) scathingly criticised psychiatric diagnoses on the grounds that such diagnoses all utilize different decision-making rules, there is an enormous overlap between different diagnoses in terms of their symptoms, they provide little information pertinent to the specific individual diagnosed and, in the vast majority of cases, they conceal the role that trauma and adverse life events have played in their genesis.

Indeed, symptoms of BPD can frequently be explained in the context of the individual’s life experiences and viewed as normal and understandable responses to abnormal experiences (such as severe, chronic or repetitive childhood maltreatment or neglect) but, instead, a BPD diagnosis pathologizes these responses (which, in the context of the individual’s life as a whole, makes absolute sense) and can be used to discredit and undermine the recipient of the diagnosis.

Furthermore, a BPD diagnosis can carry with it the implication that the source of the individual’s distress lies within his/her own disturbed psyche/disturbed personality and detracts from the external causes (e. g. childhood trauma – see above) and social context of the person’s suffering such as poverty, racism, homophobia, transphobia, bullying and social disenfranchisement in general.

In other words, it may be implied that the individual’s suffering is his/her ‘own fault’ and that s/he is the author of his/her own downfall, undeserving of the help afforded to those with ‘legitimate’ psychiatric conditions like schizophrenia. In short, the implication is often that the BPD sufferer has a profoundly defective in terms of his/her moral character.

Due to the often unhelpful or even destructive and psychologically damaging nature of the BPD diagnosis, it seems preferable to concentrate on the causes of the individual’s distress and what can be done to alleviate it rather than detract from these fundamental issues with controversial, highly disputed (including between psychiatrists) and stigmatizing labels.

One option would be to replace the BPD diagnosis altogether with a diagnosis that more accurately reflects the source of the person’s suffering, such as complex PTSD. In other words, to use a trauma framework to replace BPD. Whilst an argument against this is that it has been found that a very small minority of those who have received a BPD diagnosis do not report a history of childhood trauma, it should be stressed that BPD is more closely linked to childhood trauma than any other psychiatric condition and, according to a recent, large scale meta-analysis carried out at Manchester University, those with BPD are 13 times more likely to report having suffered childhood trauma than those without any mental illness and are particularly at risk if they have suffered emotional abuse or neglect (Varese et al. 2013). Furthermore, even if a person does not report childhood trauma, this is not identical with saying s/he categorically did not suffer such trauma (some people may have their own reasons for not reporting trauma, including irrational feelings of shame or due to a misguided sense of loyalty to the perpetrator).

It is sadly ironic, though, that if an individual who has been given the label of BPD resents it or, God-forbid, expresses anger about being stigmatised by such a diagnosis, this may be taken as further evidence to the powers that be that s/he is a difficult, confrontational and volatile individual who deserves the label as if, whatever the provocation, any sign of anger from a BPD patient is, ipso facto, a symptom of a deranged mind).

In this way, to add insult to injury, the person is disempowered and placed in a double-bind, further aggravating his/her distress. In fact, the feelings of extreme anger people with BPD often experience in relation to triggers that may seem trivial to others may be completely comprehensible when it is realized that this anger is actually rooted in the person’s past and, on an unconsious level, is really directed at his/her childhood abuser (whom the triggering event, again usually on an unconscious level) has reminded the BPD sufferer of).

Furthermore, justified anger can be a catalyst for positive, social, political and ideological change and, in the case of BPD diagnosis and the institutions responsible for stigmatizing it, healthy anger, channeled in a positive and constructive way, may help to ensure those making the diagnosis are, in the future, better trauma-informed, less inclined to blame the sufferer, and more inclined to consider familial, societal and political failings underlying the condition.

The term ‘borderline’ was initially adopted in the 1930s because, at the time, a prevailing theory was that people with the disorder were on the borderline between neurosis and psychosis. Today, though, many interpret the term as suggesting a person lies on the border of having a legitimate mental disorder which further invalidates him/her. This is particularly unfortunate as those with BPD have a profound need of validation and being invalidated severely exacerbates the condition.

David Hosier BSc Hons; MSc; PGDE(FAHE).

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