The Truth AND DANGER OF Diagnosing A Personality Disorder: BORDERLINE

Has someone who barely knows you, call you BORDERLINE, NARCISSISTIC OR BOTH???

Did you wonder why would someone make such serious statements without thinking of the consequences? Why diagnosing someone with a personality disorder, versus a mood disorder could be more harmful for the client. Why ethical and responsible mental health professionals do not making such  diagnosis easy?

This article is the first in a series of eleven. Each will describe in detail the diagnosis criteria of each the TEN PERSONALITY DISORDERS, organized in clusters A, B and C, as well as the new outlook brought on by DSM-5.

Each of the ten personality disorders has its own set of symptoms, however, ALL of them must meet the following criteria:

1. Distorted thinking.

2. Problematic emotional response.

3. Over or under regulated impulse control.

4. Interpersonal difficulties.

“Before a diagnosis is made, a person must demonstrate significant, enduring difficulties in at least two of the four areas.” (DSM-5 The Ten Personality Disorders: Cluster A by Simone Hoerman, Ph.D., Corinne E. Zupnick Psy.D. and Mark Dombeck, Ph.D)

Stigma and shame are unfortunately still attached to a diagnosis of mental illness, but WHY having a diagnosis of Borderline, or any personality disorder is even more concerning, why is it important to UNDERSTAND THE POSSIBLE LONG TERM CONSEQUENCES OF SUCH A DIAGNOSIS?

In the article, “Why psychiatrists are reluctant to diagnose BORDERLINE PERSONALITY DISORDER (BPD), by Joel Paris, M.D. published in ‘Psychiatry’ (Edgmont) 2007, Jan. 4(1): 35-39, he cites among other reasons, the fact that BPT is a complex syndrome with symptoms that overlap depression, bipolar and psychoses. The same article states that personality disorders often seem to lack precise symptomatic criteria and require clinical judgement for a accurate assessment. It further states: “Clinicians may wish to avoid making  diagnosis associated with stigma. It is an unfortunate reality that a diagnosis of BPD CAN LEAD TO REJECTION BY THE MENTAL HEALTH SYSTEM. If BPD were to be reclassified as a MOOD DISORDER, a patient would tend to be seen ad HAVING a BIOLOGICAL ILLNESS instead of a PROBLEMATIC PERSONALITY.”

Sounds complex?

Let’s take an example, something which could happen to anyone.

Let’s say, I go to see a therapist and the therapist diagnosis me as Borderline. This diagnosis stays with me throughout my life! I cannot change my personality! This is what makes Personality Disorders even more stigmatizing.

A time comes when I apply for a sensitive position and I give permission to my potential employer to have access to ALL my medical records. And here it is, BORDERLINE!!!  One of the traits of borderline is having interpersonal difficulties and “black and white thinking!” Oh my God, if I were the employer, I would NOT hire ME!!!

One could not change their personality! It could be controlled through certain types of therapies (Dialectal Therapy, known to be the most efficient) and proper medications, but it cannot be cured.

These are some of the reasons ethical  and educated mental health professionals take months of clinical observation and tests  and making sure that ALL diagnosis criteria are met before considering such a diagnose with possible life-long negative consequences.

If you are a client, be informed and be your own advocate. If you are a mental health professional, be ethical and understand how a rushed or incorrect diagnosis  may change someone’s life forever. If you are in the unfortunate habit to call people names, THINK OF THE LEGAL CONSEQUENCES!

If you are both a client and a  mental health professional be all of the above and more.

Being a  psychiatrist, psychotherapist or counselor is a calling, not a job.

The world expects us to know better, feel more, and understand the impact our words may have on people.


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