Myths and Realities about BPD

Myth 1:  People with BPD never get better.

Reality: Many people with BPD report success with proper treatment.

It is true that ingrained personality traits are not easy for people to  change. But BPD behavior that has been learned can be unlearned. And many symptoms of BPD that are biological or chemical in nature can be treated effectively with medication.

Why is it, then, that this myth persists — in spite of the fact that  researchers have demonstrated effective treatments? The problem is the stigma of BPD and the lack of awareness. The research on effective BPD treatment is so new that many seasoned clinicians weren't exposed to it during their training. In addition, clinicians are bombarded with contradictory research on BPD treatment, which may leave them confused about which treatment approaches are most effective. 

Since many mental health professionals find working with borderline patients arduous and exhausting, promising new studies often go unnoticed by clinicians who don't specialize in BPD. It becomes a vicious circle: clinicians don't read studies that could help them work with borderline patients because they believe that borderline patients are always going to be difficult to work with.

Another problem is that many insurance plans won't cover BPD treatment-again, because of the myth that treatment rarely works. This acts as a barrier for clinicians to learn about state-of-the-art BPD treatments. Clinicians then rely on outdated information, misleading statements, and false information about BPD they've heard from their associates. 

Myth 2:  BPD is a "wastebasket definition." Clinicians give patients this diagnosis when they can't figure out what's wrong with them.

Reality: BPD should be diagnosed only when patients meet the specific clinical criteria.

Janice Cauwels (1992) wrote: BPD is still a wastebasket diagnosis, a label slapped on patients by therapists trying to pretend that their illness is understood. It is also used to rationalize treatment mistakes or failures, to avoid prescribing drugs or other medical treatments, to defend against sexual issues that may have arisen in therapy, to express hatred of patients, and to justify behavior resulting from such emotional reactions. 

In other words, some clinicians use the word "borderline" like some schoolyard bullies use the word "cooties." But the fact that BPD is used as a wastebasket definition doesn't make it a wastebasket definition, any more  than calling grapefruit a fat burner makes it a fat burner. A patient should be diagnosed as borderline only if they meet the clinical criteria and only after a clinician has worked with the patient over time to verify that the BPD symptoms are persistent, extreme, and long standing.

Myth 3:  Women have BPD; men have Antisocial Personality Disorder.

Reality: Although BPD is diagnosed in women much more frequently, men have it as well. 

According to the DSM-IV, about 75 percent of those diagnosed with BPD are women and that most people diagnosed with Anti-social Personality Disorder (APD) are men. But although the personality disorders have some external similarities (i.e., difficulties with relationships, tendencies to blame others), their internal states are strikingly different. Borderlines feel shame, guilt, emotional distress, and emptiness; people with APD generally do not.

So why are more women diagnosed with BPD than men? No one knows, but several theories have arisen.

Theories of why BPD happens more often in women

• Sexual abuse, which is common in childhood histories of borderline patients, happens more often to women than men.

• Women experience more inconsistent and invalidating messages in this society.

• Women are more vulnerable to BPD because they are socialized to be more dependent on others and more sensitive to rejection.    

• Clinicians are biased. Studies have shown that mental health professionals tend to diagnose BPD more often in women than men, even when patient profiles are identical except for the gender of the patient. 
  

• Men seek psychiatric help less often.

• Men are more likely to be treated only for their alcoholism or substance abuse; their borderline symptoms go unnoticed because BPD is assumed to be a woman's disorder.

• Female borderlines are in the mental health system; male borderlines are in jail.
  

Myth 4: There is no such thing as BPD. 

Reality: More than three hundred research studies and three thousand clinical papers provide ample evidence that BPD is a valid, diagnosable psychiatric illness. 

Clinicians may claim that BPD doesn't exist for several reasons. They may not  have kept up-to-date with the research and are misinformed. They may believe that BPD is not a separate disorder, but part of another illness such as Bipolar Disorder or Post-Traumatic Stress Disorder. They may simply reject the idea of labeling anyone as "borderline" because they think it is too stigmatizing, or they may find nearly all psychiatric diagnoses limiting and misleading.