The BPD Diagnosis: To Give or Not to Give?

Saturday Night Live cast member Pete Davidson’s experience with Borderline Personality Disorder has been fairly well documented. In a recent interview in Self Magazine, Davidson spoke with Glenn Close, the actress and notable mental health advocate who’s sister has bipolar disorder. They talked about the difficulty of getting a correct diagnosis for a serious mental health condition like BPD.

“I was always just so confused all the time, and just thought something was wrong, and didn’t know how to deal with it,” Davidson, now 27, recalled. “Then, when somebody finally tells you, the weight of the world feels lifted off your shoulders. You feel so much better.”

We have had the opportunity to work with many people who have lived experience with BPD. Here’s part of an interview from our documentary video series on BPD – If Only We Had Known.

Cathleen and Jim are a married couple who recall the frustration they felt while spending many years trying to find out what was causing Cathleen’s long history of emotional difficulties.

Unfortunately, many mental health professionals firmly believe that giving a BPD diagnosis to a patient might be more harmful than helpful. Now that idea is being challenged by other experts in the field.

Amy Barnhorst, MD, who is Vice Chair of Community Psychiatry at the University of California-Davis, finds that practice unacceptable. In a recent interview in the medical journal Medscape, Dr. Barnhorst gave her perspective on the merits of ‘give vs.don’t give’ a diagnosis of BPD to patients who meet the criteria.

“We would never withhold a diagnosis of cancer or liver disease or something else we knew patients didn’t want but that we were going to try and treat them for. I’ve never had a patient say, ‘How dare you call me that!’ like it was an insult,”

In the same article, Dr. Barnhorst references a blog post on the disclosure issue written by Dr. Kaz Nelson, Vice Chair for Education, Department of Psychiatry at the University of Minnesota School of Medicine, . Here’s what she had to say:

“More is known now about the clinical entity of BPD than ever before. While it is not as often studied compared to other psychiatric illnesses, important work elucidating the epidemiology, heritability, pathophysiology, natural course and treatment has materialized over the past 20 years. The emerging picture is different from what most healthcare professionals have been taught about this disorder.”

Dr, Nelson also argues that “BPD has long been what I refer to as an “asterisk” disorder.”

To illustrate that point, Dr. Nelson lists a number of statements about provider attitudes and behaviors towards patients with serious health conditions. Each statement ends with an asterisk (*)

We tell patients when they meet criteria for a medical diagnosis*
We provide education and disorder-specific resources to patients about their condition*
We show compassion and non-judgmentalism to patients*
We encourage learners (medical students) to pursue practice in the care of complex and serious illnesses*
We do not refer to patients by their disorder*

At the bottom of the list, Dr. Nelson adds a footnote that explains the meaning of the asterisk:

*Except for people living with Borderline Personality Disorder.

It is an unfortunate reality that getting a diagnosis for BPD can be a long and difficult experience. We have had the opportunity to work with many people who have BPD as well as professionals who have great empathy for patients who live with that diagnosis.
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The tide is slowly turning on this issue as awareness of BPD grows among professionals and the general public. Gains in research, clinical practice and a slowly evolving media coverage are helping to diminish the stigma that surrounds BPD. There’s still a long way to go, but progress is being made.

Stacey is the mother of Krissy, a young woman who suffered with numerous confounding emotional difficulties growing up. She and Krissy describes the relief they felt when she was finally diagnosed with BPD in her late teens.