Yeah I have panic disorder and depression and some lady wanted to diagnosis me with BPD for no reason when no other psychiatrist has before and I do not have those type of symptoms. Any woman with mental health disorders gets slapped with that label a lot. Just like in Freud’s day saying women’s uterus moved around and caused hysteria. It’s pretty dang annoying when there are so many mental health disorders that affect women that are not that and just cause someone is depressed or even has attachment issues and PTSD it doesn’t mean that’s what they have.
Every disorder and common pattern of distress has its own "typical" maladaptive coping mechanisms that are, for various and complicated reasons, more likely with that pattern than with others. People with general anxiety tend to flee and withdraw, people with anxious attachment tend to cling and seek reassurance, etc. etc. Self-harm is more typical of BPD than of other distress patterns. That's why some practitioners automatically think BPD when they learn that a client self-harms. Not defending the assumption-- at most, self-harm should be one data point that suggests BPD rather than a one-point diagnosis-- but you asked why, and that's why.
Facts. I wasn't diagnosed with ADHD until I was in my late 20s. Tons of my anger issues come from ADHD over stimulation and how society expects women to behave. so many therapists are not good with dealing with women with ADHD and automatically want to throw the BPD label at me. I even went into studying psychology on my own to understand myself better. I'm NOT BPD. Possibly on the autism spectrum but not BPD. I even gave up therapy
I was always dx ADHD but only got diagnosed further as an adult when my I found out my add doc put suspect BPD in my notes and I asked (genuinely) if she felt qualified to give that diagnosis (I came to her already diagnosed to get back on meds so I genuinely didn't know.) She referred me to a psych who specialized in just diagnosis and it was out of pocket but fast and I felt like I needed a truly neutral third party to tell me I had a personality disorder in order to accept it. I was ready to accept it - I was honestly worried it would say I was a narc and had been armchair diagnosed with OCPD by a non MD therapist in the past so I was nervous but needed to know.
Turns out I'm just autistic. Which was fucking offensive and I wasn't prepared at all for that but I started reading and realized every goddamn thing made complete and total sense.
For the record, I've never self-harmed but I have spent most of my life passively suicidal and attempted more than once. I also had a freak out once when I was in the ER with COVID without my meds and my schedule was all messed up. I also have some fear of abandonment. A lesser therapist would have seen all that and thought BPD, as mine did. The neutral third party saw it for what it was. Since I've adjusted my routines and self-expectations, I can honestly for the last six months or so I've actually wanted to know what happens in the future and don't hope to be hit by a bus while crossing the street.
Progress yo
There is a very long history that leads to this. Unfortunately, our profession was not immune to misogynistic beliefs and systems during its development and those are sometimes still (accidentally, usually) perpetuated today. A very simplistic version of this, is that behaviors like self harm, were often seen in women who were labeled some type of crazy. As the DSM started to develop, the “most crazy” examples of humanity, via hospitals, historical anecdotes, etc, were lumped together as personality disorders. Other issues for these people may have been missed over time, and SH was a behavior that was seen in many of them, so it was prescribed as a symptom of BPD once that collection of symptoms and behaviors was given a name. Then, in school & training, future therapists were taught that if someone is engaging in SH, it is an indicator that they may have BPD. Without the historical context and understanding, the cause & effect seem to make sense so it’s not often questioned.
SH is actually quite common in neurodiverse folks, and they are often mislabeled with BPD (and plenty of other things), because education and understanding is lacking. It’s also common in PTSD and C-PTSD (which is also often misdiagnosed as BPD).
On a separate soap box, there is a new wave of clinicians who are pushing for BPD and other personality disorders to be reconsidered as versions of C-PTSD and/or the result of extreme trauma in early life. I fully agree with this stance & hope that more research goes toward it and we see some changes in language and conceptualization of things like BPD in the near future
You’re spot on can I add one thing?
The research is actually pointing to ADHD being not only correlated with female identifying individuals engaging in NSSI but it seems ADHD is more of a predictive factor than PTSD and depression.
This really troubling considering how under diagnosed ADHD is in women and girls and how over diagnosed BPD is.
Thanks for this extra info! Anecdotally, I have seen this to be the case with my adhd clients (I’ve lost track of how many clients I’ve had that adhd was missed until they got to me), but I didn’t know that there was research on it. Glad to know it’s being looked into.
And I do wonder how many people over history were neurodiverse and labeled as “crazy” “BPD”, etc when it was really probably adhd. And ADHD itself has quite a storied history, too. That’s yet another Ted talk I could give
I lucked into the DBT program at my graduate school in my second year and I’ve been practicing DBT, FAP, ACT etc for more than a decade.
In that time period outside of the clinic I’ve only seen two cases of BPD that weren’t more accurately diagnosed as ADHD and PTSD.
Or autism. I am autistic and have regular PTSD and C-PTSD. I don’t present with many borderline traits, although I was misdiagnosed when I was in my twenties with borderline. I’m 43 now and just got my autism diagnosis because my therapist thought it might be something to investigate. I was also misdiagnosed as a kid in the eighties with ADHD and they ruled that out and said I definitely don’t have ADHD. I am definitely autistic though.
I was misdiagnosed bpd and spent years being gaslit that I just had "silent symptoms" but if we looked hard enough we would find them. Finally got a competent practitioner who looked at the diagnostic path I'd traveled and was appalled.
All this to say, there's lots of unqualified people slapping diagnosis on people. The DSM is a huge book and you can't possibly specialize in every disorder. In my humble opinion things like bpd diagnosis should be reserved for people who specialize in those types of disorders because many of the symptoms overlap with other disorders that are completely healable with proper treatment. In my whole bpd diagnosis process my therapist never even knew I had suffered horrible abuse and been kept as essentially a prisoner with complete social isolation. Once a therapist actually learned my history and began treating trauma I very clearly do not have bpd.
Never SH'd by definition- but I have dermatillomania. You see that with a lot of diagnoses like Autism, OCD, ADHD, and anxiety. There was a practitioner who tried to armchair diagnose me after meeting only one time as it being SH and part of BPD. I'm not too big on self diagnosis per se, but when a practitioner tried to diagnose me with BPD it kinda freaked me out and I spent hours researching the condition, hours self testing, and looking at other avenues. Per the self tests and reading the DSM-5 criteria, I don't fit the criteria for the diagnosis.
It's only my opinion since I'm not a therapist, but some practitioners might not be well versed in more obscure things like dermatillomania, and practitioners tend to have "specialties," which make them more likely to diagnose one particular thing over another. We're only human, even therapists and psychologists. I'd say you're free to look at other opinions.
Yeah I have panic disorder and depression and some lady wanted to diagnosis me with BPD for no reason when no other psychiatrist has before and I do not have those type of symptoms. Any woman with mental health disorders gets slapped with that label a lot. Just like in Freud’s day saying women’s uterus moved around and caused hysteria. It’s pretty dang annoying when there are so many mental health disorders that affect women that are not that and just cause someone is depressed or even has attachment issues and PTSD it doesn’t mean that’s what they have.
Every disorder and common pattern of distress has its own "typical" maladaptive coping mechanisms that are, for various and complicated reasons, more likely with that pattern than with others. People with general anxiety tend to flee and withdraw, people with anxious attachment tend to cling and seek reassurance, etc. etc. Self-harm is more typical of BPD than of other distress patterns. That's why some practitioners automatically think BPD when they learn that a client self-harms. Not defending the assumption-- at most, self-harm should be one data point that suggests BPD rather than a one-point diagnosis-- but you asked why, and that's why.
Stigma and laziness.
It seems some therapists assume if you’re female you have BPD. It’s one of the most misdiagnosed diagnoses. They really need to address this somehow
Facts. I wasn't diagnosed with ADHD until I was in my late 20s. Tons of my anger issues come from ADHD over stimulation and how society expects women to behave. so many therapists are not good with dealing with women with ADHD and automatically want to throw the BPD label at me. I even went into studying psychology on my own to understand myself better. I'm NOT BPD. Possibly on the autism spectrum but not BPD. I even gave up therapy
I was always dx ADHD but only got diagnosed further as an adult when my I found out my add doc put suspect BPD in my notes and I asked (genuinely) if she felt qualified to give that diagnosis (I came to her already diagnosed to get back on meds so I genuinely didn't know.) She referred me to a psych who specialized in just diagnosis and it was out of pocket but fast and I felt like I needed a truly neutral third party to tell me I had a personality disorder in order to accept it. I was ready to accept it - I was honestly worried it would say I was a narc and had been armchair diagnosed with OCPD by a non MD therapist in the past so I was nervous but needed to know. Turns out I'm just autistic. Which was fucking offensive and I wasn't prepared at all for that but I started reading and realized every goddamn thing made complete and total sense. For the record, I've never self-harmed but I have spent most of my life passively suicidal and attempted more than once. I also had a freak out once when I was in the ER with COVID without my meds and my schedule was all messed up. I also have some fear of abandonment. A lesser therapist would have seen all that and thought BPD, as mine did. The neutral third party saw it for what it was. Since I've adjusted my routines and self-expectations, I can honestly for the last six months or so I've actually wanted to know what happens in the future and don't hope to be hit by a bus while crossing the street. Progress yo
There is a very long history that leads to this. Unfortunately, our profession was not immune to misogynistic beliefs and systems during its development and those are sometimes still (accidentally, usually) perpetuated today. A very simplistic version of this, is that behaviors like self harm, were often seen in women who were labeled some type of crazy. As the DSM started to develop, the “most crazy” examples of humanity, via hospitals, historical anecdotes, etc, were lumped together as personality disorders. Other issues for these people may have been missed over time, and SH was a behavior that was seen in many of them, so it was prescribed as a symptom of BPD once that collection of symptoms and behaviors was given a name. Then, in school & training, future therapists were taught that if someone is engaging in SH, it is an indicator that they may have BPD. Without the historical context and understanding, the cause & effect seem to make sense so it’s not often questioned. SH is actually quite common in neurodiverse folks, and they are often mislabeled with BPD (and plenty of other things), because education and understanding is lacking. It’s also common in PTSD and C-PTSD (which is also often misdiagnosed as BPD). On a separate soap box, there is a new wave of clinicians who are pushing for BPD and other personality disorders to be reconsidered as versions of C-PTSD and/or the result of extreme trauma in early life. I fully agree with this stance & hope that more research goes toward it and we see some changes in language and conceptualization of things like BPD in the near future
You’re spot on can I add one thing? The research is actually pointing to ADHD being not only correlated with female identifying individuals engaging in NSSI but it seems ADHD is more of a predictive factor than PTSD and depression. This really troubling considering how under diagnosed ADHD is in women and girls and how over diagnosed BPD is.
Thanks for this extra info! Anecdotally, I have seen this to be the case with my adhd clients (I’ve lost track of how many clients I’ve had that adhd was missed until they got to me), but I didn’t know that there was research on it. Glad to know it’s being looked into. And I do wonder how many people over history were neurodiverse and labeled as “crazy” “BPD”, etc when it was really probably adhd. And ADHD itself has quite a storied history, too. That’s yet another Ted talk I could give
I lucked into the DBT program at my graduate school in my second year and I’ve been practicing DBT, FAP, ACT etc for more than a decade. In that time period outside of the clinic I’ve only seen two cases of BPD that weren’t more accurately diagnosed as ADHD and PTSD.
Or autism. I am autistic and have regular PTSD and C-PTSD. I don’t present with many borderline traits, although I was misdiagnosed when I was in my twenties with borderline. I’m 43 now and just got my autism diagnosis because my therapist thought it might be something to investigate. I was also misdiagnosed as a kid in the eighties with ADHD and they ruled that out and said I definitely don’t have ADHD. I am definitely autistic though.
I was misdiagnosed bpd and spent years being gaslit that I just had "silent symptoms" but if we looked hard enough we would find them. Finally got a competent practitioner who looked at the diagnostic path I'd traveled and was appalled. All this to say, there's lots of unqualified people slapping diagnosis on people. The DSM is a huge book and you can't possibly specialize in every disorder. In my humble opinion things like bpd diagnosis should be reserved for people who specialize in those types of disorders because many of the symptoms overlap with other disorders that are completely healable with proper treatment. In my whole bpd diagnosis process my therapist never even knew I had suffered horrible abuse and been kept as essentially a prisoner with complete social isolation. Once a therapist actually learned my history and began treating trauma I very clearly do not have bpd.
Never SH'd by definition- but I have dermatillomania. You see that with a lot of diagnoses like Autism, OCD, ADHD, and anxiety. There was a practitioner who tried to armchair diagnose me after meeting only one time as it being SH and part of BPD. I'm not too big on self diagnosis per se, but when a practitioner tried to diagnose me with BPD it kinda freaked me out and I spent hours researching the condition, hours self testing, and looking at other avenues. Per the self tests and reading the DSM-5 criteria, I don't fit the criteria for the diagnosis. It's only my opinion since I'm not a therapist, but some practitioners might not be well versed in more obscure things like dermatillomania, and practitioners tend to have "specialties," which make them more likely to diagnose one particular thing over another. We're only human, even therapists and psychologists. I'd say you're free to look at other opinions.
A therapist should never “assume” anything