Borderline Personality Diagnosis: Two Things That Matter

The cover story of Psychology Today this month, “Diagnosed In Adulthood,” made me think back to the timing of my own diagnoses. They all came in adulthood, in my late twenties: anorexia, major depressive disorder (with the modifier of with psychotic features added later), and borderline personality disorder.

This was 1990 and we had never heard of borderline personality disorder. Depression, yes. Anorexia, yes, but BPD, no. There was no internet to turn to, no way to research this diagnosis. We had to take the doctors’ word. Even though I was 29 when I was diagnosed with BPD, the team of the psychiatrists on the acute unit to which I was admitted following my second suicide attempt spoke to my parents and not to me. My mother didn’t tell me this until many years later, but the psychiatrists had told them the prognosis was poor and not to hope for much.

An article that discusses the life span of individuals with borderline personality disorder states, “Until around 1990, therapeutic nihilism prevailed concerning the treatment options of BPD. Since then, beneficial effects have been demonstrated for four comprehensive treatments: dialectical behavior therapy (DBT), mentalization-based treatment (MBT), transference-focused psychotherapy (TFP), and schema therapy.”

It looks as though I was right on the cusp. The psychiatrists’ prediction to my parents reflected the therapeutic nihilistic thinking that accompanied the BPD diagnosis right…