Should You Tell The Borderline He's Borderline?

Most treatment approaches, including Dialectical Behavioral Treatment, Mentalization Based Treatment, and Gunderson’s Good Psychiatric Management, initiate the therapy program by educating the patient about BPD. Experts in the field, Linehan, Kernberg, Gunderson, and others in the field, endorse this approach. But is it always best to label the patient with this diagnosis?

In most cases, an individual seeking help is relieved to learn that his behavior has a name, is understood, and can be treated. Many patients are already familiar with the diagnosis, and feel validated by the therapist’s confirmation. Working with the practitioner on the diagnosed disorder with targeted goals can facilitate progress. But there may be instances when emphasis on the BPD label may result in “too much information” that hinders treatment.

Most individuals who satisfy (the admittedly somewhat artificial) criteria that define our understanding of BPD also suffer from co-morbid illnesses, such as depression, bipolar disorder, substance abuse, eating disorders, etc. In some of these cases, concern with the BPD label, and its frequent negative connotations, might distract focus from what may be more life-threatening symptoms. Some BPD patients with a victimization self-image might wallow in the diagnosis, invoking the label as a reason for behaviors, but avoiding confronting them. Some BPD patients over-identify with the label, excessively researching it, and acting out symptoms.

It is always best to individualize treatment approaches to achieve the optimal fit between patient and therapist. Bestowing a diagnostic label upon suffering is much less important than determining how best to relieve it.