Why is Borderline Personality Disorder Hard to Diagnose?

Borderline personality disorder (BPD) can be hard to diagnose because the symptoms of this disorder overlap with many other conditions, such as bipolar disorder, depression, anxiety, and even eating disorders. Some of the symptoms of BPD closely resemble these other psychiatric problems and, for that reason, it is often misdiagnosed or underdiagnosed.

What are the Signs and Symptoms of Borderline Personality Disorder?

A person with borderline personality disorder has a lot of difficulty with regulating emotions. Feelings are experienced with a great degree of intensity, and it can be hard to return to a calm state of mind after an episode of extreme emotional upheaval. Key signs and symptoms of this disorder include:

• Intense fear of abandonment
• Unstable personal relationships
• Unstable or distorted self-image
• Risky, reckless or impulsive behaviors
• Self-harming behavior, which may include suicide attempts or threats
• Recurring feelings of emptiness or boredom
• Depression and anxiety
• Intense outbursts of anger followed by shame or guilt
• Dissociative feelings, loss of contact with reality

How BPD is Diagnosed and Why it is So Often Misdiagnosed

Diagnosis of borderline personality disorder starts with a physical exam to rule out medical causes for behavioral changes. The doctor or mental health provider will conduct a detailed interview and review all signs and symptoms that have been occurring. A psychological evaluation may include a questionnaire. In some cases, there may also be interviews with previous clinicians or with family members or friends.

Because there is no easy method to diagnose BPD, the medical professional may become focused on particular symptoms and may come up with a diagnosis of a variety of similar conditions, which include depression, anxiety, bipolar disorder, eating disorders, substance abuse and post-traumatic stress disorder. When only one or two symptoms become the focus, the big picture may be missed.

Borderline Personality Disorder and Stigma

Personality disorders in general and borderline personality disorder in particular are often associated with stigma.  Patients who have been diagnosed with BPD may feel ashamed as they encounter discrimination and negative assumptions from others.

Even mental health professionals are sometimes under the assumption that borderline personality disorder is not treatable or that patients resist treatment. Because of the stigma associated with this disorder, medical professionals can be reluctant to diagnose a patient with BPD or may even refuse to use this diagnosis even when all the signs and symptoms are clearly present.

Borderline Personality Disorder Treatment

A person with BPD who is misdiagnosed or encounters a medical professional who refuses to diagnose BPD even when aware of the problem will not be able to obtain effective BPD treatment that can improve symptoms and make a difference in the individual’s life. Misdiagnosis can lead to an ineffective approach to treatment.

Engaging in a comprehensive treatment plan can lead to positive outcomes. Successful BPD treatment includes a combination of psychotherapy and support from peers and family members. Medication may be indicated in some cases, particularly in people with co-occurring disorders.

Psychotherapy for BPD Treatment

Psychotherapy is the most important aspect of borderline personality disorder treatment. It helps the individual learn new coping skills and gain insight into emotional upheavals and reckless behavior.

Dialectical behavior therapy (DBT) is offered at both residential and outpatient treatment centers for borderline personality disorder. Through progressive stages of treatment, individuals gradually increase coping skills and improve in their ability to regulate their emotions, tolerate distress and improve their personal relationships.

Other forms of psychotherapy can also be helpful in the treatment of borderline personality disorder, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy.

Although BPD can be difficult to diagnose, after obtaining a correct diagnosis there are options for treatment that will help bring symptoms under control. Effective treatment begins with getting an appropriate diagnosis. With the proper treatment, BPD is treatable and those with BPD can lead healthy, productive lives. Dialectical behavior therapy (DBT) was developed specifically for BPD. Using the concept of mindfulness, DBT focuses on paying attention to present emotions. DBT teaches skills to control intense emotions, reduce self-destructive behaviors, manage distress, and improve relationships.