Do I have BPD? Do I need DBT?

Knowledge about Borderline Personality Disorder (BPD) in the mental health system and wider community has certainly increased over time. When I first started working in community mental health my organisation would often receive referrals where the presenting problem was couched as “depression, anxiety, PTSD, chronic suicidality and self-harm”.

This was written almost as a code to ensure that the client got help without disclosing that the primary diagnosis was BPD. Many times I would call these referrers and tell them that they could provide the (missing) primary diagnosis because we did work with this client population (this was at a time when government funded mental health clinics would often exclude from treatment people with personality disorders).

To some extent the reticence to diagnose BPD continues today. Experts suggest that BPD can be diagnosed as young as 12 years old but those treating adolescents will often withhold what is seen as being a pejorative label. Some mental health professionals treating adults also withhold the BPD diagnosis, sometimes because they hope that the client will come to this understanding on their own, or other times because they want to protect their client from the stigma that is associated with this label, including in our emergency departments.

I feel differently. When I meet a new client where BPD is the accurate diagnosis I am quick to share this information with them for a number of reasons. Firstly, because they are entitled to know this vital information about their own mental health. People with BPD have often been misdiagnosed and mistreated for many years. Secondly because information is power. Knowing your diagnosis means that you can seek out others in the same boat and get the validation that comes from others who’ve walked the walk. But thirdly, knowing your diagnosis means that you can get the right treatment quickly. DBT has the highest level of evidence attainable for the treatment of BPD and has a good chance of success.

Which brings me to the last reason I am willing to diagnose BPD. It is because I really enjoy working with people with BPD. I feel positive about the diagnosis because I know that DBT is likely to give them the skills they need to overcome life’s challenges. I have had the pleasure of working with so many people who undertake our program and subsequently lose the diagnosis of BPD that I feel tremendously hopeful when the diagnosis presents itself.

A diagnosis of BPD is the beginnings of hope. Treatments that work are here!