Case Study


Case Study

The Problem with the Borderline Diagnosis: Getting Beyond the Label

By Courtney Armstrong

September/October 2019


No diagnosis conjures up stigma quite like borderline personality disorder (BPD). Early in my career, while working in psychiatric hospitals, I was warned that BPD was very resistant to treatment and the best we could do was set firm boundaries with these patients and resist their attempts to manipulate us. Admittedly, it’s tempting to have a clear label for difficult clients who present with swift changes in mood, impulsive behaviors, and an uncanny ability to expose our vulnerabilities. However, many clinicians today believe we’ve unfairly pathologized people some call “borderlines,” rather than acknowledge our failure to do a better job of addressing the attachment issues underlying their struggles.

While therapy approaches like Marsha Linehan’s dialectical behavior therapy have provided guidelines for teaching these clients coping skills, research indicates attachment trauma plays a major role in the development of BPD. Indeed, when I began to think of BPD as being a form of anxious or disorganized attachment, instead of a terrifying mental illness, treating it became easier. More importantly, my clients got better.

Leslie was one of the tormented souls who taught me this lesson. Even though she was 30 years old, she looked like a teenager the day she shuffled into my office, wearing baggy jeans and a huge Hello Kitty sweatshirt that swallowed her lithe, 90-pound, 5’ 2” frame. Her pale blue eyes peeked out timidly beneath her curly red hair. She whispered,…

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2 Comments

Wednesday, October 30, 2019 4:36:29 AM | posted by Donna Donato
Great article and a gentle reminder

Saturday, October 26, 2019 5:32:12 PM | posted by Mary kay Cocharo
Leslie was a very lucky client to find Courtney! As always, her work and it’s description, is clear, intelligent, compassionate and effective. Thank you for sharing this clinical story.