Door knobber Diagnosis: Misdiagnosed Borderline Personality

When a client drops a therapeutic bombshell as they are leaving a session, counselors call this a “door knobber”.  Lynn came to talk with Bernadine about her experience with the Borderline Personality and the door knobber that her therapist laid on her at the tail end of a phone conversation to terminate therapy.  Just before she hung up, Lynn was shocked to hear the therapist say she should consider getting a therapist who works with borderline personality.  After working together for 2-years where this was never mentioned, it was a casual, quick comment at the end of therapy.  This is a door knobber done by the therapist.   

My ex-therapist told me at one point that she didn’t believe borderline existed and that therapists only give it to the clients they don’t like.  And certainly, in therapy abuse it has become cliche.  One after another, survivors are describing being labelled borderline after confronting an abusive therapist.  Why would therapists employ borderline so often?  Because one of the things people believe about those who are borderline is that they lie and make up things:  ergo, victims won’t be believed that the abusive therapist did harm or sexual assault them.   

And once you have that label it is a sticky thing – even if it is wrong.  Worse, professionals make assumptions about folks with that label  – even when it is a misdiagnosis.  Like Lynn’s experience, people have described being told they are borderline after the first 15- to 20-minute session.  Given the level of stigma that is attached to diagnoses like this, applying them should be done with the utmost care. In fact, according to the DSM, a BPD diagnosis must be based on assessing the functioning and behaviour of the patient over a length of time AND after other diagnoses have been ruled out.  What they mandate for this diagnosis is a “thorough evaluation” that provides a “comprehensive assessment” which “considers multiple sources of information, including personal history, collateral information, and a mental status examination.” Clearly this is not possible in an initial 20-min session or during a first consultation.  But nonetheless, we hear of it over and over where this diagnosis is being applied all too quickly.  And those who have been misdiagnosed with BPD, in particular, suffer even more from the stigma the medical and mental health community. We all need to be more careful about our professional work and our attitudes. 
 
Lynn wrote an article on this issue.  It is on Medium.com and entitled “Dear Therapists:  This is what BPD Stigma looks like”.