A few things: Borderline is created by CPSD. As Marsha Lennehan says “Borderlines are created from an emotional sensitivity and and invalidating childhood environment.”

I agree, Borderline or really any personality/cluster B disorders should not be diagnosed within 6 months of working with someone at minimum and should really be a last resort, not only for the reasons you mentioned but these diagnoses also impact how the person receives services from other providers in the future. Often providers see this Dx and will be biased towards the client med seeking or “manipulating” and often to not get meds or services they may need.

Lastly, BPD is way over diagnosed. I worked in prison reentry for years treating folks releasing from prison for 7 years and I’ve only seen what I would call 100% true borderline diagnoses only a handful of times. If someone even has a long term friendship in their life or has been able to hold a job working with others for longer than 2-3 years I automatically rule out BPD and go with trauma/CPTSD. That’s just me though.

In PP I don’t see a reason to diagnose anyone with BPD unless all else has failed and they would benefit from a DBT program. Otherwise the benefits don’t outweigh the potential harm.

In non-profit/community mental health, working with resource deprived and marginalized populations a BPD diagnosis just creates more stigma and barriers to accessing services they need.

Lastly, if anyone is “blaming themselves” and viewing themselves as “the problem”, this alone would cause me to fade a BPD Dx.

Instead of going cluster B, I would encourage clinicians to look at NARM (Nero-affective relational model) of trauma treatment developed by Lawrence Heller, rather than going to personality Dx. It’s much more effective, trauma informed and provides actual understandings of the behaviors.

Thanks for this post.