February 17, 2021

Our Understanding of Borderline Personality Disorder is all Wrong.


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It seems that each person I meet with severe child abuse and/or neglect has a personality disorder diagnosis.

Borderline Personality Disorder (BPD).

It’s a diagnosis characterized by feeling frequently empty, not having a strong sense of self, feeling intensely, and struggling to let go of relationships. 

About 75 percent of those diagnosed with this disorder are women. 

Yes, 75 percent are women. 

Between 40 and 86 percent have suffered sexual abuse.

The majority report physical and emotional abuse, as well as neglect. 

While most have experienced significant trauma, those with this label continue to experience inappropriate treatment by mental health providers. 

These clients are often terminated early by therapists without giving significant time to process the termination.

One person I spoke to today said she was given this diagnosis this week. The therapist provided only one closing session and said their work was done. 

Such treatment of this population puzzles me. 

Time and time again, people with this diagnosis are dropped by mental health providers, and I don’t understand why. 

I also don’t understand why Dialectical Behavioral Therapy is considered the “gold standard” and is referred to so often.

While I do believe it helps many with emotional regulation and self-harm, there are many individuals with BPD traits who do not struggle with these issues, but rather, their biggest struggle is an attachment wound.

I believe it’s time the mental health system look at this population differently.

For starters, it’s time to stop using the terms:

“Attention seeking.”


“Fear of abandonment.”

Instead, we should be thinking about the effects that insecure attachment has on one’s ability to self-soothe.

We should consider talking about this population as struggling with attachment trauma and needing help to regulate the screaming child within them that wasn’t comforted enough during infancy. 

I am not a clinical psychologist. I am a researcher though who studies attachment and childhood trauma.

From personal experience, I question what clinicians are doing and how they feel that the termination of these clients is ethical. 

Rather than have them feel abandoned, why not help form a secure internal working model of attachment and allow them to leave when they are ready? 

If they would like to return, why not open your hearts and welcome them?

Just like children, when the internal working model is developed, they will likely wander away.

It’s time we do the work with these clients, and we consider other approaches that use an attachment focus lens.

If you haven’t already, consider reading Janina Fisher’s book, Healing the Fragmented Selves of Trauma Survivors, and learning about Internal Family SystemsSomatic Experience, and the Flash Technique.

There is much work to be done with this population.

It begins with more compassion, understanding of attachment trauma and its presentation, and working to heal the person from the inside out (Internal Family Systems) instead of the outside in (Dialectical Behavioral Therapy).

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