For years, I was diagnosed with major depressive disorder. One of my doctors said I had a form of bipolar disorder and only a few years later was I diagnosed with BPD. It seems that it is a frequent occurrence.
People with BPD typically also meet the criteria for multiple other diagnoses, including depression, anxiety, post-traumatic stress disorder, substance use disorders, eating disorders, bipolar disorder, and so on. These disorders, of course, are not independent of BPD, but are connected and related through shared psychological, social and biological pathways. However, when these other diagnoses are the focus of treatment, they can dominate professionals’ attention, preventing any significant focus on the whole pattern of difficulties, resulting in missed diagnosis of BPD.
This is one of the factors. It also doesn’t help that so many people keep important details about themselves a secret while being interviewed by a mental health professional.
The fact that the diagnostics requirements are so arbitrary is also a reason why so many people go undiagnosed.
To be diagnosed with borderline personality disorder, a person must demonstrate a number of core traits or symptoms, as identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).But there is an inevitable degree of randomness or arbitrariness built into such standards. If an individual experiences just a few of these symptoms intensely or in a broad range of situations, their lives might be disrupted even more than someone experiencing even more symptoms at a manageable level. Nevertheless, they would not pass the diagnostic threshold for BPD, and if they had a BPD diagnosis in the past they might now be considered “in recovery.” If borderline personality disorder exists on a continuum with varying levels of severity, its rate of incidence may still be underestimated, given the requirement that a certain set of symptoms be detected before a diagnosis can be given. Should standards ever change to include those seriously impacted by fewer symptoms, the rates of diagnosis for borderline personality disorder could rise once again.
This is a major problem and something that should be solved by the mental health community. You can be severely affected by only a few symptoms and improve with DBT or medication for BPD.
There is also the myth that BPD isn’t treatable.
Some of the problems with diagnosing result from the fact that there was no evidence of effective treatment for BPD until the 1990s. The first published evidence for the effectiveness of Dialectical Behavior Therapy was by Marsha Linehan in 1991. Before then, many clinicians blamed people with BPD for not getting better, rather than acknowledging that professionals had not yet figured out how to treat people with BPD successfully, or trying to find more effective pathways for treatment. Today, unfortunately, many professionals continue to think that BPD is not treatable despite growing evidence that it is. This leads some professionals to avoid giving the diagnosis even when someone meets the criteria.
It’s a shame that so many psychiatrists and psychologists don’t know about DBT and how helpful it is for people with personality disorders like BPD. Though, according to my psychiatrist, every kind of psychotherapy can be helpful. If you don’t have DBT in your area, you can buy a book or ebook and do the exercises. You can ask a psychotherapist to do exercises from the DBT book. Some psychotherapists agree to it. Mine did. In my case, DBT was very expensive and now I’m doing therapy for a fraction of the price.
If you feel like you have been misdiagnosed, find another doctor. Find one that specializes in BPD or personality disorders. Don’t give up. It happened to me and a lot of us. Be as descriptive as you can, take notes during the week to discuss with your therapist. This helps doctors and therapists to have a clearer picture of what is going on with you.