As a therapist who specializes in Dialectical Behavior Therapy (DBT), people with Borderline Personality Disorder (BPD) are the focus of my work. Like most therapists I know who also specialize in DBT, I have so much compassion for people who work so hard to improve their lives, achieve their goals and build a life worth living. I am almost daily rendered speechless by my client’s insights, drive and willingness to do whatever it takes to have the life they want.
Because of that, any time a client or even potential client tells me that they have been researching “Borderline Personality Disorder,” I have a very mixed emotional response. On the one hand, when someone who has been struggling, sometimes for years, to find a label or an explanation for their struggles finally discovers BPD, that can be very reassuring for some people. Everything seems to click into place and their struggles start to make sense. And then to find that there is a type of therapy specifically designed to help them — Dialectical Behavior Therapy — can give lots of hope! People allow themselves to begin to have hope that things can actually get better.
On the other hand I often worry about all the frightening, judgmental things they might read online, or the hope-crushing experiences they may have to endure in trying to find an effective BPD therapist. It does not take long for people to run up against the stigma of Borderline Personality Disorder.
Descriptions such as “manipulative,” “attention-seeking,” “unmotivated” and “treatment resistant” are frequently used by professionals and lay people alike (except for perhaps that last one — I don’t know of many lay people who throw around terms like “treatment resistant”).
Mental health professionals often perpetuate this stigma by misdiagnosing clients, by declining to work with people who have BPD, or by using methods of treatment that have no evidence of efficacy for Borderline Personality Disorder. In addition, incorrect information online can easily reinforce the idea that people with Borderline Personality Disorder never get better.
The Stigma from Within the Mental Health Field
Perhaps the most damaging form of BPD stigma comes from the professionals who are supposed to help. Research has documented that mental health clinicians — including therapists, psychiatrists, and emergency room staff — often hold more negative attitudes toward patients with BPD than toward patients with other diagnoses. People with BPD are frequently described in clinical settings as “difficult” or “resistant to treatment,” language that would rarely be applied to someone with depression or anxiety.
This professional stigma has real and measurable consequences for patient outcomes. Some therapists explicitly refuse to work with BPD patients. Others accept them but approach treatment with low expectations, which becomes a self-fulfilling prophecy. When a therapist doesn’t believe a client can improve, the client picks up on that — and their own hope erodes.
Misdiagnosis is another consequence, and it is one of the most common ways stigma directly delays effective treatment. It is not uncommon for people with BPD to arrive at our practice diagnosed with Bipolar Disorder or Major Depressive Disorder, having spent years in therapeutic work that does not quite address all aspects of their life. While BPD can co-occur with these conditions, the treatments are different. Someone receiving medication management for bipolar disorder when their primary issue is emotion dysregulation stemming from BPD is unlikely to get the relief they need — because the core problem isn’t being addressed.
What the Research Actually Shows
The stigma around BPD rests on outdated assumptions. Here is what we actually know:
DBT works. Dialectical Behavior Therapy has been studied in dozens of randomized controlled trials and consistently demonstrates significant reductions in suicidal behavior, self-harm, emergency department visits, and psychiatric hospitalizations. After one year of comprehensive DBT, the majority of participants no longer meet full diagnostic criteria for BPD.
Recovery is common. Longitudinal studies following people with BPD over 10 to 20 years show that the natural trajectory of the condition is toward improvement. The most dramatic symptoms — self-harm, suicidal behavior, impulsive actions — tend to decrease first. With effective treatment, this improvement happens faster and more completely. The McLean Study of Adult Development, one of the longest-running longitudinal studies of BPD, found that by the 10-year follow-up, 85% of participants had achieved remission that lasted at least four years. These are not outliers — they represent the expected course of the condition when adequate support is available.
People with BPD are not “manipulative.” What gets labeled as manipulation is almost always a desperate attempt to get needs met by someone who lacks the interpersonal skills to ask directly. When you understand the biosocial model — that BPD develops from the interaction between biological emotional sensitivity and an invalidating environment — the behaviors that look manipulative from the outside make complete sense from the inside. They’re survival strategies developed in response to overwhelming emotional pain, not character flaws.
The Impact of Stigma on Help-Seeking
All of this rattles around in my head when someone mentions they have looked up Borderline Personality Disorder online as I prepare to refute any of the negative things they may have read or validate their frustrations at trying to find a therapist who gets it and can help them work toward their goals. I keep this information in the front of my mind when doing phone consultation and intakes, reviewing disappointing and sometimes harmful experiences people have had in treatment before. It is not uncommon for people with BPD to come to our practice diagnosed with Bipolar Disorder or Major Depressive Disorder, having done therapeutic work that does not quite seem to address all aspects of their life and the symptoms of BPD they struggle with. It is also not uncommon for people to show up in our offices with little belief or hope that this time will be different, or this type of treatment will work.
The stigma doesn’t just affect how professionals view BPD — it affects whether people seek help at all. Someone who reads that their condition is “untreatable” may decide that therapy isn’t worth trying. Someone who has been turned away by previous therapists may stop looking. Each negative experience compounds the next, and the person who most needs help becomes the person least likely to pursue it.
What We Can Do
As a therapist who specializes in Dialectical Behavior Therapy, who made an active choice to learn this type of therapy and work with people who have Borderline Personality Disorder, I am mindful of this great burden. This burden is shared by all mental health professionals — to work to decrease the stigma associated with BPD. We can do this by educating ourselves thoroughly about what Borderline Personality Disorder really is, how to effectively treat it, and holding other mental health professionals to the same standard.
For those of us in the field, fighting stigma means using person-first language (“a person with BPD” rather than “a borderline”), correcting misinformation when we hear it from colleagues, refusing to use pejorative labels in clinical notes, and — most importantly — providing the evidence-based treatment that demonstrates recovery is possible.
For family members, fighting stigma means learning about what BPD really is, understanding that your loved one’s behavior makes sense in the context of their experience, and advocating for appropriate treatment. Involving family in treatment can be transformative for everyone involved.
For people living with BPD, fighting stigma starts with rejecting the narratives that say you can’t get better. You can. The evidence is clear, the treatment exists, and the right therapist — one who specializes in DBT and understands your experience — can make an enormous difference. Recovery doesn’t mean you’ll never struggle again. It means you’ll have the skills, the self-awareness, and the support to navigate those struggles without being defined by them. Many people who complete comprehensive DBT go on to build careers, sustain healthy relationships, and live lives that look nothing like what the stigma would predict.
We must be realistic about the barriers our clients will face, not only internally but externally due to a diagnosis, and always be prepared to help gently correct misunderstandings and cultivate hope in the lives of our clients.
If you’re struggling with borderline personality disorder, or wonder if this diagnosis might explain some of the difficulties you are facing, contact us today to learn how DBT can help you reach your goals. You can also read our guides on how to find a BPD therapist and what to look for in a DBT program.
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