"The Mystery of Borderline Personality Disorder"

Time Magazine has a really good article out called "The Mystery of Borderline Personality Disorder," and it explores the intricacies of this poorly understood illness.

There does appear to be some overlap between many of the personality traits of Borderline Personality Disorder (BPD) and people with binge/purge behaviors. Some clinicians freely make the BPD diagnosis, which may or may not be ultimately true. While a person is malnourished and engaging in ED behaviors, it's impossible to tell which actions are driven by a starved brain and which by BPD.

Regardless, one of the key therapies for BPD--indeed, the only evidence-based treatment for the illness--is now being used to help treat eating disorders. Dialectical Behavioral Therapy is based on four core modules: mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. While the evidence base is pretty strong for DBT as a treatment for BPD, it is growing for eating disorders. Indeed, many residential treatment centers incorporate DBT into their treatment programs (more or less).

The article is very well written and non-judgemental, and I love seeing how science is opening people's eyes to both the illness itself and into possible treatments. But the best part of the article is a quote from Marsha Linehan, the developer of DBT- a quote I wish was just as embraced by the ED world:

It's important to note that Linehan doesn't just practice tough love with her patients; she also tells them she knows they are hurting and doing the best they can. She emphasizes that she believes in them even though many therapists have tossed them aside. "Clients cannot fail," she says. "But both treatment and a therapist can fail."
(emphasis mine)

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Debra said...

I've been following your blog a little while and generally been very impressed by your commentary. I am, however, very disappointed by this entry because there doesn't seem to be any acknowledgement on your part of how controversial the BPD label is (Have you looked at how vague the DSM criteria are?), or how punitive and damaging it can be.

In fact, while the Time piece may appear "non-judgemental", I'd suggest that it's also painfully neglectful of current sociological, feminist, and scientific criticism of the diagnosis. I can assure you that there's little "poetic" or "mysterious" about the impact of carrying the label in most institutional and insurance settings.

I understand that your interest here is really in the potential usefulness of DBT for eating disorder sufferers. I do think, however, that some recognition of the limitations of the piece would go a long way.

Carrie Arnold said...


Well, yes, virtually all DSM criteria for any illness is vague. And our understanding of most mental illnesses is vague. You're right- people can be labeled unfairly.

However, as a science writer, I know that writers have to limit their article in scope. I think the limitations of BPD diagnosis would be really interesting, but you can't address everything in every article.

You're welcome to disagree with me, of course, and I'm glad you pointed out some of the limitations. I am quite limited by time to point out the limitations of every article I write about; I was intending to point out there are other illnesses out there about which not much is known, and which has some overlap with EDs. That's all. I don't know enough about BPD to put together a lengthy, accurate commentary on everything I read.

marcella said...

As someone with a loved one who has, at various points, been given both "labels" - "ED" and "BPD" I'm fascinated by this and thank you for posting it. However I don't have much time to read it at the moment so I'll be back later to pour over it in detail.

Lola Snow said...

Hands up everyone who has been tarred with the BDP diagnonsense? Me too. What annoys me more is that genuine patients of BDP bear an incredible amount of pain, and when the label is banded about to anyone who has Bulimia and depression, it takes the focus away from them.

Not to mention it means the misdiagnosed recipient can no longer easily get into mainstream ED treatment, and is shoved into "Complex Needs", the service treating all the genuine BDP sufferers, a hotbed of emotion, and tough love.

Lola x

Carrie Arnold said...


You raise a valid point. Diagnosing BPD is tremendously difficult, and I don't think it should be given to people with EDs until symptoms are under control.

And our mental health system (whether US or UK) has a hard enough time dealing with a single diagnosis and has literally NO CLUE what to do should a person have more than one illness.

marcella said...

I agree that the diagnosis is STILL handed out as a catch all label for those who services don't want to deal with. Lola, your Trust is possibly unusual in having a "Complex needs" service - ours just seems to try to offload anyone difficult onto someone else/anyone else.

All that said, the article is hopeful and has certainly encouraged me to keep looking into DBT as an option for me and mine.

Just one criticism - WHY are two out of three of the sponsorship ads at the end for diets?

Carrie Arnold said...

Most sponsorship ads are diet ads, I've found!

Tormented said...

The TIME article was good at explaining the basics of BPD and how many people it affects.

I don't agree with the other posters that this is a vague or catch-all diagnosis. If you spend some time with a person who appears to have it, you will know that their behaviors are really extreme. I'm talking about extreme like you make a valid compliment of the person or something they've done, and the next thing you know is you've got the person raging at you about how you are a liar and trying to manipulate them. There was no argument before the compliment, and a compliment doesn't seem a reasonable trigger for such emotionally intense hate being flung your way. Maybe this is why it is sometimes called Emotional Intensity Disorder.

The worst part about the TIME article is what it doesn't cover. It left out the impact Borderlines who haven't learned to control their behaviors have on others. That's like writing about a war and leaving out all the parts about death and destruction.

For more on that perspective, see a blog post TIME Covers BPD but Omits the Full Story.

Carrie Arnold said...


Thank you for the link- I will check it out when I get a moment.

I do think an article about what happens to people who don't get adequate treatment for BPD would be great- my cousin has severe BPD and her life is in shambles and it's really really sad. However, knowing what I do about science journalism and space requirements, I'm not surprised that it didn't get included in this particular article. I do, however, think it should be covered in another article.

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