Your Bias Against People With Borderline is Still Ableist

256.

That’s how many different ways borderline personality disorder can present itself, just looking at the diagnostic criteria alone. Factor in co-existing disorders, trauma history, and all of the biological, sociological, and psychological influences that make us individuals? You’ll find that “borderline personality disorder” loosely describes a very diverse group of people.

It’s also been used to describe me. More specifically, as a survivor, it’s been used to describe the sort of “emotional PTSD” I developed overtime as a response to very traumatic life circumstances.

But no one ever wants to talk about borderline as a product of abuse. I continue to encounter people who only view borderline as a propensity for abuse — as irredeemably horrible people to be avoided at all costs.

And painting people with borderline with one uncomplicated, overgeneralized brushstroke? Treating us like a plague, as inherently immoral, as dangerous? That’s still ableist.

We need to start calling abusers what they are: Abusers.

And we need to start calling people who unilaterally demonize people with any mental illness what they actually are: Ableist.

Because here’s the thing: So long as we keep treating borderline as synonymous with abuse, we take a very painful and difficult disorder and deeply stigmatize it. BPD is not a disorder that causes abuse — more appropriately named, it’s a disorder of emotion dysregulation. Abusers themselves, regardless of their mental health status, are solely responsible for their actions.

I’m not denying that there are people with borderline personality disorder that are abusive. But I reject the idea that all people with BPD are abusive, or should be assumed to be abusive. And further, I reject the idea that people with BPD aren’t deserving of competent care and compassion that would allow them to thrive — and if we dismiss them as being irredeemable, that support becomes more difficult to access.

I also think that, too often, we erase survivors who have developed the disorder as a valid response to trauma. We selectively look at abusers who have borderline, while ignoring the high prevalence of trauma in borderline folks. Many of the symptoms associated with BPD, like dissociation and interpersonal instability, are incredibly common in folks who have been abused.  In fact, if we took into account trauma history, many (but not all) people with borderline could easily be diagnosed as having complex PTSD.

With all the same symptoms and simply a different framework, we go from being assumed to be abusers to being honored as survivors — that’s the power of stigma.

As a survivor that has been diagnosed with both complex PTSD and borderline, I find myself stuck between a rock and a hard place. To access spaces where I can connect with other survivors, I find myself withholding my borderline diagnosis, so I’m not considered “suspect.”

But as someone who believes that borderline shouldn’t be stigmatized, rejecting BPD as a diagnosis feels like betraying other people with the disorder who are battling everyday against painful assumptions.

I personally find “borderline” to be a difficult word to reclaim, because it’s so entrenched in negative assumptions that it fails to be a useful word when I’m trying to access spaces that help me and mental healthcare that supports me. If I enter into a space as a person with borderline, I am feared and ostracized. If I enter into a space as a person with complex PTSD, I am cared for and affirmed.

Ask anyone if they want to see people with borderline to be well and to thrive, and they won’t necessarily disagree. But ask them to be careful about the language that they use — so that thriving is a real possibility that isn’t impeded by stigma — and you’ll get pushback that these conversations stigmatizing borderline are actually helping survivors.

I’m wondering which survivors are being helped by these conversations, though. Because survivors with borderline don’t seem to count — they’re apparently just a necessary casualty here, as if their trauma doesn’t matter the moment they become too emotionally unstable, too much.

As a trauma survivor, I deeply empathize with folks who have been abused by someone with BPD, and have found community and support by connecting with other people who have been similarly abused. But I believe that we can have conversations about patterns of abuse without ableism — and decoupling “abuse” and “borderline,” recognizing that there are many ways that BPD manifests, is an important first step.

The reality is, we relinquish abusers of their responsibility if we attribute their abuse to mental illness, rather than demanding that they take ownership of the harm that they’ve caused. And when we equate a particular mental illness with abuse, we draw false equivalences that actually harm survivors and psychiatrically disabled folks alike.

The reality is, most people with BPD are far more likely to hurt themselves than someone else (notably, this is true of mental illness generally). And much of the research shows that mental health outcomes improve drastically overtime for folks with borderline (90% will be more or less “recovered” by age 50), especially when they have access to competent care.

But the more that we interfere with folks seeking out that care, the longer it takes for folks with BPD to access it — which, no doubt, contributes to the 1 in 10 people with BPD that complete suicide (a number that, frankly, should be unacceptable to us all and cause for alarm).

Survivors, then, don’t need to be unilaterally protected from all people with BPD — survivors need to be protected from people who exhibit abusive behaviors, regardless of their mental health status. Behaviors like poor boundaries, manipulation, impulsivity, aggression, and verbal abuse are not unique to BPD and never have been; the sooner we recognize that, the better we can support all survivors and not just those we deem “worthy” of that care.

Abusers have never been taken to task by pushing responsibility off of them and onto an inherent “disorder,” and survivors have never been helped by demonizing and pathologizing their trauma. 

This false dichotomy — that it’s survivors versus “borderlines,” that we are always at odds — has created the very harmful idea that abuse is a disorder, and that survivors with maladaptive coping strategies are inherently dangerous or untrustworthy. The reality is much more complicated than this, which is that abusers are not a monolith and neither are survivors.

Mentally ill folks are falsely and repeatedly depicted as violent, dangerous, and dishonest. And it’s ableist, regardless of the disorder, to make those generalizations.

While folks with borderline may exhibit behaviors or coping strategies that can be leveraged in abusive ways, it’s ableist to assume that all of them will present that way. Some abusers have BPD, but not all people with BPD will go on to be abusers — similarly, some abusers are survivors of abuse themselves, but not all survivors will go on to abuse, either.

There are many risk factors that correlate with abuse. But those correlations do not cause abuse.

I am close to many people who have borderline, and many of those relationships are beautiful in their own way. I’ve found that, for folks with BPD who have a solid support system, some of the best qualities can emerge out of those struggles. I’ve known folks with borderline to be incredibly loyal friends.

They care deeply. They feel intensely. And that kind of depth, when harnessed, leads people with borderline to be some of the most passionate and empathic people that I know.

I’m not asking anyone to maintain a relationship with an abusive person. I’m also not asking survivors to ignore their gut feeling when a person seems like they could be harmful, or stay in a relationship that seems like it’s heading into dangerous territory.

I’m just asking folks to self-reflect on their biases, and in particular, acknowledge the ways in which those biases can be harmful.

Especially when considering the long history of borderline as a diagnosis being leveraged to dismiss “difficult” patients (especially women) and linked to oppressive ideas about marginalized people, we should all be wary of the conclusions we draw based on a framework that is already, in many ways, flawed.

As a survivor of trauma, there is no deeper betrayal (in my mind) than other survivors ostracizing me because of a mental health diagnosis — especially one that is a direct result of a kind of suffering we both share. Our coping strategies may be different (and the intensity with which we feel this anguish may differ, too), but our pain is very much the same.

If we’re invested in a world in which those struggling with mental illness can access the support, care, and compassion that they need to live well, we need to push back on this idea that disorders like borderline are inherently abusive, and that those suffering from them are disposable.

Dehumanizing people, regardless of their diagnosis or history, is in itself a very toxic behavior. And I believe that people with borderline and survivors alike deserve a hell of a lot better.

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5 thoughts on “Your Bias Against People With Borderline is Still Ableist

  1. ponetium says:

    In Trauma and Recovery it is written that there is at least 60% of corrolatin, and the author suggests that BPD is in a way the modern Hysteria. Because both were so prevelent in survivors.

    Another interesting fact that links BPD with queerness is the almost automatic tendency to diagnose multi-attractioning falks with BPD, throwing them under the bus of stigma and queer ablism (there should be a word for this intersection). I have more then one friend who were diagnosed with BPD by an incompetent psychiatrist for being Bi/Pan.

    Liked by 1 person

  2. lesbehonest2017 says:

    When teaching new residents or students about BPD I always start with- at the core of this illness is an emotional dysregulation related to an awful trauma history. I have yet to meet or treat BPD without significant PTSD, and I remind people new in our field that these patients are not perpetrators, they are survivors and they are owed that respect and dignity. I enjoyed your writing, and agree whole-heartedly that there is significant stigma around BPD and lack of empathy within healthcare.

    Liked by 1 person

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