Why Is It So Hard to Get Diagnosed With BPD? (And Is Anyone Doing Anything About It?)

This topic is deeply personal to me, because it only took a little over 30 years (give or take!) to finally get my Borderline Personality Disorder diagnosis. Of course, being both “highly functioning” and a certified perfectionist made the journey extra slow—as if I’d set my GPS for “scenic route” by accident. After many years, a family and two wonderful children, what was hidden finally came out to play…and let’s just say, it did NOT play nice.

Let’s say you’ve been feeling all the feelings—all at once, very intensely, all the time. You finally muster up the courage for the therapist’s couch, bravely ready to put words to the chaos. Imagine your surprise when—three different therapists and a pile of mental health quizzes later—you’re still wandering in the diagnostic wilderness, possibly clutching a stack of pamphlets about everything but Borderline Personality Disorder (BPD).

Why the run-around? Why is nabbing a BPD diagnosis—despite those tell-tale Google searches—so much trickier than finding matching socks when you’re late?

#1: The Diagnosis Is Wrapped in Stigma

First up, BPD comes with a PR problem. Some clinicians hesitate to hand out the diagnosis because, frankly, BPD has a reputation (think: the ‘bad boy’ of psychiatry). Some professionals worry it might feel like getting stamped with “troublemaker,” and not in the cute, rebellious movie-montage way.

#2: Emotional Countertransference—Wait, Who Has the Feelings?

Here’s a fun twist: clinicians are human, too. Sometimes, when faced with the emotional rollercoaster that is BPD, even highly trained therapists might feel overwhelmed, frustrated, or worried—leading to “countertransference,” which is psychologist-speak for, “Wow, I’m really feeling some kind of way about this.” Instead of seeing the big picture, they might shy away from making a firm call.

#3: Symptom Soup

BPD loves a good costume party. Its symptoms can dress up as anxiety, depression, PTSD, or even good old-fashioned existential angst. Clinicians who aren’t specially trained might chase down every lookalike, making a proper diagnosis as slippery as an eel on an oil-slicked dance floor.

So, Are Specialists Just Throwing Their Hands Up?

Not at all! Here’s how the mental health field is trying to clean up its act (and maybe even return your missing sock):

• Trauma-Informed Approaches: Some experts are asking, “Hey, instead of labels, shouldn’t we look at what actually happened to you and how you survived?” Novel concept, right?

• Destigmatization: There’s a movement to clear BPD’s bad rap and see it simply as one flavor of the human experience, with its own quirks and strengths (see: super empathy, creativity, and fierce loyalty).

• Training, Training, Training: New waves of education encourage clinicians to get comfy talking about BPD, recognize their own reactions, and see the human—not a diagnosis—across the room.

• Connection Matters: Clinicians are encouraged to build authentic, compassionate relationships, which not only helps with diagnosis but also with the healing itself.

A Hopeful Outlook (Yes, Really!):

If you’ve spent years wondering what’s going on inside your mind—or dealing with wrong or missed diagnoses—you’re not alone, and you’re not hopeless. The field is changing, ever so slowly, in the direction of compassion, science, and openness. More therapists are learning to spot BPD, talk about it without judgment, and support healing rather than despair.

So keep advocating for yourself, laugh when you can, and remember: the search for an answer isn’t wasted time. It’s part of the story—and with more understanding, things are actually getting better.