Why I Don't Love the Term BPD (And What I Think It Actually Is)
Let me say something that might surprise you if you've recently been handed a diagnosis of Borderline Personality Disorder: I don't particularly like the term. Not because what you're experiencing isn't real, because it absolutely is. But because I think the label itself gets in the way of understanding what's actually going on, and more importantly, what's possible for you.
I've been working with young people who carry this diagnosis for close to two decades. I trained personally with Marsha Linehan, the psychologist who created Dialectical Behaviour Therapy (DBT), the most evidence-based treatment approach for this presentation. And the longer I do this work, the more convinced I am that how we name something shapes how we understand it, and how we understand it shapes whether we believe things can change.
So let's talk about what BPD actually is, where the label comes from, and why I think there's a more useful and more hopeful way to make sense of it.
What the Diagnosis Actually Says
Borderline Personality Disorder is a diagnosis characterised by intense and unstable emotions, difficulties in relationships, an unstable sense of self, impulsive behaviour, and in some cases self-harm or suicidal thinking. It's one of the more common diagnoses in mental health settings, affecting an estimated 1 to 3 percent of the general population, and considerably higher rates in clinical settings, with some studies suggesting up to 20 percent of psychiatric inpatients carry the diagnosis.
It's also a diagnosis that is given predominantly to young women, a pattern that has attracted significant criticism from researchers and clinicians over the years. Men presenting with similar patterns are more often diagnosed with antisocial personality disorder or substance use disorders. This disparity alone raises questions worth sitting with.
Here's what the research also tells us: the vast majority of people diagnosed with BPD, estimates range from 70 to 90 percent across studies, report histories of adverse childhood experiences. These include emotional invalidation, inconsistent caregiving, chaotic or unpredictable home environments, and in many cases more overt forms of abuse or neglect. A landmark study by Zanarini and colleagues found that over 90 percent of people with BPD reported some form of childhood maltreatment or neglect.
I'm not telling you this to hand you a story about your childhood. I'm telling you because this pattern matters for how we understand the diagnosis itself.
The Problem with the Word "Disorder"
The word disorder implies something has gone wrong inside you. That your personality, the way you relate to yourself and the world, is broken or defective in some fundamental way.
But what if that's not what's happening at all?
Elaine Greenberg, a psychologist whose work has significantly shaped how I think about personality, offers a different lens. Rather than personality disorders, she talks about personality adaptations. The idea is straightforward but genuinely shifts things: our personalities don't arrive fully formed at birth. They develop, they grow, they adapt to the environments we grow up in.
If you grew up in an environment that was emotionally unpredictable, where love felt conditional or inconsistent, where you had to work hard to get your emotional needs met or where expressing them felt unsafe, your developing personality learnt to adapt to that. It developed strategies, ways of relating, ways of managing intense emotion, ways of reading other people, that made sense in that context.
Those strategies might look like: needing a lot of reassurance from people you're close to. Finding that your emotions go from zero to one hundred very quickly. Struggling to hold onto a stable sense of who you are, particularly when relationships feel unstable. Acting impulsively when emotional pain gets intense.
These aren't signs of a broken personality. They're signs of a personality that learnt to survive a particular kind of environment.
You Don't Need a Trauma Story to Make Sense of This
I want to be careful here, because this is where people sometimes switch off.
You might read the words "adverse childhood experiences" and think: that's not me. My childhood wasn't that bad. I don't have memories of anything traumatic happening. And so this framework can't apply to me.
But the environment that shapes personality isn't always about specific events you can point to and name. Sometimes it's more subtle than that. An environment where emotions were never quite talked about or validated. A parent who was physically present but emotionally unavailable. Inconsistency, not cruelty, just inconsistency, in how love and approval were expressed. A family system where you learnt to attune carefully to others' moods because the atmosphere was unpredictable.
You don't need to have an explicit memory of something terrible happening for your environment to have shaped your personality in ways that now cause you difficulty. The absence of something, consistent emotional attunement, felt safety, the experience of having your inner world taken seriously, can be just as formative as the presence of something harmful.
This is why I hold the trauma framing lightly. Not because it isn't often relevant, it frequently is. But because requiring a clear trauma narrative to explain your experience can exclude a lot of people whose experiences were more complex and less nameable than that.
What the Research Actually Supports
The complex trauma literature, particularly the work of psychiatrist Bessel van der Kolk, has done a great deal to shift how the field understands these presentations. Van der Kolk and others have argued that what gets labelled BPD in many cases looks remarkably similar to what we'd call complex PTSD, a response to prolonged or repeated adverse experience rather than a single event.
The ICD-11, the international diagnostic classification system updated in 2019, now formally recognises Complex PTSD as a distinct diagnosis, characterised by the same features as standard PTSD plus significant difficulties with emotion regulation, self-perception, and relationships. Sound familiar?
I'm not suggesting everyone with a BPD diagnosis actually has Complex PTSD. The picture is rarely that clean. But the overlap is significant enough that it's worth asking: what changes when we understand these patterns as responses to experience rather than as inherent features of a disordered personality?
What changes is hope. And the belief that change is possible.
Why the Label Matters for What Comes Next
Here's what concerns me most about the term Borderline Personality Disorder, particularly for young people who receive it in their late teens or early twenties.
Personality, by definition, sounds fixed. A disorder of personality sounds even more fixed. The implicit message embedded in the diagnosis, even if a clinician never says this explicitly, is that this is who you are. This is your personality. It's disordered. And personality doesn't change much.
But this runs directly against what the evidence actually shows.
Research consistently demonstrates that the features associated with BPD are not stable over time in the way the disorder framing implies. A landmark longitudinal study, the McLean Study of Adult Development, followed people with BPD over ten years and found that the majority experienced significant reduction in symptoms, with many no longer meeting diagnostic criteria at follow-up. Recovery rates are substantially better than for many other mental health conditions.
And this makes sense when you understand the presentation through an adaptive lens. If these patterns developed in response to a particular environment, then a new environment, with the right skills, relationships, and scaffolding, can genuinely shift them. The brain remains plastic. Patterns that were learnt can be unlearnt, or more accurately, new patterns can be built alongside them.
This is not toxic positivity. It's what the data shows.
DBT and the Skills That Actually Help
Marsha Linehan developed Dialectical Behaviour Therapy in the late 1980s, originally for people who were chronically suicidal and who fit the BPD diagnostic profile. I had the privilege of training directly with Linehan many years ago, and her approach has shaped my clinical work profoundly, not just with this presentation but across many of the people I work with.
DBT is built on a foundation that I think reflects the adaptive understanding of BPD rather than the disorder model, even if it doesn't always frame it that way explicitly. The core assumption of DBT is that the person in front of you is doing the best they can with what they have, and that they need new skills, not a fixed personality, to be able to respond differently.
The skills DBT teaches, emotion regulation, distress tolerance, interpersonal effectiveness, mindfulness, are not niche techniques for a specific disorder. They are skills for navigating a world that is genuinely difficult, particularly when your nervous system learnt early to operate in high alert mode.
These skills work. The evidence base for DBT is robust, with multiple randomised controlled trials demonstrating significant reductions in self-harm, suicidality, emotional dysregulation, and hospitalisation. And critically, they work because they give people something new to work with, not because they fix something that was broken.
What I Want You to Take From This
If you're reading this and you've been given a BPD diagnosis, or you suspect the description fits your experience, I want to offer you a few things.
First, what you're experiencing is real. The intensity of your emotions, the difficulty in relationships, the unstable sense of self, these are real and they are genuinely hard to live with. You don't need to minimise them or feel embarrassed by them.
Second, these patterns make sense. They developed for reasons, even if those reasons aren't always clear or nameable. Your personality adapted to the environment it grew up in. That's not a character flaw. That's how human development works.
Third, change is genuinely possible. Not as a vague reassurance, but as something the research demonstrates clearly. With the right support, the right skills, and environments and relationships that offer something different from what shaped these patterns in the first place, people change substantially. I see it regularly.
And fourth, you deserve a clinician who holds you with that belief, who works from the understanding that you are not disordered, but adaptive, and that what you've adapted to can itself be changed.
If you're in Hillarys, Sorrento, Duncraig, Padbury, Ocean Reef, Joondalup, or anywhere in Perth's northern suburbs and this resonates with your experience, I'd encourage you to reach out. You can find more at www.mindharbour.com.au.
You are not your diagnosis. You are a person who learnt to survive. And there's a meaningful difference between the two.
This article is written for general informational purposes and reflects the clinical perspective and theoretical orientation of the author. It is not intended to replace individualised clinical assessment or advice. If you or someone you know is experiencing significant distress or suicidal thinking, please contact a mental health professional, your GP, or Lifeline on 13 11 14.