3 Reasons Why Borderline Personality Disorder Is Often Misdiagnosed

Borderline Personality Disorder (BPD) is one of the most common personality disorders, affecting at least 2 percent of adults in the United States. It is characterized by unpredictable moods, bursts of emotions, extreme instability in relationships, and distorted self-image.

Borderline Personality Disorder is a complicated psychiatric disorder, and is often misdiagnosed. While there’s no national data available to show how often the disorder is mistaken for another psychiatric disorder, there’s at least one study that shows how often it’s misdiagnosed as Bipolar Disorder. Researchers at the University of North Texas and Brown University found that at least 40 percent of the people in their sample who had BPD were previously misdiagnosed as having Bipolar Disorder.

Here are some of the reasons why BPD is so often misdiagnosed:

1. Symptoms don’t appear early on. People with Borderline Personality Disorder can come off as quite normal in their superficial relationships, such as those with friends and initially with therapists. It’s not because they’re hiding their symptoms, but because symptoms of Borderline Personality Disorder manifest when people with BPD get deeper into relationships – often at stages where their dependency on the other person starts.

2. Co-occurrence of other psychiatric disorders. Borderline Personality Disorder frequently co-occurs with other psychiatric disorders, such as depression and anxiety. As a result, clinicians sometimes fail to catch the symptoms of BPD, which can be overshadowed by symptoms of other disorders.

For example, a number of people suffering from BPD often get misdiagnosed with Bipolar Disorder because of certain characteristic similarities between the two conditions.

“The true bipolar has mood swings that are to some extent affected by situational events, but are largely a matter of problems with internal regulation of mood that probably has a biochemical basis, and often occur uncontrolled, without any situational trigger,” says San Diego psychiatrist Dr. David Reiss. “On the other hand, the borderline mood swings are very directly related to situational events and particularly events that are occurring within relationships.”

3. Confusing diagnostic criteria. The previous version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) outlined very vague criteria for the diagnosis of Borderline Personality Disorder, leaving a wide gap between the understanding of the disorder among clinicians and therapists.

“Sometimes there is an overdiagnosis for a person who is seen as difficult, angry, provoking, etc.,” says Dr. Reiss. “Not everyone who is disagreeable is borderline. At times doctors, therapists, and psychiatrists will go too quickly to that diagnosis for a patient they are frustrated by, or angry at, or the patient who is prone to ‘acting poorly.’”

Misdiagnosis among Men

Men with Borderline Personality Disorder are more commonly misdiagnosed, according to Randi Kreger, author of Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder. She mentions that men with BPD are often misdiagnosed as having Antisocial Personality Disorder when their BPD symptoms spiral out of control.

Getting an Accurate BPD Diagnosis

Because of the vague diagnostic criteria, it’s hard for clinicians to get a Borderline Personality Disorder diagnosis right all of the time. You can save yourself a lot of time and agony by going to a BPD treatment professional with years of clinical training and experience in BPD.

Self-diagnosis of BPD is not a good idea, so you should not attempt to do it. However, it is helpful to be familiar with the various symptoms of BPD to help you decide whether you might need to get yourself examined. Before going for an appointment, make a note of all your symptoms and recent events of relevance so that the clinician does not miss out on any vital information about your specific case and has a better chance of diagnosing you correctly.