Borderline Personality Disorder & DBT: Breaking Through Stigma and Misinformation
Over the years, I’ve worked with many people who have been diagnosed with Borderline Personality Disorder (BPD), and one thing has become clear—there is a lot of misunderstanding about what BPD actually is.
Through my work, I have gained a deep understanding of these experiences—the challenges, the stigma, and the ways people navigate a world that often misunderstands them. I frequently find myself advocating for clients with their own family members, medical providers, and even fellow mental health practitioners who have absorbed harmful misconceptions about the disorder.
Much of what people believe about BPD is shaped by social media, outdated clinical perspectives, and popular books that often paint those with BPD as narcissistic, selfish, or manipulative. These descriptions fail to capture the full picture and, more importantly, ignore the pain and emotional distress that come with it. When stigma replaces understanding, it doesn’t just make symptoms harder to manage—it also makes it harder to be taken seriously and to receive effective, compassionate care.
Understanding BPD: A Trauma-Based Perspective
Newer research is shifting the way BPD is understood, moving away from the idea that it is simply a personality disorder and recognizing its deep connection to trauma and attachment wounds. Instead of seeing BPD as a set of behaviors that need to be "fixed," many experts now conceptualize it as a trauma-related disorder—a response to early invalidation, emotional neglect, or repeated experiences of feeling unsafe in relationships.
This shift is important because it removes the shame and blame that are so often placed on people with BPD. Instead of labeling behaviors as attention-seeking or manipulative, they can be understood as attempts to get needs met in ways that have been learned over time—often in environments that made healthy communication feel unsafe or ineffective.
The Biosocial Model: How BPD Develops
BPD is often described as a disorder of emotion dysregulation, meaning emotions feel more intense, last longer, and can be more difficult to manage.
The biosocial model helps explain how BPD develops. Some people are naturally more emotionally sensitive, meaning they feel things deeply and have stronger reactions to stress. When this emotional sensitivity is met with an environment that doesn’t provide the tools to regulate emotions effectively, it can lead to long-term struggles with self-regulation, relationships, and identity.
This might look like:
Being told you're overreacting when you're in distress
Having emotions dismissed or ignored (“You’re too sensitive.”)
Growing up in a chaotic or inconsistent environment
Experiencing situations where emotional needs weren’t met or understood
Over time, this combination of high emotional sensitivity and invalidation makes it difficult to develop self-regulation skills, which can result in patterns of intense emotions, fear of abandonment, and difficulties in relationships.
What BPD Is—And What It Isn’t
Many people experience intense emotions, fear of abandonment, or impulsive behaviors at times—this does not mean they have BPD. A personality disorder is not diagnosed based on a few behaviors in isolated situations.
To meet the criteria for BPD, the patterns must be:
✔️ Pervasive – Present across many different situations, not just in one area of life.
✔️ Persistent – Ongoing over time, rather than occasional reactions to stress.
✔️ Impactful – Causing significant distress or problems in daily life.
Common Misconceptions About BPD
🚫 BPD is not the same as Dissociative Identity Disorder (DID) – Some people mistakenly believe that BPD involves "multiple personalities," but that is not the case. While struggles with identity are common in BPD, this is not the same as having separate identities or "alters" as seen in DID.
🚫 BPD is not the same as psychosis – Under extreme stress, some people with BPD may feel temporarily disconnected from reality (like feeling emotionally numb or as if things aren’t real) or may have brief moments of paranoia. However, these experiences are usually short-lived and tied to distress—not ongoing symptoms like those seen in schizophrenia or other psychotic disorders.
🚫 People with BPD are not manipulative, attention-seeking, narcissistic, or disrespectful of boundaries – Many behaviors labeled as manipulation, attention-seeking, or boundary violations are actually distress responses from someone who has not been taught effective ways to communicate their needs.
When people feel unheard, abandoned, or powerless, they may resort to behaviors that seem dramatic or reactive—but these behaviors are often rooted in survival instincts, not intentional deceit or control.
It’s important to note that no single behavior or example is indicative of a diagnosis. Personality disorders are diagnosed based on long-standing, pervasive patterns across multiple areas of life.
BPD & Boundaries: Why They Feel Different
Boundaries are often discussed in relation to BPD, especially in medical and mental health settings. A common perception is that people with BPD push boundaries, making interactions feel challenging.
But for many people with BPD, boundaries feel different than they do for others—not because they don’t respect them, but because boundaries can feel like rejection.
For example:
A client may message their provider multiple times in distress, not realizing that their therapist has limits on communication outside of session.
A patient may become frustrated at a doctor’s office when told they need to wait or schedule another appointment, feeling unheard or dismissed rather than recognizing it as a standard policy.
A person may take offense to a friend setting a boundary, interpreting it as abandonment rather than a healthy way to maintain the relationship.
Clear and consistent communication can make all the difference.
BPD, "Attention-Seeking," and What’s Really Happening
One of the most harmful misconceptions about BPD is that people with it are "attention-seeking."
When someone with BPD expresses distress—whether by reaching out frequently, having emotional reactions, or struggling with boundaries—it is often not about seeking attention for the sake of it. Rather, it may be a desperate attempt to feel safe, reassured, or connected.
Here’s what that might look like:
Someone shares their struggles repeatedly—not for drama, but because they feel unheard or like no one understands what they’re going through.
A person posts online about feeling alone—not to get attention, but to feel less invisible.
Someone expresses strong emotions in a group setting—not to make things about them, but because they don’t yet have the skills to regulate those emotions privately.
This is not attention-seeking in a manipulative way—it’s seeking connection, support, and validation.
DBT & DBT-Informed Therapy: What’s the Difference?
Dialectical Behavior Therapy (DBT) is an evidence-based treatment designed to help people who experience extreme emotional dysregulation. It teaches practical, skill-based strategies for managing distress, improving relationships, and balancing acceptance with change.
Some therapists incorporate DBT-informed therapy, meaning they integrate DBT skills and strategies into treatment but may not offer the full DBT program. The full DBT program includes:
Individual DBT therapy
Group DBT skills training
Phone coaching between sessions
A DBT consultation team for therapists
DBT-informed therapy still uses the same core skills—mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness—and can be incredibly effective for people struggling with emotional intensity and relationship difficulties.
Moving Forward
The way BPD is talked about matters. Misconceptions and stigma don’t just make it harder to get support—they also affect how people see themselves.
BPD is often portrayed as untreatable, but that couldn’t be further from the truth. With the right skills, support, and understanding, it is possible to build fulfilling relationships, regulate emotions, and create meaningful change.