Therapists use a variety of diagnostic criteria, typically from a manual known as the DSM-V, to identify when someone has a mental health disorder. But diagnosing these issues is not like a checklist. While there are certainly some mental health disorders that fit into a neat little box – for example, a therapist can often diagnose depression based on some very specific symptoms – other times, a therapist needs to read between the lines in order to determine if the person meets diagnostic criteria.
This is especially true of issues like borderline personality disorder, or BPD. Borderline personality disorder is typically diagnosed through discussions, where a therapist keeps an ear open for stories that indicate that the person may have BPD. The person is unlikely to specifically say that they have the disorder, or that they experience exactly the challenges that are associated with it. But they may share stories that help indicate that it is possible.
What Might a Story Sound Like?
The following are purely hypothetical stories that a therapist may hear from a young teen girl that could indicate to the therapist that they may have BPD. None of these would be diagnostically relevant on their own, but they may trigger further questions with the therapist that would help them determine if someone had BPD.
- Pattern of Unstable Relationships
“My relationships have been really toxic. I have gotten into screaming matches with a lot of the boys I’ve dated, and then we’d break up and get back together again. One time I asked a guy I was dating to get me flowers from the store, and he only brought back 5 flowers, and I went off on him and called him a lot of names. He broke up with me, but I begged him back and he came back.”
- Fear of Abandonment
“Last week, my best friend didn’t text me back right away, and I became convinced that she hated me. I sent her a long message, accusing her of being a bad friend and I said a lot of really mean things. I guess I just felt so hurt and rejected that I wanted to hurt her back.”
- Impulsive Behaviors
“I have a good job but I’ve had a really hard time saving money. I love to shop. Any time I get paid or I get a new client at my work I treat myself to something. I am not able to save much money. I had a fight with my boyfriend once and he lived far away, so I took a plane to see him and apologize and I had to put it on my credit card because I didn’t have any money left.”
- Identity Disturbance
“I had a fight with my mom. She said I was acting fake depending on who I was with. She said that I acted totally different depending on which friend I was with. I told her that’s who I am, and that that’s how I’m social.”
- Chronic Feelings of Emptiness
“I don’t really like my job. I don’t have anything I like to do during my time off. School was boring. I tried to find fun things to do but everything I tried felt like it just wasn’t the right fit. Most of the time I just sleep or watch TV, because I can’t find anything else I want to do.”
Follow Ups and Expertise
Now, one thing to keep in mind about all these stories is that, on their own, they are not enough to fit a diagnosis of BPD. For example, a person that shares a story about their unstable relationships may have just been in some bad relationships. The therapist’s role is to continue to ask questions, and use the answers to help them gain a better understanding of the patient.
But you can see from the above examples that it is through stories that therapists can diagnose issues like borderline personality disorder. We hear these stories, we ask questions, and we use the answers to gain more insight into our patients.
For more information about diagnoses or borderline personality disorder, contact Right Path Counseling, today.
