“Borderline Personality Disorder” and Survivor Injustice

Author’s Note: Content warnings for trauma, abuse, sexual abuse, child sexual abuse, victim-blaming, sanism and involuntary psychiatric incarceration.

I grew up in an abusive family. It took me decades to realise this, and to be able to name the child sexual abuse I endured.

It also took decades for the memories of it to fully return, stuffed down into the deepest recesses of my mind as they were, as trauma memories can be.

When the memories finally formed, the first things that I remember feeling were immense pain and terror.

I could still hear the sounds sometimes; they came to me as intrusive thoughts. And I could still see images, like flashes, as though everything was happening all over again.

Out of that pain grew rage towards my mother, the person responsible for all of this unbearable, life-altering trauma that had driven me out of my own body for most of my life, had made it the site of this trauma and an unsafe place for me to occupy.

My mother, in an attempt to deflect accountability for the harms that she had caused, positioned herself as the victim and told people that I was full of all this inexplicable rage towards her, citing decontextualised examples of my rage and the psychiatric diagnosis of borderline personality disorder that I had been given as “corroboration” that my rage was a sign that I was mentally ill.

In our last exchange before I ended contact, she wrote to me, “You turn your rage and anger on me with no provocation. I tried my best to do everything to please you, but it never helped. You need professional help.”

She didn’t mention to anyone her own rage that I had learned to fear or the severe abuse that I had endured for so long under her. She didn’t mention the fact that I had grown up in a house full of domestic abuse and death threats. And she didn’t mention the sexual trauma that I had survived as a child.

There was no accountability for what had been done to me, for all of the horrors that had led to my anger.

It was such a narrow retelling of the facts. And this diagnosis would make it even more credible.

The psychiatric diagnosis of borderline personality disorder has long come under fire by many different camps of people, and one of the most common critiques is its complicity in oppressing abuse survivors.

 

There are multiple ways that it does this.

1. It divorces survivors’ responses from the abuse they endured and allows abusers to evade accountability

For one, the “causes” of BPD are still overwhelmingly attributed to biological and genetic origins. Even though a history of child abuse and neglect are included as possible causes, they are still only considered one among many– mainstream psychiatry argues that these are primarily personality traits that are innate to the bearer and not actual responses to abuse. When a survivor is given a diagnosis that permits the ways that they’ve adapted to their abuse to be attributed to brain abnormalities and genetics, it easily allows the abuser’s role to be minimised or dismissed.

Even when there are acknowledgements of the role that abuse, particularly sexual abuse, can play, this diagnosis still locates the issue within the survivors themselves, in their “disordered” personalities.

Another of the harms that comes from decontextualising our suffering is the type of ‘treatment’ that survivors then receive for it. Non-consensual ‘treatment’, such as forced drugging and involuntary commitment, remain common for people with this diagnosis. Less overt forms of non-consensual treatment include denying people with BPD a right to have a say in their own treatment goals and plans, labeling them “difficult” and “non-compliant” for refusing treatment, and punishing people for continuing to self-harm by withdrawing compassion and abruptly ending the therapeutic relationship. Abuse survivors have already traumatically been denied their right to agency and bodily autonomy—what happens when these same dynamics are then re-created in ‘treatment’?

With a diagnosis that decontextualises all of their responses to their abuse, these treatments are not recognised as potentially compounding existing trauma—they’re instead considered ways of dealing with people who have defective personalities and behavioural issues.

I remember the night that I heard a knock at my front door and the way that I froze when I realised what was happening. My mother, upset about my expressions of anger towards her, had decided to use my diagnosis to confine me.

They all surrounded me and said, “we’re here to take you to St. Ann’s.”

For those unfamiliar with St. Ann’s, it’s a psychiatric facility notorious for being abusive, including sexually abusive.

I told them it’s an abusive place. I told them, it’s very possible that I’d even be subjected to sexual abuse there.

Still moving to take me, they said, “You’re sick. You have borderline personality disorder—you need help.”

I remember not only the terror I felt at the prospect of being committed, but the unbelievable amount of pain at having this diagnosis be used by my abusers to mask the decades of harm that they had caused and to subject me to even more harm.

In his book, Psychiatric Hegemony, author, lecturer and sociologist Bruce M.Z. Cohen writes, “A bitter irony for those labelled with BPD is that many are known to have experienced sexual abuse in childhood.” He writes that they are then victims of “a psychiatric pattern of depoliticising sexual abuse” by “pathologising the survival mechanisms of the victim as abnormal.”

Unfortunately, incarcerating survivors is also far from an anomaly in our society, and psychiatric incarceration is one form that it takes. A writer for the Baltimore Beat, Elaine Millas, writes how “survivors sit in jails and prisons while abusers… are protected.” And advocates against psychiatric incarceration write that “psychiatric institutionalization is not “like” prison; the prison and the asylum are two sides of a carceral coin.” There is a very straight line that we can draw from the fact that psychiatric incarceration still remains such a common method of “treating” people with BPD, a large portion of whom are abuse survivors, to the fact that our society criminalises survival.

2. It pathologises and decontextualises anger and rage

It’s true that survivors of chronic trauma can struggle with their relationship to their anger, and may even have a destructive relationship to their anger, i.e. one that can cause harm.

And, yet, anger has no place in a psychiatric diagnosis. Psychiatry’s history is indicative of why anger or rage should not be allowed to be psychiatrised. One example is the progression of schizophrenia from being viewed as a disease primarily affecting “harmless” middle-class white women to a disease associated with anger and aggression and African-American men. This evolution allowed their anger to be divorced from its social and political roots, permitting these men to be incarcerated.

On an interpersonal level, to include anger or rage in the diagnosis of borderline personality disorder is to allow folks who bear it to unjustly have their anger and rage at the harms they’ve experienced be invalidated as a “symptom” of their “mental disorder”—including by those harming them. What my rage had desired was to have the harms that I’d endured be acknowledged, for accountability for what had happened to me. Instead, uprooting it from the context that had created it and including it as a “symptom” of my diagnosis allowed for my traumas to be further invisibilised.

On a much larger level, similar to the ways that anger in other psych diagnoses has been weaponised as a tool of oppression, pathologising anger in this diagnosis allows us to divorce it from its origins in historical and ongoing injustices. I think about my own history as an Indian person and a descendant of people who experienced extraordinary abuse and oppression under colonisation. We were never given the space or the conditions to process any of this trauma and to heal, while continuing to experience even more oppression, as is the case for many colonised peoples. My body holds so much rage, and I don’t believe that all of it is my own.

Dr. Jennifer Mullan, founder of Decolonizing Therapy, posits that “rage is ancestral, in that it is the love child of what I think is intergenerational trauma and / or historical trauma”. In her view, rage is older than us, “older than our generation”. In other words, a decolonial approach to rage is to recognise that rage has roots.

The diagnosis of borderline personality disorder does not. It has no roots. It is an entirely individualistic perspective on human suffering and experiences.

It’s not hard to find articles written like this that paint rage and anger in BPD as coming out of ‘nowhere’:

Who is your loved one with Borderline Personality Disorder — really? Does he or she sometimes act kind or caring and then on a dime, out of nowhere, either rage or disengage, detach, and give you the silent treatment?

‘Inappropriate’ is, similarly, how the anger of people diagnosed with BPD is described in the DSM-5. Describing anger and rage as ‘inappropriate’ and containing them within this psychiatric diagnosis is to divorce them from their roots, to ignore that there was ever any violence and injustice that bore them. If white supremacy asks us to forget the harms that we’ve incurred, then an anti-oppression stance is to remember.

3. This diagnosis easily allows abusers to reverse the roles

D.A.R.V.O., short for deny, attack, and reverse victim and offender, is a common strategy that abusers enact to avoid accountability for their harm. It involves the abuser denying the victim’s version of events, and positioning themselves as a victim instead, accusing the actual victim of being abusive, reversing the roles between victim and abuser.

The borderline diagnosis is constructed in a way that so easily facilitates this role reversal—the inclusion of “inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights)”, for example, is yet another way that the inclusion of anger through this diagnosis can be used to harm victims.

This isn’t to say that people bearing a BPD diagnosis can’t be abusive—anyone, bearing any psychiatric diagnosis, or none at all, can be abusive.

But that denying the harms that they’ve caused and painting the victim as the harmdoer instead is a common manipulation tactic used by abusers that not only works, but that also becomes much easier when the victim bears a diagnosis that portrays them as having “inappropriate, intense anger”, “frequent displays of temper”, as physically aggressive and with difficulty “controlling” their anger.

In a society that has a very poor understanding of abuse, isolated and decontextualised incidents of anger and retaliation by victims and a diagnosis that portrays them as violent make it easy for people to incorrectly assume that victims are the perpetrators. Not only must many victims bear the burden of having endured abuse, but they must also bear the burden of being considered the abuser.

4. BPD is constructed as the antithesis of the “perfect victim”

The “perfect victim” fallacy dictates very narrow and unrealistic ways that survivors are supposed to conduct themselves in order to be considered credible and worthy of aid and justice.

Eliana Dockterman, correspondent for Time Magazine, describes the perfect victim as:

…an innocent. She doesn’t drink or do drugs. As a result, she has a clear memory of her assault. She has corroborating evidence—but not too much evidence because that would indicate she’s vindictive and planned to speak out. In fact, when she comes forward, she does so reluctantly. She cuts off contact with her abuser as soon as the abuse takes place. She does no wrong—at the office, in relationships, as a mother or daughter. She’s never lied about anything, ever, in her entire life. She dresses “appropriately.” She’s ideally virginal. She’s simplistic. She does not exist.

The perfect victim fallacy is used in the criminal justice system to question the credibility of survivors’ testimony—if your memory of the event is not crystal clear and perfectly coherent, as trauma memories often aren’t, like mine weren’t, then you’re lying. If you stayed in contact with your abuser, like I did, like many do for a multitude of reasons, then it clearly wasn’t abuse.

In reality, victimhood is messy. Victims return to their abusers, victims lash out, victims use drugs and alcohol, victims can be criminals. Victims are whole, complex people. We have very one-dimensional ideas around what a victim should be and when someone does not meet those expectations, it casts doubt on their victimhood.

In the Depp-Heard trial, Shannon Curry, a psychologist hired by Depp, diagnosed Amber Heard with borderline personality disorder, describing people with BPD as “very destructive”, “dramatic, erratic and unpredictable” with an “underlying drive to not be abandoned but also to be center of attention”. And, yet, a victim can be all of these things and still be a victim. Curry described Heard in particular as full “of inner hostility”, “self-righteous, judgmental, and full of rage”. Far from focusing solely on the merits of the cases themselves, we see that abuse trials often rely on unflattering depictions of victims’ personalities to discredit their testimony.

With an overwhelming number of bearers of the BPD label being abuse survivors, it’s not hard to see how the construction of the borderline diagnosis is itself a vilification of survivors for failing to meet the standards of the “perfect victim”. The perfect victim does not struggle with substance use, engage in ‘risky’ sexual activity, doesn’t act in ‘self-destructive’ ways, is not full of anger and rage—even towards her abuser. She is not “dramatic, erratic and unpredictable” as Curry describes. According to Deborah Tuerkheimer, author of Credible: Why We Doubt Accusers and Protect Abusers, “Victims are expected to represent the right amount of emotionality… If they’re too emotional, they’re perceived as hysterical and untrustworthy and suspect. If she’s too calm and her affect is flat, that too is held against her.” In other words, she also cannot be ‘emotionally dysregulated’. Survivors bearing a BPD label inherently do not fit the mold of the perfect victim.

Dr. Jessica Taylor writes that “this tactic demonstrates that we have never truly moved on from recasting abused women as insane, deviant and disordered”.

With ‘credibility’ assessments continuing to play a key part in sexual abuse trials, and the construction of the borderline diagnosis fundamentally antethical to the image of the credible victim, this diagnosis continues to be used in legal cases to deny survivors justice.

Efforts to destigmatise this diagnosis alone are unlikely to make a difference until we learn to complicate victimhood and to move beyond these neat boundaries we’ve drawn to delineate what a victim (and what an abuser) can be, and to address a ‘justice’ system that relies on the misogynistic, sanist, racist construct of ‘credibility’.

It’s true that not everyone who bears a BPD diagnosis is an abuse survivor, but many are, and understanding that there is a much larger movement at play in society to oppress resistance to abuse can help us to see the harms that people bearing this diagnosis face as a matter of survivor injustice. It can help us to move from silo-ed efforts to end harm and discrimination towards people diagnosed with BPD towards building solidarity with those who are doing anti-violence and abolitionist work.

It’s heart-breaking that so many receive this diagnosis with relief, with a sense of finally feeling understood, and with hope for the possibility of an end to their suffering. It is such a sinister thing that something packaged as a route to healing can also be weaponised against those who bear it, many of whom have already endured unbelievable suffering.