Borderline Personality Disorder: A Difficult Diagnosis

borderline personality disorder: a diffidcult diagnosisA client’s diagnosis of Borderline Personality Disorder is one of the most difficult ones to make.

The complexity, structure and never ending aspects of BDPD are, for many of us, frightening to label. A person paying with insurance fears it will always remain on record.

Many have suggested it is the goulash of disorders; one that is used when all else do not fit criteria.

Case In Point

Sarah is a 29-year-old Caucasian female who owns her own business. Sarah was seen in my office for the purpose of substance assessment following an arrest for operating while intoxicated (OWI) and upon referral from her attorney.

Sarah is open, honest and wanting to be accepted by others (to a fault). She is involved in numerous volunteer roles as well as specializing in special events in particular weddings. She has been regarded by others as a hard worker with solid worth ethic. Sarah shared no risks or liabilities that could interfere with changes she might need to make in her life.

Chemical Use History

Sarah stated her first drink was wine at age 16 and did not pick up another drink until she was 21 (did not like the taste). Sarah suggested she was a social drinker at best. She stated that she began smoking marijuana when she was 16 and has used it off and on since then (medical marijuana card) to reduce anxiety.

She has a long history of prescribed medications for PTSD relating to anxiety and depression but stated there has been no abuse of prescription medication. Sarah had no history of recovery or treatment history. She constantly stated the alcohol was not what was puzzling her rather the anxiety within inside of her that never seemed to go away (knot in stomach).

Sarah indicated alcohol issues from both parents. Mother had a severe 10-year binge of alcohol abuse and now has five years of recovery time. Father, until recently, was regarded a heavy closet drinker. The client stated that her maternal grandfather had severe alcoholic tendencies.

Family History

 Currently, the client stated she has a guarded relationship with parents. Numerous issues related to trust from the past are, at times, severing her relationship with divorced parents.

She suggested that she has numerous healthy friends but has, at times, been involved in needy relationships with men that have generated enabling behaviors, not always healthy emotionally or physically for her.

She shared numerous events in her life related to her relationship with her parents that have caused diagnosed PTSD symptoms along with adjustment disorders generating anxiety and depression. The effects have had relying on prescribed medications  since the age of 9.

Sarah stated she has seen therapists along with taking medications to overcome the after effects of PTSD. Suppressing her feelings has resulted in symptoms of depression which developed into anxiety issues.

She has a tendency to develop co-dependent relationships out of the need to be accepted. Self-esteem has been an issue most of her life and she has a tendency to be over accepting, anxious, fearful and a worrier who has difficulty asking for help.

She has issues of not accepting herself and a limited her view of herself.

Borderline Personality Disorder: A Difficult Diagnosis

Steve Greenman, MA, LPC, NCC

Steve Greenman, MA, LPC, NCC is a licensed professional counselor (LPC) in northern Michigan who has a passion for reading, writing, music and helping others. He specializes in counseling complex family situations, substance abuse, and parenting. Steve’s counseling philosophy is holistic, approaching each issue on its own merit and evaluating influences to help overcome life’s dilemmas.


APA Reference
Greenman, S. (2016). Borderline Personality Disorder: A Difficult Diagnosis. Psych Central. Retrieved on August 13, 2020, from


Scientifically Reviewed
Last updated: 3 Jun 2016
Last reviewed: By John M. Grohol, Psy.D. on 3 Jun 2016
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