Tag Archives: Bpd Misdiagnosis

BPD – A Masked Illness : And Why It’s Hard To Identify


We have seen from other posts how childhood trauma, especially multiple and cumulative trauma, is strongly associated with the development of borderline personality disorder (BPD) in adult life.

However, many BPD sufferers are at risk of going undiagnosed or misdiagnosed.

The reason for this is that BPD can generate a number of symptoms associated with other conditions that mask the underlying illness (BPD).

Sadly, because of this, BPD can go undiagnosed for years, decades or a whole lifetime. This means many go without the proper treatment they require.

When one considers that approximately ten per cent of those diagnosed with BPD end their lives by suicide, the full, tragic implications of this failure of accurate diagnosis can be appreciated.

What Symptoms Of BPD Can Mask It, Thus Making It Less Likely To Be Accurately Diagnosed?

They include :

– excessive use of alcohol, leading to a diagnosis of alcoholism

self-harm / suicidal thoughts, leading to a diagnosis of depression

instability of mood, leading to diagnosis of cyclothymic or bipolar disorder

aggression/violence, leading to diagnosis of sociopathy (sometimes still referred to as psychopathy)

eating problems, leading to diagnosis of anorexia nervosa or bulimia

Whilst this list is not exhaustive, it represents some of the ways in which BPD can seemingly, upon preliminary invetigations, present itself as other psychological conditions, leading to misdiagnosis or incomplete/partial diagnosis.


Because, too, many with BPD are able to work successfully, and/or socially integrate successfully, much of the time without displaying blatant signs of psychological pathology, identifying BPD in individuals becomes trickier still.

However, such individuals are still likely to display tell-tale signs of the disorder due to sudden, dramatic and unpredictable shifts in mood (such as explosions of rage) which may, by the layman (or even the professional) be put down to ‘a difficult temperament’.

In order to correctly diagnose BPD it is necessary to look at the whole tapestry of the interplay of the individual’s behaviours and emotions in the context of their lives as a whole, with a particular focus on their relationship history (tends to be tumultuous), mood stability/instability, drug/alcohol use, sexual history (tends to be promiscuous and high risk), internal/mental life (often marked by feelings of chronic emptiness and lack of identity), emotional reactiveness/lability, and, vitally, of course, experience of childhood trauma.

In short, accurate diagnosis calls for a holistic approach; only then will all BPD sufferers get the treatment they both desperately need and deserve.




Above eBook now available on Amazon for instant download. Click here.


David Hosier BSc Hons; MSc; PGDE(FAHE).

Why BPD is Sometimes Mistakenly Diagnosed.


BPD mistaken diagnosis

One of the main reasons that borderline personality disorder (BPD) is sometimes believed to be a misdiagnosis is that it has symptoms in commom with two other disorders. These are :

1) Asperger’s Syndrome (a milder form of autism).

Steven Fry suffers from bipolar

Steven Fry suffers from bipolar

2) Bipolar Disorder. This used to be called manic-depression – its key feature is that it produces dramatic mood swings ,eg from being suicidal to being ecstatic, in those who have the disorder (as you might well already know, if you live in the UK, that  Steven Fry -pictured above-  has been diagnosed with this condition).

Let’s briefly look at these 2 in turn :

1) Why is Asperger’s Syndrome sometimes misdiagnosed as BPD?

Research suggests that it is mainly females who are likely to be wrongly diagnosed with BPD when, in fact, the condition from which they suffer is BPD. Why should this be? It has been hypothesized that because studies on Asperger’s Syndrome, until recently, had concentrated upon boys, the diagnostic criteria, whilst relevant to males, was not so relevant to females (as symptoms of Asperger’s Syndrome manifest themselves differently in boys and girls). In other words, the criteria for diagnosing Asperger’s derived from a non-representative sample as far as females were concerned.

It has also been suggested that girls were adept at concealing their Asperger’s Syndrome, sometimes by modelling their own behaviour on somebody else (who did not have Asperger’s).


These are as follows :

– serious difficulties in forming and maintaining relationships

– feeling like a social outcast or pariah; feel they do not belong anywhere

– eating disorders such as anorexia

– great difficulties understanding subtle, unspoken rules of social interaction

2) Why is bipolar disorder sometimes misdiagnosed as BPD?

Sometimes. too, those who actually have bipolar disorder are falsely diagnosed with BPD. Again, the confusion arises due to the fact that there is an overlap between the symptoms of bipolar disorder and the symptoms of BPD.


These include :

– mood swings

– instability

– impulsivity/risk taking

However, there are also differences between the two conditions. For example, whilst mood swings for those who suffer from bipolar disorder tend to be extremely dramatic (see above) and are often independent of what is going on in the patient’s life, the shifts in mood for those suffering from BPD are less extreme (for example, a transition from feeling distressed to feeling just about alright).

Also, for those suffering from BPD the mood changes are much swifter than for those with bipolar disorder. For example, a person with BPD may go from feeling upset to OK, back to upset again and then revert to feeling OK again all on the same day. In contrast, a person with bipolar disorder may feel profoundly depressed for a month and then elated for, say, the next to weeks.


It is not unusual for individuals to report that they feel they have been diagnosed without being properly assessed (eg they have not been asked very much about their behavioural and psychological history). Obviously, this, too, is likely to be another reason for a mis-diagnosis


More research needs to be conducted in order to answer this question. However, one study showed that 1 in 5 individuals with BPD also suffer from bipolar disorder; however, only 1 in 10 of individuals with personality disorders other than BPD were found to also suffer from bipolar disorder. Whilst these findings certainly support the idea that the two conditions are related, they do not provide us with sufficient evidence to draw any firm conclusions.

eBook :

BPD ebook


Above eBook now available on Amazon for immediate download. CLICK HERE.

David Hosier BSc Hons; MSc; PGDE(FAHE).