Intergenerational impacts of borderline personality disorder clinical practices

Given the enormous stigma associated with the diagnosis, Borderline Personality Disorder (BPD) is an excellent case to explore how diagnostic practices can affect care. This study relied on a combination of in-depth interviews with clinicians and patients (n=32), as well as triangulated data from message board support groups for adult children with a borderline parent and for patients (n= 312). The online data from adult children examines the effects current clinical communication practice has on the subsequent generation using a cross-sectional sample. The response to the borderline diagnosis varies dramatically between these groups. Clinician and patient data established that providers frequently withheld the BPD diagnosis from patients. Interviews also confirmed that patients have a preference for knowing the diagnosis as it secures them access to treatment, and better tools for self-advocacy and research. Without knowledge of their condition, many go untreated for this particular disorder. Online data suggest adult children suffer long-term effects from the lack of sufficient mental health treatment for their parents. Furthermore, since being “an adult child with a parent who has BPD” is not a DSM category, this group must define their own subsequent health struggles through the lens of a parental diagnosis. Current clinical practices of withholding the borderline diagnosis from patients affects treatment, and the gaps in treatment that result then impact the children who grow up with under-treated parents.