In this article from Psychology Today, Daniel S. Lobel, PhD, discusses why mental health providers can be reluctant to diagnose BPD:

“Not diagnosing BPD, where appropriate, can adversely affect treatment. Most medical insurances do not cover treatment for personality disorders. Claims submitted with these diagnostic codes are generally rejected without justification. Individuals with BPD very often have comorbid disorders, such as anxiety or depression, so therapists use these codes as primary. A diagnosis of personality disorder can be stigmatizing to people. This is especially true for Borderline, Narcissistic, and Antisocial Personality Disorders. This is probably largely due to the portrayal of these disorders by the media as being caustic or dangerous to the general population.

Valid diagnosis requires the diagnostician to sample behavior in a broad range of settings. Most clinicians see their patients only in one setting (the office), which not only does not meet the criteria of a “broad range” of situations, it is not even a typical setting. The only other way to sample behavior outside of the office is to interview collaterals or people who work or play with the patient. Interviewing collaterals is generally only done in forensic settings. This criterion makes the diagnosis of any personality disorder nearly impossible in a traditional mental health or hospital setting. One major consequence of clinicians avoiding the diagnosis of BPD is that in many situations these symptoms do not get addressed. The clinicians diagnose comorbid disorders, such as anxiety, depression, posttraumatic disorder, etc., and this becomes the focus of treatment.”

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