Notes From Clinical Rounds: On Borderline Personality Disorder, Armchair Diagnosing, & Social Media’s Mental Health Renaissance

Every Wednesday at Blueprint, we lock the doors before appointments start for the day for about an hour or so, and we all gather for clinical rounds. Basically, this is a meeting where we’re all able to discuss and get feedback on challenging scenarios we’re working through with our clients, and any trends we might be noticing in our field.

Clinical rounds help us provide a better level of service to everyone who walks through our door by having our entire team provide valuable insight on BP clients, while at the same time keeping our clinical tools sharpened. Toby and Charlie additionally weigh in with paradigm-shattering psychological epiphanies about the nature of human consciousness and interconnectedness of all living entities that would make Freud and Jung weep with jealousy (unless they’re napping). It’s good times.

I must say, as a grad student who still has a both few years and few thousand hours to go before I’m a licensed therapist, this is one of my favorite parts of being at BP. The knowledge and insight that gets dropped is WILD to witness, and certainly gives my grad program a run for its money.

Where was I going with this? Oh yeah – so, a few weeks back Michele mentioning something for us to be aware of, which was an influx of information about Borderline Personality Disorder (BPD) going around on Tik Tok that is being consumed by young people. For those not in the know, BPD is a condition oftentimes highlighted by rapid mood swings, explosive anger, an intense fear of abandonment, unstable relationships, and several other symptoms that can make life for those afflicted pretty tough.

While I think it’s generally a good thing that social media can be used as tool to spread awareness about different aspects of mental health and the unique challenges some of us face, there’s also some concerns that come with the territory of consuming information this way.

It’s important to know that conditions such as BPD are actually very complex and take A LOT of clinical precision to properly diagnose and fully understand. Despite the highly engaging and well-meaning nature of bite-sized social media content, we want to avoid scenarios where people are using this content to “armchair diagnose” every difficult person around them — or even themselves — unjustly.

Know that many therapists these days are more carefully considering the utility of diagnosing someone with a “disorder” unless there’s a valid reason to do so (many times there absolutely is), or even whether or not it would be beneficial to the client to disclose said diagnosis. While some people might feel a sense of relief from finally being able to put a label on everything they’ve been struggling with, other might feel devastated to learn that there’s something “wrong” with them. As therapists, one of our main goals is to help everyone who sits on our couch strengthen their identities by integrating both the positive and negative aspects of themselves, not send them off with a new identity as a broken person in to addition everything else they have been experiencing.

So how does the average non-mental health pro educate themselves about mental health via social media in a way that’s helpful while simultaneously minimizing one’s potential to any develop inaccurate perceptions or negative stereotypes? Here’s a few thoughts to start:

Make empathy the goal. Empathy is our ability to understand what someone else is feeling. Honing our sense of empathy can be a superpower that pays dividends in every area of our lives – including our relationships, friendships, careers, interactions with strangers, etc. Thus, it could be helpful to learn about various mental health conditions via social media if we go into it with the intention of strengthening our empathy muscles.

When consuming information about a mental health disorder online or via social media, it’s important to consider what may or may not have contributed to the development of that disorder, not just the behavior it causes. In many cases, trauma occurring during childhood that was out of one’s control plays a significant role in the development of many disorders, BPD included.

We can all understand that Bruce Wayne puts on a bat costume and fights vigilantes at night as a response to the trauma of witnessing his parents’ death – it makes a ton of sense. I’d probably do the same. I bet you would, too. But it’s a lot harder apply that same understanding to our daily lives, and the people we encounter and interact with.

Know “The Goldwater Rule.” In the mental health world, we have something called The Goldwater Rule. In essence, this acknowledges that it would be unfair for a professional such as a psychiatrist, psychologist, social worker, counselor, etc., to comment on the mental health of someone they haven’t been able to observe in a clinical setting. You can read more about how it came to be here.

While the rule itself was made specifically in reference to political figures as observed through the lens of the media, we live in a day and age where anyone using social media may want to take this rule into consideration, simply for common courtesy of those around us. Remember that armchair diagnoses are just that — how someone presents and interacts in daily life or certain social settings might be completely different than what’s happening inside their head.

Therapy, and the confidentiality it provides, allows people the space to open up about their internal process and things they otherwise couldn’t, which allows an experienced, properly trained clinician to determine what’s going on and assign a diagnosis if necessary.

 Balance Your Understanding. I get it. It can be fascinating to go down a Tik Tok or YouTube rabbit hole watching video after video about what illness infamous criminals or whatever politician you don’t like has, but make sure this isn’t the only component of educating yourself – i.e. don’t learn about mental illness without also learning about mental health.

For every way we speculate what might be “wrong” with someone, equally consider something that’s positive about them – even that person that really pissed you off the other day. Reframe that difficult interaction as an opportunity to practice assertiveness or strengthen your personal boundaries. I know this stuff is hard. But it’s totally doable.

Finally, read some articles or watch some videos about Dialectical Behavior Therapy. While DBT was specifically developed with treating BPD in mind, the principles of DBT can help just about anyone improve their life whether you meet the diagnostic criteria for BPD or not. DBT focuses on cultivating our capacity for mindfulness, interpersonal effectiveness, emotional regulation and more. I have yet to meet the person who couldn’t benefit from having these tools ready to go as daily life throws its challenges our way. Another great resource I recently finished is the book “I Hate You, Don’t Leave Me,” which offers a lot of real-life case studies and a 360-degree glimpse of what living with BPD is actually like.

At the end of the day, there’s no need to necessarily stop consuming information about disorders such as BPD on social media – there really is a lot to be learned and it can be a great introductory experience to expanding your knowledge of mental health. It’s simply important to do so from a place of sparking your curiosity while simultaneously resisting the tendency to allow any negative assumptions or stereotypes about BPD or any other condition to develop.

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