What We’ve Said

What we’ve said about Stigma

10 points from 6 episodes, newest first

In short

Much of the stigma around borderline and personality diagnoses comes from clinicians themselves: who they give the label to, and how. Avoiding the diagnosis does its own harm by leaving a treatable problem untreated, and stigma should not keep a useful treatment like ECT off the table.

Where it comes from

  1. The borderline diagnosis is stigmatizing because clinicians reserve it for patients they dislike and withhold it from patients they like. One skeptical read is that complex PTSD now goes to the patients clinicians like, even though the life histories of borderline patients hold a lot of trauma.

    “borderline personality disorder is basically reserved now for patients that the clinicians dislike and complex ptsd is being given to the patients who they like because if you look at the life history of patients with borderline personality disorder they have a lot of trauma”
    32:03CPTSD vs BPD: How to Think About the Difference and What to Do About ItMar 2026
    Also said in 1 more episode
    “the reason why it's stigmatizing is because the clinicians themselves are the ones reserving the diagnosis for patients that they dislike. They withhold the diagnosis when they have patients that they like. I'm reminded of a time where I was discussing a patient with another clinician, and in my opinion, extremely clear borderline personality disorder”
    53:46Understanding Borderline Personality Disorder with Dr. Mark L. RuffaloDec 2024

  2. Stigma exists primarily because of clinician reactions to difficult patients, reactions that are sometimes understandable. Some patients are simply more difficult than others.

    “I believe that stigma exists primarily because of clinician reactions, which are sometimes understandable to difficult patients. Let's face it, some patients are simply more difficult than others”
    7:03Treating Borderline Personality Effectively aka How To Be A Good Psychiatrist Through GPMMay 2025

  3. Many of us are describing the same clinical problems in different language because of poor practice by clinicians in who they give diagnoses to and how they give them.

    “we're all describing the same clinical problems and we're trying to use different language because of poor practice on part of clinicians in terms of who they give diagnoses to and how they give those diagnoses”
    12:51Healthy Personality Traits, Trauma vs. Personality, and Why Trauma Doesn’t Explain It AllOct 2024

  4. If understanding yourself requires a diagnosis that most practitioners will judge negatively and read you through a hurtful lens, of course you look for a different one.

    “You're telling me that to understand myself, I need a diagnosis that 80% of practitioners are going to negatively judge me and interpret my thoughts, behaviors through this pretty hurtful lens”
    14:44Healthy Personality Traits, Trauma vs. Personality, and Why Trauma Doesn’t Explain It AllOct 2024

Pitfalls and myths

  1. Borderline personality disorder is not an untreatable condition of bad patients. Many want to get better and do not know why they are suffering.

    “it really shifts the idea of borderline personality disorder isn't this untreatable uh condition these aren't bad patients um a lot of patients uh they want to get better they don't know why they're suffering”
    6:16Treating Borderline Personality Effectively aka How To Be A Good Psychiatrist Through GPMMay 2025

  2. Manipulation and being a bad person are not part of the borderline diagnosis whatsoever.

    “i don't think that manipulation and being a bad person is part of the diagnosis whatsoever”
    49:04CPTSD vs BPD: How to Think About the Difference and What to Do About ItMar 2026

  3. Ignoring a problem you need to treat does its own harm. It is as if stigma against OCD kept us from recommending exposure and response prevention.

    “there's also a harm in ignoring a problem that you need to treat. It's as if we had some social stigma against OCD and we didn't want to recommend exposure and response therapy”
    6:45Healthy Personality Traits, Trauma vs. Personality, and Why Trauma Doesn’t Explain It AllOct 2024

  4. Clinicians say they do not like to "jump to" a personality diagnosis. Imagine saying that about bipolar disorder, an eating disorder or an anxiety disorder.

    “Imagine if you said that about any other diagnosable psychiatric condition. Oh, I don't like to jump to bipolar. Oh, I don't like to jump to an eating disorder. I don't like to jump to an anxiety disorder”
    17:17What Psychiatrists Get Wrong About Personality DisordersOct 2024

  5. Whether someone does something on purpose is not the same as whether they had control over it.

    “whether or not you do something on purpose is also not the same thing of whether or not you had control over it”
    14:16What Psychiatrists Get Wrong About Personality DisordersOct 2024

Treatments

  1. ECT has a lot of stigma, and it got that stigma for good reasons. It is also incredibly effective and incredibly safe, and it can be a very important tool for alleviating suffering in the right population.

    “ECT has a lot of stigma. It got stigma for good reasons. It's also incredibly effective. It's incredibly safe. And it can be a very important tool that can alleviate suffering in the right population”
    9:26ECT Treatment: When to Refer, Who It Helps, and What Actually Happens with Dr. MaryEllen EllerJun 2026Guest episode

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From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.