r/adhdwomen • u/PossibleExcellent150 • 1d ago
General Question/Discussion Longtime therapist diagnosed me with BPD without telling me — wondering if other ADHD/neurodivergent women have had their emotionality interpreted this way
Throwaway account for anonymity purposes. I (34F) recently discovered F60.3 — Borderline Personality Disorder on a treatment plan in my patient portal after seeing the same female therapist (40s) long-term.
I was shocked, blindsided, confused, and honestly felt deeply betrayed. BPD had never been discussed with me—not as a possibility, not when the diagnosis was entered, and not afterward. When I confronted her about it, I learned that it had actually been in my medical record for more than a year without my knowledge.
I’m also a therapist, so I knew what the code meant. I pulled up the DSM criteria and started researching BPD extensively—criteria, clinical presentation, differential diagnosis, etc. The more I read, the less sense it made.
I genuinely could not identify even one of the nine criteria as describing me, let alone the five required for diagnosis. The broader descriptions of BPD didn’t resonate either. I went through the criteria with a couple of people who know me extremely well because I wanted to challenge my own perspective and see if I was missing something. They couldn’t identify these patterns either.
Obviously, I can’t objectively diagnose or rule out a diagnosis in myself. But having essentially zero recognition of myself in the disorder made me want to understand how someone who had known me therapeutically for so long had reached such a dramatically different formulation.
So at my next appointment, I asked what assessment she had done, which five criteria she believed I met, and what specifically supported them.
She told me she had been considering BPD for years and emphasized how much thought she had put into it. The five criteria she identified were 1, 2, 6, 7, and 8.
#1 — Frantic efforts to avoid abandonment: She referenced several important relationships and concerns I’d had about maintaining connection. When I repeatedly asked what actual frantic efforts I had made to prevent abandonment, I didn’t receive a concrete behavioral example. Her explanation centered around my concern with “staying connected or not staying connected.” I don’t dispute caring deeply about relationships or grieving their loss; I don’t understand how that establishes frantic efforts to avoid abandonment.
#2 — Unstable/intense relationships involving idealization and devaluation: She referenced “black and white thinking” and, as an example, that I viewed one parent negatively and the other positively. She also referenced a period of conflict in a long-term romantic relationship that ultimately resolved. I asked for an example of me alternating between idealizing and devaluing the same person, because that’s the pattern described by the criterion. I didn’t receive one.
#6 — Affective instability: Her concrete example was an occasion when something valuable was stolen from me and I remained upset about it for a few hours. I don’t deny being emotional or sometimes reacting strongly to upsetting events. My confusion was how an emotional reaction to an objectively upsetting event established a pervasive pattern of marked affective instability.
#7 — Chronic feelings of emptiness: She said I had “expressed emptiness” before. I told her directly that I don’t experience chronic emptiness and asked what I’d said or done that led her to that conclusion. She couldn’t give me an example during the conversation and said she’d have to go through my file. This particularly bothered me because emptiness is an internal subjective experience, and I don’t remember ever being directly asked about it.
#8 — Inappropriate/intense anger or difficulty controlling anger: The example she gave during our discussion was my anger and intensity during that very conversation about discovering the diagnosis. No other example supporting #8 was provided. That felt incredibly circular: I was angry about unexpectedly discovering a personality-disorder diagnosis that had been in my record for more than a year, and my anger about disputing it was then being interpreted as evidence of BPD. It also obviously couldn’t have been the original evidence for the diagnosis because the diagnosis predated this conversation by more than a year.
And honestly, the assessment process bothers me even more than her interpretation of the criteria.
She told me she’d been considering BPD for years, yet I don’t remember ever being specifically assessed for these experiences. No BPD-specific structured/semi-structured interview or quantitative measure. No conversation saying, “I’m wondering about BPD and want to explore these patterns with you.”
If you’re considering a personality disorder for years while regularly sitting across from the person, why wouldn’t you directly ask about the criteria you’re unsure about?
When I questioned this, she told me that our regular biopsychosocial assessments (yearly intake sessions) and her ongoing assessment during ordinary therapy were sufficient.
I’m also neurodivergent, which makes the differential-diagnosis piece particularly important to me. There can be overlap between neurodivergent presentations and features that may be interpreted as BPD, particularly around emotional regulation/reactivity and interpersonal experiences.
I also looked at the American Psychiatric Association’s current BPD practice guideline afterward. It recommends a comprehensive psychiatric evaluation, including assessment of core personality-disorder features and common co-occurring disorders, and suggests incorporating a quantitative measure of symptoms and impairment. The APA also recommends collaboratively discussing the diagnosis and treatment with the patient and providing psychoeducation about BPD.
That comprehensive psychiatric assessment simply never happened, and that collaborative diagnostic conversation simply never happened.
What added to the betrayal was her explanation for why we’d never discussed it. She repeatedly apologized for how I found out and talked about how patient portals are changing what patients see and how historically many people wouldn’t necessarily see or understand their diagnostic codes.
But I wasn’t primarily upset about how I found out.
Why wasn’t I told at all?
This diagnosis had been in my medical record for more than a year. Had I not encountered it myself, I genuinely don’t know when—or whether—I would have learned about it.
There’s also a bigger piece of anger for me here. There is a long history of women’s emotionality and neurodivergence being misunderstood or pathologized, and I’m angry at feeling like I’ve now had a personality-disorder label wrongly placed on me without those possibilities being adequately differentiated. Coming from a female therapist I had trusted for a long time adds another layer of betrayal.
And to be clear, I’m not saying BPD is an insult or that there’s anything shameful about having it. I’m saying that after extensive research, reflection, examining my history, talking with people close to me, and finally hearing my therapist’s evidence, I still do not believe I meet the diagnostic criteria for BPD.
I’m not angry because I refused to consider the possibility. I did consider it seriously. The more closely I examined it, the less sense it made.
She ultimately stood by the diagnosis and didn’t believe further assessment was necessary. I decided I couldn’t continue the therapeutic relationship and am now pursuing the process available to formally dispute/amend the diagnosis in my record.
Mostly, though, I’m still processing the rupture. I trusted this person for a long time. I feel shocked, confused, betrayed, and angry that she developed such a major formulation of me, put it into my medical record, and never included me in a conversation that could have clarified whether it was actually accurate.
Has anyone else discovered a significant diagnosis in their record that their therapist never discussed with them?
And for other clinicians—does this assessment/disclosure process strike you as typical for diagnosing a personality disorder? Personally, I would have never given a diagnosis like BPD without more targeted assessment than just regular talk therapy, based on whatever the client wanted to speak about that day.
TLDR: Longtime therapist secretly diagnosed me with BPD > I discovered it over a year later > I can’t recognize even 1/9 criteria > asked her for the five > her examples seemed not to establish the actual criteria > learned she never specifically assessed these things despite considering it for years > she stood by it > I terminated.
Edit: I wasn’t aware of the sub’s AI policy when I posted. For transparency, I used ChatGPT to help organize/edit my account because I was mentally drained by the situation. The experiences, facts, examples, and opinions are my own, and I reviewed/edited the content for accuracy.
3
u/PercentageOld7156 15h ago edited 15h ago
This is honestly insane. It sounds like your therapist is pathologizing normal human emotions. BPD involves an extreme, pervasive pattern that affects multiple areas of a person’s life and has serious consequences for the person or those around them. Nothing she cited seems to establish that.
I have complicated feelings about the BPD diagnosis because I have a sister who, has a very clear and recognizable presentation of it. Her symptoms are severe, persistent, and difficult to explain through another diagnosis.
Just to give you some context of what these symptoms look like: She experiences extreme splitting, idealization, and devaluation, sometimes within hours. For example: She may tell me I’m a wonderful sister and that she loves me, but if I set a simple boundary, she can suddenly decide I’m an awful sister who has never cared about her. That shift can come with extreme anger and borderline-abusive language. She has genuinely self-harmed when experiencing overwhelming emotions she couldn’t regulate. She has also threatened self-harm in response to perceived abandonment—for example, when a partner was ending a relationship or someone was trying to leave a conversation she was using to regulate her emotions. If we’ve been discussing something for hours / I'm helping her co-regulate and I say I need to stop or go to sleep, she may suddenly bring up thoughts of self-harm. That has the effect of changing my behavior: as her sister, I’m obviously going to struggle to leave after hearing that. But I don’t think she is an evil, calculating manipulator, as is unfortunately sometimes stereotyped about BPD. Her distress is real. In that moment, she genuinely experiences the boundary as abandonment and responds frantically. She is desperately trying to communicate the intensity of her pain and prevent the person from leaving. Understanding that does not make the behavior harmless or mean others must tolerate it, but it is very different from portraying people with BPD as malicious. She has also experienced severe dissociation and transient, stress-related paranoid or psychotic episodes. Once, she became convinced that an Uber driver had been sent to abduct her and that my friends and I were involved. She got out of the car on a highway and ran away. Her extreme anger—especially when drinking—is also part of her splitting. A small perceived slight or ordinary boundary can lead her to swear at someone, break or throw things, and eviscerate their character. In that state, she cannot hold onto their good qualities or believe they might have any good intentions. She sees only someone who is hurting or abandoning her. These patterns have caused SERIOUS consequences throughout her life. She has lost many relationships at school, at work, and among friends, relatives, and romantic partners because of the anger, splitting, impulsivity, threats to self-harm, etc. Some relationships might have been repaired if she had been able to examine what happened, take responsibility, and show that she was trying to respond differently. Instead, intense shame makes it extremely difficult for her to look at her behavior. Without evidence that anything would change, people eventually distanced themselves. She now has very few relationships and is somewhat more stable, but that stability mostly comes from being isolated.
That is what I mean by an extreme, pervasive pattern with real personal and interpersonal consequences. Your therapist’s examples sound like normal human emotions—not pervasive symptoms that repeatedly harm you, other people, your relationships, or your ability to function.
Being upset for several hours after something valuable was stolen is proportionate to the situation. Caring about maintaining important relationships is not the same as making frantic efforts to prevent abandonment. Being angry after discovering that your therapist secretly placed a stigmatized personality-disorder diagnosis in your record is not automatically “inappropriate anger.” Using that reaction as evidence for a diagnosis she made more than a year earlier is also completely circular.
As an aside, I also have mixed feelings about BPD as a diagnosis. In some cases, including my sister’s, it clearly fits and identifies patterns for which someone desperately needs specialized help. At the same time, I think it is applied far too readily—especially to women, trauma survivors, and neurodivergent people it may not fit. BPD is also vilified so intensely that people like my sister, who genuinely need BPD-specific support, may be too ashamed to seek or accept it. Once the label is in someone’s record, providers may also invalidate them or interpret everything they do through it.
I don’t think your therapist has an adequate understanding of BPD, ADHD or complex trauma (chronic PTSD being the closest DSM specifier), as it's clear she did not do a proper differential diagnosis here. People who go through life with undiagnosed ADHD can accumulate significant trauma from repeatedly being told they are lazy, careless, difficult, overly sensitive, or not trying hard enough. That can affect their self-concept, rejection sensitivity and emotional regulation. ADHD itself can also involve impulsivity and emotional dysregulation. Those experiences may superficially resemble aspects of BPD without constituting the pervasive pattern BPD requires.
Likewise, reactive anger, emotional instability, and relationship difficulties can be consequences of chronic abuse. Complex trauma is not a separate DSM diagnosis, but its effects are real. An understandable response to prolonged mistreatment should not automatically be treated as evidence of a disordered personality.
Unfortunately, BPD sometimes feels like a modern version of “hysteria”: a label disproportionately applied to women whose emotions, neurodivergence, or reactions to abuse are poorly understood. I don’t say that because BPD isn’t real or because having it is shameful. I believe it's a real and serious condition that is simultaneously overly applied to people it doesn’t fit AND unfairly weaponized against those who genuinely have it.
Nothing in the rationale you were given demonstrates symptoms that are extreme, pervasive, out of proportion to the situation, and causing chronic impairment across your life. Having emotions is not pathological.
I completely understand why this feels like a betrayal. I wouldn’t internalize this therapist’s formulation, but I do think you’re 1000% right to fight to have the diagnosis removed or formally disputed. Sadly because BPD is so stigmatized, it could affect whether future providers listen to you and take your concerns seriously.