Working around a contested diagnosis: borderline personality disorder in adolescence

Area of Science:

• Psychiatry
• Sociology
• Discourse Analysis

Background:

• The diagnosis of borderline personality disorder (BPD) is contentious and stigmatized across mental health settings.
• Clinicians in adolescent mental health services face challenges applying adult diagnostic criteria to individuals under 18.
• Existing research often overlooks the practical application and social dynamics of BPD diagnosis in youth mental health.

Purpose of the Study:

• To analyze how Child and Adolescent Mental Health Services (CAMHS) clinicians in Australia use the BPD diagnosis.
• To explore the social and discursive strategies clinicians employ when working with adolescents and the BPD diagnosis.
• To understand how these strategies impact clinical practice, diagnostic uncertainty, and adolescent identity development.

Main Methods:

• Discourse analytic study of interviews with clinicians in two Australian publicly funded CAMHS.
• Analysis focused on clinicians' reflections and practices regarding the BPD diagnosis in adolescent care.
• Identified specific strategies such as team rules, hedging language, informal 'borderline talk', and reframing.

Main Results:

• Clinicians actively resisted and subverted the BPD diagnosis, contrary to diagnostic primacy or transparency.
• Strategies included discouraging disclosure, using hedging, informal discussion, and reframing the diagnosis for young people.
• These practices legitimized clinical skepticism and managed diagnostic uncertainty with vulnerable adolescents.

Conclusions:

• Everyday clinical practice reveals a contestation of the BPD diagnosis, moving beyond theoretical debates.
• Clinician strategies help forestall a fixed BPD trajectory, allowing space for adolescent identity development and change.
• Findings highlight the complex interplay between diagnostic labels, clinical communication, and therapeutic outcomes in youth mental health.