"I am Borderline": Psychiatric Diagnosis, Identity, Self-Presentation, and Digital Culture in Borderline Personality...

The psychiatrization of borderline personality disorder (BPD) has expanded beyond clinical contexts into identity formation, interpersonal regulation, and digital self-presentation. For individuals with BPD-whose psychopathology centrally involves identity diffusion-the diagnostic label may function not only as an explanatory framework but also as a stabilizing, defensive, or performative identity resource, particularly within online environments.

This article aims to examine how individuals with BPD integrate psychiatric diagnosis into their self-concept, to identify the psychological and relational functions of diagnostic identity in offline and digital contexts, and to explore clinical implications for psychotherapy, with a focus on schema therapy.

A narrative review of international literature on psychiatrization, identity diffusion, stigma, and digital self-presentation in BPD was conducted and integrated with four analytically constructed clinical case vignettes. The vignettes are composite, theory-driven models derived from extensive clinical experience and are used to illustrate recurring patterns rather than individual patient trajectories. The analysis is grounded primarily in schema therapy, complemented by psychodynamic and mentalization-based perspectives.

Across the reviewed literature and case material, psychiatrization in BPD emerged as a dynamic and context-dependent process. Four prototypical patterns were identified: (1) diagnosis as a public or performative identity, (2) diagnosis as a protective shield against guilt and responsibility, (3) diagnosis as an idealized marker of sensitivity and moral value, and (4) diagnosis as a community-based identity providing belonging. While diagnostic identification often provides relief, coherence, and a shared language for emotional experience, rigid identification may constrain agency, reinforce maladaptive relational strategies, and become amplified by digital environments that reward emotional intensity and visibility. This article introduces a clinically grounded typology of psychiatrization in BPD, linking diagnostic identity to specific relational and regulatory functions across offline and digital contexts Conclusions: Psychiatric diagnosis in BPD functions as a double-edged tool: it may support understanding and self-compassion, yet also risk becoming an identity substitute that limits psychological growth. Effective psychotherapy should therefore address not only symptoms but also the meaning and function of the diagnosis within the patient's identity system. Identity-focused work, strengthening of mentalization and emotion regulation, and reflective engagement with social media use are central clinical tasks. Further qualitative and longitudinal research is needed to examine how relationships to diagnosis evolve over the course of psychotherapy and across sociocultural contexts.