Talk:Borderline personality disorder

Article is too big

At almost 10,000 words this article should definitely be trimmed, per WP:TOOBIG. I suggest we create articles for some sections, such as Causes of borderline personality disorder (redirect to the "Causes" section), diagnosis, signs and symptoms; like we already do for management and misdiagnosis. The Blue Rider 16:00, 14 March 2024 (UTC)

I agree, I’ve done copyediting to most of the current content. Snipping out excess or twice-repeated content. However, for the most part it was just fact checking, updating some facts that play an important role, and letting it all flow nicely. I’m sitting with the following facts after my huge copyedit:

1. Causes should be grouped into three: genetic, neurobiologic, psychosocial. And then we expand if so on the new research into that.
2. In diagnosis, we put the criteria into prose, possibly removing the subtypes or prosing the subtypes by Millon as I haven’t seen their substantiveness in all the medical literature I’ve read there isn’t much mention of them?
3. Adolescence should move more forward or to a separate section termed prodrome where like schizophrenia there may be a prodrome or adolescence behaviour pre-disease pattern prior to developing the disease, as this is so “pervasive” unlike a mood disorder there is a prodrome of sorts I’ve picked up on although that is original research.
4. The differential diagnosis section is giving me the “ick”. It’s very overwhelming as summarised BPD can occur comorbid with a lot of other conditions, and not so typically talked about vice versa, if you get what I mean. And it speaks of the statistics in the old terms of Axis I and II instead of Sections I and II and I think we should speak of them in comorbid other personality d/o and comorbid other mental d/o (like mood d/o, trauma d/o etc.)
5. Management I need to tackle the main article, then we can filter what needs to be there knit pick onto the BPD article, maybe by {transclusion}? -- I’ve never done that before so you’re suggestions would be appreciated.
6. Epi I touched a little with the latest stats
7. Prognosis and History and Controversies I haven’t touched at all!!

What do you think? waddie96 ★ (talk) 15:33, 16 March 2024 (UTC)

I agree with all the points, I will start by putting the criteria into prose. The Blue Rider 17:55, 16 March 2024 (UTC)

Well, after you put it into prose, it really misrepresents the diagnostic criteria as outlined in the DSM V TR. I don't think diagnostic criteria is the time for prose, or any sort of personal editing or paraphrasing. It should be presented the same way it is in the scientific, medical, text. I see criteria such as self harm and fear of abandonment under the ICD section, but why is none of it listed in the DSM V section? Why is that part all loosely summarized and missing major diagnostic components of the disorder? 2600:8801:9A01:7070:0:0:0:E5D6 (talk) 07:40, 23 August 2024 (UTC)

@The Blue Rider I don't think there's anything wrong with it being long it provides the most information 45.19.219.33 (talk) 19:25, 21 March 2024 (UTC)

Good day, and welcome to Wikipedia. See Wikipedia:Welcome and Wikipedia:Article size. waddie96 ★ (talk) 20:29, 21 March 2024 (UTC)

I can't speak to the state of copyediting since I haven't thoroughly examined the article, but I think branching any of this off into a separate article would be a huge mistake. You suggest, for example, branching 'Causes of borderline personality disorder', yet I just trivially removed about 400 words from that section solely by trimming out two subsections which read like two people came in and decided to write a short essay about their favorite paper. With that done, the current section 'Causes' is of a totally reasonable and manageable length within this article. What I can almost guarantee would happen if it were branched is that 1) none of the people who branched it would stick around to maintain it long-term, and it would never see that kind of care and attention again, 2) the article would either not be much longer (if at all) than it would be as a section here or it would metastasize and come to be dominated by people indiscriminately turning single papers into entire essay-like subsections (whereas here it can be localized and easily eliminated, fewer eyes are on a subarticle like that), 3) it would be linked to basically just by this article, making it hard to find for typical readers, 4) coordinating what goes in the main article or both would be tedious, contentious, and likely detrimental to the completeness of the main article, and 5) the quality of both would suffer as they split editor attention. Biology of depression works so well because it's been so widely explored by hundreds upon hundreds upon thousands of studies. It really needs that space. With the suggestion to branch any article because it would make for a robust article on its own, I think there needs to be a standard of "prove it", i.e. present in a sandbox the exact version of what you think this article's first revision should look like and let editors examine that, not just whatever future ideal they can come up with in their head. TheTechnician27 (Talk page) 09:45, 14 April 2025 (UTC)

Agree, I don't think it needs a separate article. I think a lot of the article is just repetitive and too detailed. Zenomonoz (talk) 09:48, 14 April 2025 (UTC)

The diagnosis section is also too big, and probably doesn't need tables of comorbid diagnoses, given these rely on primary source studies. Zenomonoz (talk) 09:51, 14 April 2025 (UTC)

The DSM V TR does not use the term "manipulative"

Here's links to various articles with the exact language used for the diagnostic criteria for BPD in the DSM V TR:

https://emedicine.medscape.com/article/913575-overview?form=fpf

https://www.medcentral.com/behavioral-mental/borderline-personality-disorder/dsm-criteria-comorbidities-and-treatments

https://bpdfoundation.org.au/diagnostic-criteria.php

I also have a physical copy of the DSM V TR and can include pictures or scans. The whole manipulative and lying section is inaccurate and very biased. 2600:8801:9A01:7070:0:0:0:E5D6 (talk) 07:26, 23 August 2024 (UTC)

I will have to look more into this and talk to some other editors who are more active in this page but thank you for pointing this out. CursedWithTheAbilityToDoTheMath (talk) 21:42, 23 August 2024 (UTC)

Image

The image used in this article is weird. It says that it's "Idealization" by Edvard Munch, but when I click on the image it says that it's "The Brooch. Eva Mudocci". Is the image right for the article, considering that it's a portrait of someone else who does not have BPD and not something else? Should the image be changed to something else? Spinixster (trout me!) 08:04, 12 September 2024 (UTC)

The image represents Edvard Munch's idealisation towards Evangeline Muddock. Edvard Munch allegedly had BPD and therefore its symptoms were allegedly depicted through his art. Morslyte (talk) 09:54, 20 September 2024 (UTC)

Do you have a source saying that it's an idealization? It could just simply be a stylized portrait. Plus, I don't think it's a good image to represent BPD as a whole, since, again, just a portrait of someone. Spinixster (trout me!) 10:24, 20 September 2024 (UTC)

In support of removing the image by Munch and also removing references to Munch in this article, the claim that Munch had BPD is supported only by citing one pharmaceutical marketing publication, and one academic article that does not claim Munch had BPD, and if anything, argues that such a diagnosis would be mistaken. The first source (Aarkrog) cited for the claim that Munch had BPD is of unacceptable quality for two reasons: it is a publication by a pharmaceutical company, Lundbeck, that makes and markets two medications prescribed for BPD, and Munch was not diagnosed with BPD. It appears to be a marketing publication making speculative a diagnosis of a famous artist in order to promote its pharmaceutical products. The second source, the article by Wylie, that is cited for the proposition that Munch had BPD does not support that claim, rather it argues that under severe stress Munch displayed certain qualities of BPD due to him having Narcissistic Personality Disorder (speculatively, undiagnosed). Spz2025 (talk) 15:52, 13 April 2025 (UTC)

Agree with removing text about Munch. Very good arguments, Spz2025. Lova Falk (talk) 16:26, 13 April 2025 (UTC)

I hate to say this, but the original conversation is about the image on top of the article. While I support the removal of the Munch-related text based on arguments by @Spz2025, the question is still "Should this image be removed/changed?" And if changed, what to? CorrectionsJackal (correct me) 00:52, 14 April 2025 (UTC)

@CorrectionsJackal I think the image on top could be changed because in my opinion it doesn't even capture the essence of BPD very well. On the other hand, I really do think that the picture with the two faces, representing idealization and devaluation (according to the narrative), should be retained somehow, as it illustrates the phenomenon rather well, as I see it. I don't know how, of the top of my head, but it could possibly be possible to keep it without making the claim that Munch definitely had BPD. In general I believe that this article should not contain speculative posthumous armchair diagnosis, regardless of it is a scholar sitting in the armchair. It counts as trivia rather than actual information about BPD, and if included anywhere, it could be discussed in an article about Much. BlockArranger (talk) 02:12, 14 April 2025 (UTC)

@BlockArranger I'm strictly talking about the image on top of the article, which appears to be a seemingly normal portrait of Eva Mudocci, who does not have BPD, by Munch, who is only speculated to have BPD. It might be inappropriate to have that as the image to illustrate BPD as a whole. A different image should be chosen for the infobox, such as the one with the two faces, or the portrait be removed entirely. Sorry if I was not clear earlier. CorrectionsJackal (correct me) 02:25, 14 April 2025 (UTC)

@CorrectionsJackal Well, I see. Could I possibly suggest going back to the time when the picture was "Despair" by Munch, as I have not managed to find any clear reason as to why it was switched out? This article doesn't have to and shouldn't speculate whether or not Munch had BPD, but I believe the illustration was good, and I was even rather surprised when it was changed to the current one. The Despair image did in my opinion in many ways convey the experience often had by people with BPD. BlockArranger (talk) 02:29, 14 April 2025 (UTC)

@BlockArranger I agree, and I also had no idea why the image was changed. We should invite some editors to form a consensus, so in case the image gets switched out again, there's a reason to undo it back. CorrectionsJackal (correct me) 02:33, 14 April 2025 (UTC)

We can immediately dismiss the Wylie WH (1980) source, as having read through it 1) I can find no evidence they ever even mention BPD, 2) it's debatable if BPD was even well-understood enough at the time to have made such a retroactive diagnosis as it was published Winter 1980 whereas the DSM-III (1980) contained its first formal description as personality disorder, and 3) the article expressly describes Munch as having NPD – cluster C as well but nonetheless distinct under our current diagnostic frameworks. This to my mind completely fails verification and even directly contradicts what we're saying, which is a bad sign given it's one of our three sources. I would go so far as to say that our use of it is an outright lie. I've also removed it from the article on Munch, because its inclusion (and subsequent re-addition after an IP correctly removed it two years ago) is – put bluntly – a goddamn embarrassment to the project.

Tove Aarkrog appears to be a psychiatry researcher with multiple peer-reviewed publications on BPD. This was published in 1990, and thus our understanding of it had surely matured somewhat, although I can't imagine nearly as much as 35 years later. I think the ad hominem argument that this being published by a pharmaceutical company it makes it non-credible isn't sound. Pointing to it not being peer-reviewed is much more sound. Additionally, it's a photo gallery more than it is a sound scientific exploration of how Munch could be diagnosed with BPD. This to me is flimsy as a source – not inherently, but on its merits.

Thirdly, we have JF Masterson cited in the second caption, and we cite chapter 12 "especially pp. 212–213". (Incidentally, our article on Masterson was until just now a mass of what appears to be original research characteristic of poorly edited early 2010s-era biographies.) This was in 1988, so still pretty old, but ahead enough of the formal description as a PD that I wouldn't raise a fuss with the date. Masterson was a psychiatrist specializing in personality disorders, and thus I don't think his credentials are in question. This is a book published by Simon and Schuster, not a peer-reviewed medical publication, and so it feels a little bit weird that neither of our sources (discounting Wylie altogether) would be peer-reviewed by other medical experts. Half of page 212 and the entirety of page 213 are a brief summary of his psychological symptoms throughout his life (keeping in mind this seems to be the entirety of the discussion on Munch), and Masterson states: "From his graphic portrayals of separation anxiety and abandonment depression and the difficulties he had in personal relationships in his life, I hypothesize that he was a borderline personality [...]" Masterson additionally talks about instances of substance abuse, childhood trauma, loneliness and abandonment, interpersonal issues (including tenuous relationships), and fractured sense of self. This is definitely our strongest source, but keep in mind that we have another source (peer-reviewed) in Wylie 1980 diagnosing him with NPD. If somebody could gather more sources (robust and preferably recent) echoing that Munch was likely BPD, I think this is fine, but Masterson 1988 can't stand on its own for something this obviously contentious.

Lastly, I think it's debatable if the portrait really does a good job at representing BPD. The black-and-white imagery and the expression are... Serviceable, I guess? BPD isn't as easily digestible as something like uni- or bipolar depression or NPD (which our images do a good job of representing), so it's hard to come up with something that screams "borderline". I think outside of something egregious, which to me this image isn't, we should have a modest consensus around a new image before considering removing this current one. TheTechnician27 (Talk page) 22:17, 14 April 2025 (UTC)

Thank you for your analysis of the sources! Well, provided that your analysis is correct, I agree with your conclusions. So far, however, I would state more clearly that I don't see a reason for this article to discuss Munch much at all, as he is regardless not of that much relevance to BPD. I think the Eva Mudocci picture in itself would not carry much merit at all by itself, if it weren't for the fact that this article had already previously had a painting by Munch, and at the same time at some point someone included the information about Munch having BPD.

I believe that a picture used in this article should arguably have clear merits on its own, regardless of the artist; I would most definitely prefer an artwork which to many clearly would illustrate a core aspect of BPD, even if made by someone of excellent mental health. On the other hand, I believe that the Despair painting more clearly illustrated a "BPD experience", and it could work even without claiming that Munch must have had BPD. Maybe, it would be possible to make the claim that Munch "has posthumously been suggested by [whomever] to have suffered from BPD, just for context if nothing else.

Surely, it must be possible to find sources for the phenomenon being depicted in the Despair painting being phenomena associated with BPD. Sure, I get that this might lead to a WP:SYNTH situation, but I am hereby merely suggesting that this close-to-worst-case scenario might somehow be possible to avoid. BlockArranger (talk) 00:51, 15 April 2025 (UTC)

Uncomfortable / Triggering section head image?

The current section lead image for Signs and Simptoms can (and do) look quite uncomfortable (for me at least). Maybe we should illustrate the point w/ something else?

After a while of searching i still haven't find a good-enough image that is released under CC-BY. Perhaps we can just... draw a new image and upload it?

Does someone know how to paint...? I'm an utter rookie when it comes to handling my apple pencil. irisChronomia (talk) 17:22, 20 January 2025 (UTC)

Do you mean an image that illustrates abandonment? It's one of if not the biggest hallmark of BPD, and thus I think an image illustrating abandonment should be included. The current image does it in a clear, effective way via easily recognizable silhouette, showing a person helplessly reaching out for someone leaving them and breaking up inside as they do it (it being played out by two black silhouettes against a white-ish backdrop could even be nodding to black-and-white thinking which serves as BPD's other most recognizable hallmark; the shattering at their core can even be nodding to an unstable sense of self). Even the watermark which I'd suggest we should strive not to have in any form is done as elegantly, subtly, and tastefully as it can reasonably be.

Wikipedia is not and has never been censored for any reason if we can legally help it. Just like any other image, the sole merits this CC-BY-SA image is judged by are under MOS:IMAGES. 1) Is the image pertinent? (As established, I think yes.) 2) Is the image an aid to understanding? Given BPD is a psychological disorder and that this isn't the section about neurology, we're assessing the emotions and behaviors of a person diagnosed with BPD. I think the image captures this well and aids the emotional understanding of someone who hasn't struggled with BPD in a way that our necessarily academic treatment of it may not; it arguably (as described above) hits at least three of the most major hallmarks of BPD. 3) Is there reason to believe this is lower-quality than another usable image, either on technical grounds or that the other one is more informative? I honestly don't think so. I think the current image is absolutely fantastic at what it does.

Now we can move onto "Even if Wikipedia were censored...", because I feel the suggestion to implement a new image would be weak even on a bizarro-Wikipedia where "it's offensive; remove it" is even worth considering. Firstly, BPD is a (frankly quite serious) personality disorder characterized highly triggering symptoms and causes. BPD is often rooted in childhood abuse and especially childhood sexual abuse. BPD is linked to disproportionate rates of self-harm and suicide. BPD is linked to eating disorders, substance abuse, uni- and bipolar depression, dissociation, etc. And it often presents with highly chaotic interpersonal relationships and even domestic abuse. A competent encyclopedic treatment of BPD cannot avoid those triggers, nor should it be expected to try. Even if we could accept that we should self-censor our treatment of BPD to avoid making readers uncomfortable, this image is frankly quite benign compared to what's in the prose. It really is a silhouette person perceiving abandonment by another silhouette person and figuratively breaking up inside because of it. You may be the only one to have ever brought up this discomfort, and I think the overwhelming majority of people to within a rounding error would look at this image and feel no discomfort or a level of discomfort that's healthy and transient. If we were to remove it, it seems like the justification would solely be: "We're going to break our rule about censoring this one time for this image that does its job well and is about as benign as it could possibly be because one editor says it made them uncomfortable."

I have panic attacks frequently, and I know it's not as simple as "this shouldn't be uncomfortable to you; try harder". What I am suggesting is that if even an illustration about BPD is making you uncomfortable enough to start a discussion around replacing it, it may be worth 1) attempting exposure therapy in a clinical setting or on your own, or 2) avoiding depictions of mental health disorders until you're in a healthier place emotionally. Replacing this image with something else to avoid discomfort would be needlessly and counterproductively sanitizing an article about an inherently discomforting topic. TheTechnician27 (Talk page) 08:58, 14 April 2025 (UTC)

I agree with you. Additionally it's worth pointing out that enabling people's mental vulnerabilities to go unaddressed doesn't seem like a very optimal strategy. I am also fully sympathetic to people who have such difficulties, but some people finding topics, images, or information hard to deal with is not sufficient reason to exclude said things. BlockArranger (talk) 12:04, 14 April 2025 (UTC)

Agree on keeping the image. Lova Falk (talk) 09:41, 15 April 2025 (UTC)