Longtime therapist diagnosed me with BPD without telling me — wondering if other ADHD/neurodivergent women have had their emotionality interpreted this way
Cross-posting because the neurodivergence piece is one of the parts I’m struggling with most. I have ADHD, and I’m particularly interested in hearing from other ADHD/neurodivergent women who have had emotional reactivity, rejection sensitivity, or interpersonal experiences interpreted as BPD—or who were evaluated for both and can speak to how clinicians differentiated them.
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 may bother 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’m sure she saw my emotionality over the years. I don’t dispute the emotionality; I question how she determined what it represented.
I’m not saying neurodivergence rules out BPD. It doesn’t. I’m saying overlapping presentations make careful differential assessment more important. When I specifically asked how neurodivergence and other differential explanations had been considered, I didn’t feel I received a clear explanation.
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.