Discursive constructions of emotionally unstable personality disorder and borderline personality disorder: a critical exploration of how diagnosis is constructed by service users and clinicians

Abstract

Section A
Background. Emotionally Unstable Personality Disorder (EUPD) and Borderline Personality Disorder (BPD) are diagnoses surrounded by significant clinical debates and controversies dating back to their early roots in psychiatry. The introduction considers some of the historical origins of the diagnoses and highlights shifts in diagnostic language and criteria. The history of the diagnoses also highlights the imprecision and limited efficacy of the diagnostic frameworks that have arguably contributed to the way EUPD/BPD is viewed in the present day.
The review also considers some of the growing research around the stigma held by clinicians who have negative views towards individuals with EUPD/BPD and how they contribute to the unhelpful narrative around it. The recent shift in language and its impact on these narratives are explored. Critically, it questions the meaning behind evolving terminology and the implications for those who receive the EUPD/BPD label. This was particularly pertinent as more people sought out the diagnosis.

Aim. This review aimed to critically examine how service users (SUs) constructed and made sense of their diagnosis of EUPD/BPD.

Method. Following the search of three databases, thirteen papers were identified. A narrative synthesis approach was implemented, and studies were organised thematically.

Findings. The findings suggested that the EUPD/BPD construct was built on a multifaceted Discursive Constructions of EUPD/BPD 11 relationship between the label of EUPD/BPD itself, the person’s identity, and the way it affected their relational dynamics in different contexts. The review discussed how stigmatising language could become internalised by SUs. It also highlighted the duality of the diagnosis, which, for some, provided a sense of belonging and understanding of their experiences while also acknowledging how diagnosis could cement a negative self-identity. This showed how it was a fluid construct, and its understanding could not be reduced to a set of characteristics.

Conclusion. The review underscored the need for future research that better accounts for gender, cultural, and ethnic differences while acknowledging the power dynamics held by researchers and clinicians who conducted these studies.

Section B
The present study used Foucauldian Discourse Analysis (FDA) to examine how clinicians within the NHS mental health settings discursively construct and negotiate diagnostic labels of Emotionally Unstable Personality Disorder (EUPD), also known as Borderline Personality Disorder (BPD). The study adopted a social constructionist epistemology and relativist ontology.

Twelve clinicians from psychological backgrounds participated in semi-structured interviews, exploring their experiences of working with individuals with EUPD/BPD diagnoses, their language choices and the implications of these discursive constructions in clinical practice.

The results have revealed three dominant discourses: Psychiatric and Medical, “Just Being Borderline” Discourse , and Bureaucratic and Institutional. These discourses constructed EUPD/BPD as medicalised and managed through institutional and systemic frameworks that are both perpetuated and resisted by the clinicians working in those systems.

Some counter-discourses emphasised alternative frameworks of EUPD/BPD, though conceptualising it through trauma-informed approaches, service-user-led language and sometimes neurodivergence.

Moreover, the “Broken System” counter-discourse further highlighted systemic pitfalls within the NHS mental health services, positioning clinicians and service users both as constrained by resource limitations, service guidelines inflexibility and exclusion of those with these diagnoses.

The findings underscore clinicians’ complex negotiation of diagnostic discourses, illustrating how language can reproduce and resist psychiatric dominance. This highlights the need for increased critical reflexivity and attention to systemic and institutional practices that
ultimately shape diagnostic decisions and service provision.

Date of Award	2025
Original language	English