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Open Access 04-01-2025 | Borderline Pattern | Scientific Contribution

Borderline personality disorder and moral responsibility

Author: Agnès Baehni

Published in: Medicine, Health Care and Philosophy

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Abstract

This paper seeks to determine the extent to which individuals with borderline personality disorders can be held morally responsible for a particular subset of their actions: disproportionate anger, aggressions and displays of temper. The rationale for focusing on these aspects lies in their widespread acknowledgment in the literature and their plausible primary association with blame directed at BPD patients. BPD individuals are indeed typically perceived as “difficult patients” (Sulzer 2015:82; Bodner et al. 2011), significantly more so than schizophrenic or depressive patients (Markam 2003). The “responsibility question” for patients with BPD has already been raised (Martin 2010; Zachar and Potter 2009; Bray 2003), but this paper tackles it from a novel perspective. First, I narrow down the category of things for which the responsibility question is specific to individual with BPD. After that, I argue that some of the diagnosis criteria of BPD such as emotional instability or impulsivity might serve as excusing factors targeting the “control condition” on moral responsibility. Second, this paper also considers another widely accepted condition on moral responsibility: the epistemic condition. The view defended in the paper is that the answer to the responsibility question for individuals with BPD, concerning both the control condition and the epistemic condition, hinges on an understanding of their epistemic profile.
Footnotes
1
For instance, while manipulation is often associated with a borderline personality, it is not among its diagnosis criteria. For a discussion on BPD and manipulation, see Potter, Nancy Nyquist. ‘What Is Manipulative Behavior, Anyway?’ Journal of Personality Disorders 20, no. 2 (April 2006): 139–56; discussion 181-185. https://​doi.​org/​10.​1521/​pedi.​2006.​20.​2.​139. Bowers (2003:323), quoted in Nyquist Potter (2006: 139) observes that “so frequently does the word crop up in conversations and discourses about such patients, that it might wrongly be thought of as the major problem that such patients pose to psychiatric services, or the major defining criteria of their disorders”.
 
2
As an example of this tendency, Sarah Sulzer, notes that “The very symptoms and behaviors associated with BPD are linked with how providers define the “difficult patient” (2015: 82).
 
3
American Psychiatric Association. (2013) borderline personality disorder. Diagnostic and Statistical Manual of Mental Disorders, 5th, ed. American Psychiatric Publishing. DSM-V, https://​dsm-psychiatryonline​-org.​ruby.​uhv.​edu/​doi/​full/​10.​1176/​appi.​books.​9780890425596.​dsm05.
 
4
There might be social factors influencing the prevalence of BPD diagnosis in women, as well as important consequences to this asymmetry. For a recent discussion see Dorfman, Natalie, and Joel Michael Reynolds. ‘The New Hysteria: Borderline Personality Disorder and Epistemic Injustice’. International Journal of Feminist Approaches to Bioethics 16, no. 2 (2023): 162–81.
 
5
There are two main kinds of dichotomous thinking, unidimensional and multidimensional. Unidimensional dichotomous thinking is the tendency to make extreme evaluations where these evaluations are always either all good or all bad (Veen & Arntz 2000: 24). On the other hand, “multidimensional” dichotomous thinking is defined as the making of extreme evaluations with different valences on the positive–negative dimension. In this case, a person can be simultaneously evaluated as ‘‘totally reliable’’ and ‘‘totally lacking self-confidence’’ and is therefore not seen as ‘‘all good’’ or ‘‘all bad.’’ (Veen & Arntz 2000: 24). Extreme evaluations can explain that BPD patients react in extreme ways. (Sieswerda et al. 2013: 36).
 
6
See aksi Barnow et al., 2010
 
7
Quoted in Menges 2023 p. 616.
 
8
Although it is somehow difficult to find academic works on the topic, references to this difficulty abound on website dedicated to helping families cope with individuals with BPD. See for instance https://​www.​grouporttherapy.​com/​blog/​borderline-personality-disorder-blaming-others. One can also find numerous discussions on Quora https://​www.​quora.​com/​Why-can-t-BPD-people-ever-admit-they-are-wrong and Reddit, of people living with individuals with BPD, testifying that their loved ones with BPD can never admit that they are wrong. It is surprising that not more academic work is devoted to this aspect of living with an individual with BPD. See also https://​adrtimes.​com/​high-conflict-personality/​ and https://​www.​psychologytoday.​com/​intl/​blog/​5-types-people-who-can-ruin-your-life/​201803/​are-you-target-blame-borderline-personality
 
9
Of course, depending on some circumstances such as his age, his education, his wealth, social context and so on, one could expect that Mario seeks therapeutic help by himself. It is thus difficult to render definitive verdict in the abstract.
 
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Metadata
Title
Borderline personality disorder and moral responsibility
Author
Agnès Baehni
Publication date
04-01-2025
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-024-10243-6