The reality of having Borderline Personality Disorder in the workplace – and what employers actually need to know
06 Aug 2023
When my sister was 13, she began showing symptoms of borderline personality disorder (BPD). However, she wasn’t diagnosed until she was 21, due to a sheer lack of knowledge around psychiatric illness in the UK health system – an admission many doctors have given over the years.
Over that period, I watched as my younger sibling was traipsed from hospital and doctor appointments, to numerous school meetings. Her symptoms were often dismissed as depression and anxiety – something sadly common with women her age. Along with all these meetings came a bevy of unsubstantial pieces of advice such as writing her problems on a piece of paper and scumbling it into the bin (we laugh at this now).
After years of battling unstable thoughts without the psychiatric medication we now know she needed, she was finally diagnosed with borderline personality disorder. While it was a relief to finally get the diagnoses, it also caused an identity crisis in Ellie., As I bared witnessed to her journey I could see first-hand the sheer bias people have towards BPD in comparison to other mental illnesses. A lot of it seems to come from a lack of understanding, because while those looking to understand the condition are well-intentioned, they often place focus on the wrong aspects.
So, in effort to add some lived-experience insights to the mental health conversation, I decided to share some of the realities around working with Borderline Personality Disorder in the workplace – with the help my sister.
Why employers need to focus less on BPD symptoms
Borderline Personality Disorder is essentially a psychiatric illness. I’m not going to list out the less-than-flattering NHS symptom list, but in essence, it means that those with BPD will sometimes just feel really rubbish. They may have knee-jerk and very emotional reactions, and sometimes they’ll just hide away. It’s not, as many people think, split personality disorder.
I’m choosing not to outline the symptoms here because it can be very damaging for people with BPD to read. For example, if you’re already feeling like a terrible human being, you don’t really need to read that you’re a “difficult patient” alongside the gluttony of other negative descriptions.
Ellie and I see a lot of emphasis placed on symptoms, but if you’re working with someone with BPD, you really don’t need medical textbook knowledge. “It’s so much more than a list of symptoms,” Ellie confirms.
“It’s so much more than a list of symptoms.”
For Ellie, BPD comes in cycles which we call ‘episodes’. She’ll have the best month ever and then suddenly *bang*, she’s facing a couple of weeks of an uphill battle – it’s frustrating and unpredictable.
Some people can’t work because of their BPD, but Ellie does, as do many other people. She’s career-focused, holds down a professional job and is in line to progress. Of course, this is amazing but something that she’s also been penalised for by some who think, “well, if you can work, you must be alright”.
It’s just not that simple. BPD is chronic; we know she’ll experience symptoms forever so it’s about managing those symptoms. I think this can be difficult for other people to grasp and can cause frustrations within relationships and workplaces because people think they’ll be supporting someone until they ‘get better’. But the reality is that support needs to be ongoing indefinitely.
Should you disclose your BPD to your colleagues?
There’s a lot of discourse around whether employees should unveil their BPD diagnosis to colleagues. On the one hand, you may think it’s useful to disclose your diagnosis so as to receive that right support (and in a few industries, outlining BPD to your employer may be a legal or contractual requirement).
However, it can also be an incredibly challenging and daunting thing to ask someone with BPD to do – especially when so much stigma remains around BPD and people just don’t know how to react or behave. “Having to talk to someone about BPD feels embarrassing. You have to emotionally strip yourself bare and tell people all these vulnerable things,” says Ellie.
“Having to talk to someone about BPD feels embarrassing. You have to emotionally strip yourself bare and tell people all these vulnerable things.”
The label of BPD often conjures fears of being treated differently or infantilised by colleagues, which often wards people from revealing that information. One tactic Ellie deploys to make things easier for her is a ‘soft launch’ into BPD – avoiding using the term but explaining that she sometimes feels a certain way.
Ellie also says it can be useful to have a trusted person within the organisation who understands your back story and can regularly check-in. This translates into someone genuinely asking, ‘how are you?’, ‘is everything going ok today?’ rather than framing it as a flippant remark. “Have it as a leading question, don’t just say ‘you alright?’ in passing,” she says.
How to react when employees tell you they have BPD
Employees revealing their BPD status can make employers slightly nervous, especially in a time when mental health in the workplace has become such a scrutinised issue. For example, how should you manage someone with BPD? Can you talk to them about it? What if you trigger them by giving them too much work?
The fact is people with BPD in the workplace are adults like everyone else, and they can set boundaries with you. If they disclose their BPD diagnosis to you, don’t scurry away and discuss a way forward in the background. “I worry about people discussing it behind my back because it’s a sensitive topic to bring up. I’d rather people include me in those conversations,” says Ellie.
Of course, there may be people that feel differently to Ellie and don’t want to be involved in that conversation – but that’s a choice that they should have.
How to handle workload for BPD employees
Everyone in the workplace at one time or another feels stressed. And people with BPD are allowed to feel stressed too.
It’s easy to get wrapped up in thinking you should avoid giving certain responsibilities or pressures to employees with BPD due to the fear of overwhelming them. However, hesitance to challenge them can end up just fuelling fears that they’ll be passed up on opportunities or stunted in their career growth.
“My fear is that if I tell someone I have BPD they won’t want to give me responsibilities or they’ll be treading on eggshells in regard to how much work they give me because they worry I won’t be able to handle it,” says Ellie.
“My fear is that if I tell someone I have BPD they won’t want to give me responsibilities or they’ll be treading on eggshells in regard to how much work they give me because they worry I won’t be able to handle it”
Of course, I’m not saying the mental health of employees dealing with stressful workloads is not something for managers to consider – it definitely is. But there’s no need to differentiate your approach for those with BPD – check in with them like you would anyone else and enquire about workloads.
This may change your mindset for managing BPD employees:
Something I’d like to add is that work and mental illness are not always at loggerheads like you may expect. For Ellie, having structured days and a purpose helps her manage her BPD. “I feel like if you’re high-functioning, you can become very work orientated because the distraction and routine of work keeps me going. Deadlines help me going,” she says. “The issues arise when I don’t have much to do, so I overthink, and it snowballs.”
Mental health and mental illness are not the same… stop with the mindfulness resources!
There’s a difference between mental health and a psychiatric illness but the two are often bundled together. “You can have good mental health with strong support systems and still have a mental illness,” Ellie explains.
I make this differentiation because directing people with BPD towards mindfulness resources as a form of support can be frustrating, despite being well-intended. And I’ll explain why:
BPD is incredibly complex to treat to the point where a lot of therapists choose not to treat those that have it. Instead, Ellie and her peers must consult with highly qualified and specialised psychiatrists.
“You can have good mental health with strong support systems and still have a mental illness”
To get to this stage takes years, as BPD is so difficult to diagnose. In those difficult in-between years, I guarantee that every person has been pushed towards embracing mindfulness. At this point, I think we’ve done everything: mindfulness apps, journalling, meditation, walking, crafting, beauty subscription boxes, reading self-help books, a therapy rabbit named Dandelion, the list goes on… In fact, you’ll find the people that struggle most with mental illness often actually know the most about self-care.
So, when people very kindly recommend mental health activities (I have made this mistake), it can sometimes be misinterpreted as undermining, inferring that the person with BPD hasn’t tried. “It’s easy to go the wrong way because of how you interpret situations,” says Ellie.
That’s not to say workplaces need to revoke their mental health resources. They should absolutely be accessible to all employees and can be a great support to cultivating good mental health. Just be cautious in presenting them in correlation with BPD employee support.
Why people with BPD can make great managers
Conversations about people with BPD are often negative, so I want to flip this by telling you why Ellie and I think employees with BPD can make especially great managers.
Often patients will have been in therapy for years, they’ve also usually experienced the lowest of the lows. Both of these things build a great deal of emotional intelligence which enables them to talk to other employees who may need support.
“I’ve been in therapy since I was 14 years old,” says Ellie. “I know how to talk to someone vulnerable, and I’m way more aware of self-care and mental health than the average person.”
Ways your workplace can actually support employees with BPD
Small changes over grand gestures are really what makes the difference for BPD employees in the workplace. Here are some things that you can do to support:
- Provide clear explanations on decisions that affect BPD employees and regularly reassure them that actions aren’t personal or a reflection of their ability.
- Make allowances for employees to attend medical and therapy appointments.
- Understand that working from home might be needed during ‘episodes’.
- Involve BPD employees in discussions about how to approach and manage them.
- Don’t restrict opportunities to learn and progress due to fears of stress.
- Be careful in offering mindfulness resources to directly support BPD.
- Facilitate a ‘trusted person’ in the workplace that can act as a confidante.
- Focus on the person, their skills, and their value, not just their symptoms.
*This piece is borne out of Ellie’s experience with BPD in the workplace. Please be mindful that some people’s needs may differ.