In a previous blog post, we explored what neurodivergent affirming therapy is, and how to find a neurodivergent-affirming therapist near you. That post also included an exploration of what neurodivergence is, which can basically be summarized as brains that experience the world differently, and complete tasks differently. Not everyone agrees on what conditions are considered neurodivergent, and which are not.
Sonny Jane Wise, a neurodivergent educator I really admire, advocates for a more inclusive neurodivergent umbrella. In a more narrow definition of neurodivergence, only neurodevelopmental disorders (ie. the disorders in the neurodevelopmental disorder section of the DSM) count as neurodivergence. The DSM defines a neurodevelopmental disorder as a group of conditions that primarily affect the development of the nervous system, particularly the brain. These disorders typically manifest early in a person's development, often during childhood, and can have a lasting impact on various aspects of cognitive, emotional, social, and motor functioning. Neurodevelopmental disorders are believed to be rooted in atypical brain development or functioning and may have genetic, environmental, or a combination of factors contributing to their occurrence. A lot of people accept the definition of neurodivergence as pretty much just ADHD and autism.
This doesn’t sit well with me. Why not? Because it assumes that some disorders are the result of different development of the brain and others are not.
As much as neurodivergent and neurotypical are medical categories (whether or not the medical establishment embraces these terms or not), they are also social categories. They are just a socially constructed way of sorting people into groups (neurodivergent vs. neurotypical) and deciding who belongs in which group.
Diagnoses are Socially Constructed
The debate over neurodivergence serves to remind us that every disorder in the DSM is a collection of symptoms, not an essential biological truth about who you are. Yes, some people may be born with different brains, or a predisposition to certain traits or symptoms, but as a society, we decide what is a symptom, and how to cluster groups of symptoms together into disorders. Neurodivergence and mental illness are not like a broken leg. Even if we had a machine that was sensitive enough, we could not scan a brain and say which brain had which disorder, and whose was the result of their environment and whose was genetic. It is just too much of a tangle of biology and environment, nature and nurture, and our natural tendency to want to categorize things and people.
Why do we think of some disorders as brains that were born different, and others as people with problematic behaviour? Increasingly, online mental health spaces seem to just equate BPD with bad behaviour. No one comes to therapy and says they think their mother-in-law has undiagnosed ADHD, but many, many people come and talk about the difficult relative who they have decided has borderline personality disorder or narcissistic personality disorder. I’ve seen a bunch of Instagram social media stuff talking about borderline people crying in order to manipulate others, but the same accounts advocate compassion and understanding for autistic meltdowns. For both a person with BPD and a person with ASD, uncontrollable crying is a sign that the nervous system is completely overwhelmed. So why the contempt and disdain for one but not the other?
Conversely, many people have expressed to me a sense of relief after an ADHD diagnosis, particularly a diagnosis that occurs in adulthood. This diagnosis has an explanatory power that makes the ways that have struggled until now make sense. Many people with undiagnosed ADHD blame themselves for their difficulties, and a diagnosis allows them to say, “it’s not my fault; my brain is built differently.” This is a kind of relief that rarely follows a BPD diagnosis.
Who Decides What's Under the Neurodivergent Umbrella?
It’s important to remember that the classification of mental health conditions serve purposes other than just connecting the right person with the right treatment or accommodation. They also exist to stratify society and to as a way to control and exclude people with certain ways of thinking and being. Want to discredit someone? Call them crazy. The category of “neurodivergent” in some ways protects people who are included in that category, because it says “we are not less than, we just have different brains.”
BPD, for instance, is widely connected to experiences of complex trauma and invalidating early environments. We know that trauma requires the brain. So if someone’s brain adapts to allow them to cope in a traumatic environment early in their development, why do we hesitate to call this a neurodevelopmental condition? In fact, there’s an enormous amount of overlap between BPD symptoms and ADHD and autism symptoms, including emotion dysregulation, social difficulties, impulsivity, and more. If the same person saw three different diagnosticians, they might be diagnosed with three different disorder based on the diagnostician’s interpretation of their symptoms. And we know that who gets what diagnosis is often based on who they are - women and trans people are more likely to be diagnosed as borderline.
So why do some people maintain that neurodivergent should just mean ADHD and autism?
Because language is funny. Just because a narrow, stigmatizing definition of neurodivergence exists, are we bound to it? As a neurodivergent affirming therapist, I believe we have the choice to use neurodivergence to describe a wider range of experiences that differ, including the stigmatized ones. And broadening the category of neurodivergence may actually be an act of resistance against social forces that want to say people with BPD symptoms are “less than.”
So Is BPD Neurodivergent?
One of the things that ADHD, autism, and BPD have in common is the experience of feeling things deeply. When I started Stillwaters as a counselling practice with the mission of supporting LGBTQ+ and neurodivergent people, one of my main goals was to create a safe space for people who feel deeply. As much as feeling deeply can be a really difficult experience to have in the world right now, I also believe it is a real strength. As a therapist for neurodivergent people, I work hard to affirm the experiences of all my neurodivergent clients, including the ones with BPD.