Authors
Rachel Galea, Alison Rodgers, Catherine MacDonald, Ayanna Robertson, Alessandra Rooney
Published in
Nursing inquiry. Volume 33. Issue 4.
Abstract
Borderline personality disorder (BPD) is a contested diagnosis that has been criticized for pathologizing women's responses to trauma, adversity, and relational harm. This paper examines how BPD, as a gendered, historically situated, and institutionally mediated diagnostic category, shapes community mental health nursing (CMHN) practice. Using a critical conceptual analysis, it synthesizes historical, feminist, psychiatric, nursing, and Mad studies literature, combining genealogical, critical feminist, and social-structural perspectives. The paper argues that BPD functions not only as a clinical description of symptoms but also as an institutional category that influences documentation, referral pathways, eligibility criteria, and service design. Through these processes, the diagnosis shapes clinical visibility, therapeutic relationships, service access, and continuity of care. Moving beyond explanations of stigma that focus solely on individual clinician attitudes, the analysis demonstrates how diagnostic meanings are reproduced through organizational and health system structures, contributing to forms of structural stigma that constrain relational and trauma-informed care. The paper concludes with implications and recommendations for nursing practice, education, service delivery, and policy, including trauma-informed and relational approaches to assessment, non-stigmatizing documentation practices, transparent referral and eligibility processes, investment in community-based services, and strengthened clinical supervision and workforce supports.
PMID:
42927650
Bibliographic data and abstract were imported from PubMed on 26 Oct 2026.
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