Spaghettification and the conceptual black hole of borderline personality disorder: a qualitative discussion around competing meanings given to the diagnosis and their potential consequences

This paper explores competing meanings which may arise through receiving a diagnosis of “borderline personality disorder,” discussing how this may impact a person’s treatment and their sense of self. This paper is informed by qualitative case study research, which utilized interviews to explore experiences of crisis and crisis intervention for people diagnosed with borderline personality disorder, their family and friends, and professionals who work with them. Utilizing this qualitative research data, alongside wider literature, the conceptualization of “borderline personality disorder” and the actual and potential real-world consequences of receiving this label are explored. Potential meanings are mapped onto a “black hole” model where potential competing meanings exist in the same place at the same time, and harm a persons sense of self. “Borderline personality disorder” is the most controversial personality disorder diagnosis. People may conceptualize their distress through four different labels for borderline personality disorder, be seen as “not real mental illness,” “borderline of what?”, not personality disorder, only personality disorder, and too unstable for therapy. Spaghettification, a term from astrophysics, is used as a metaphor to explain how a persons sense of self can fragment as they are pulled into the confusion of this black hole.