You've probably heard the terms. Borderline Personality Disorder. BPD. Emotionally Unstable Personality Disorder. EUPD. But unless you work in mental health services, there's a reasonable chance they've never come up in a management meeting, a wellbeing review, or a conversation about workplace culture.
And that silence is a problem.
Because according to NHS England's Adult Psychiatric Morbidity Survey, around 1.9% of adults screen positive for BPD, and that figure is likely an underestimate, given how frequently the condition goes unrecognised or mislabelled. (Morris et al., n.d.) Behind every statistic is a real person trying to do their job, manage their relationships, and hold things together, often without their employer having any idea what they're dealing with.
So, what exactly is BPD/EUPD?
BPD, or increasingly referred to in UK clinical settings as EUPD, is a mental health condition that affects how a person thinks and feels about themselves and others. The core experience is one of intense emotions that are difficult to regulate, and a deep sensitivity to how others perceive them. For someone with BPD, the emotional volume is turned up significantly higher than it is for most people. A perceived rejection that others might brush off can feel catastrophic. Or, conflict that most people manage to contain can feel overwhelming.
The condition typically involves some combination of: intense and unstable relationships, a shifting or fragile sense of self, fear of abandonment (real or imagined), impulsive behaviour, and significant emotional swings that can come on quickly and feel very difficult to manage.
And it's worth being clear: none of this is a character flaw. BPD has been found to be three times more strongly associated with a history of childhood trauma than other psychiatric diagnoses.(Porter et al., 2020, pp. 6-20) For many people living with it, the condition is the long-term legacy of experiences they had very little control over. (NHS England)
The gendered dimension
BPD doesn't discriminate, but its diagnosis does. Historically, women have been three times more likely to receive a BPD diagnosis than men, and the NHS's own survey reflects this: women are more likely to screen positive for BPD (2.5%) than men (1.3%). (Wiley Online Library)
Research increasingly suggests this gap reflects something important about how the condition is identified and in whom. (Stiles et al., 2023, pp. 177-194) Part of the criteria for BPD are angry outbursts, and those reactions are often less acceptable in women than in men. We've always had diagnoses that disproportionately label women for experiencing or expressing things. There are also growing questions about the overlap between BPD and neurodivergence, particularly in women. Emotional dysregulation, sensitivity to rejection, and relational intensity are features of ADHD and autism, too, and women are frequently misdiagnosed with one condition when they may in fact have another, or several alongside each other. (British Association for Counselling and Psychotherapy)
What this means practically is that if you have women in your workforce, and you do, there is a meaningful chance that some of them are living with BPD, possibly without a formal diagnosis, possibly without having told anyone at work.
Why is the stigma so damaging?
BPD has been described as the most stigmatised psychiatric diagnosis. (Stiles et al., 2023, pp. 177-194) That's a significant claim in a landscape where conditions like schizophrenia and bipolar disorder also carry considerable social weight. Studies comparing internalised stigma across different diagnoses have found that people with BPD consistently report higher levels of perceived discrimination, social isolation, and shame than those with other conditions. (nih)
Much of this stigma operates within healthcare itself. BPD has long been subject to stigma in health and social care settings, and people frequently describe receiving worse care for both physical and mental health problems once the diagnosis appears on their records. BPD has often been referred to as a 'dustbin diagnosis' — a label applied when a clinician isn't sure what else to say, carrying a sense that the person is somehow difficult or untreatable. (British Association for Counselling and Psychotherapy)
When that's the experience in clinical settings, it's no surprise that the stigma follows people into the workplace. Employees with BPD often go to extraordinary lengths to hide what they're going through, masking symptoms, overcompensating with performance, and avoiding any disclosure that might change how they're perceived.
Then there's the media. According to a study by Scott Parrott and Caroline T. Parrott, U.S. crime dramas frequently depict characters with mental illnesses as unstable and unpredictable antagonists, which often leads to the use of mental health diagnoses like borderline personality disorder as part of these characters' backstories. (Parrott, S., & Parrott, C. T. 2015)
BPD does appear more frequently in forensic and prison populations than in the general public, and that fact gets picked up and amplified without the context that matters: the vast majority of people living with BPD are not violent. (Dahlenburg et al., 2024)
They are, far more often, the ones absorbing the impact of other people's behaviour rather than inflicting it. The idea that a BPD diagnosis signals danger, that the person sitting across from you in a job interview is quietly plotting their Netflix true crime arc, isn't just inaccurate. It's the kind of cultural shorthand that makes people hide their diagnosis for years, sometimes for their entire careers, because they've absorbed the same stories everyone else has.
The cost of that sustained concealment, psychologically, emotionally, and in terms of productivity, is considerable. And it's entirely preventable.
What can employers do differently?
You don't need to become a clinician to make a difference. What you need is a workplace culture where the conditions that make disclosure feel unsafe are replaced by ones that make it feel possible.
Name it, normalise it
Most employees have never heard BPD or EUPD mentioned in a workplace context. Including personality disorders in your mental health communications, alongside depression, anxiety, and burnout, signals that no one is too complex or too difficult to be supported.
Train your managers
Line managers are often the first point of contact for employees in distress, but most have had no training in how to respond to intense emotional presentations without either dismissing them or escalating unnecessarily. A manager who can stay calm, listen without judgment, and respond with curiosity rather than alarm is one of the most valuable assets your organisation has.
Review your language
Words like "dramatic," "attention-seeking," "manipulative," and "difficult" are regularly applied, consciously and unconsciously, to people whose behaviour stems from a condition they haven't chosen. Consider what language your team uses, both formally and informally, when describing employees who are struggling.
Create genuine psychological safety
Not just on paper, but in practice. Employees need to trust that disclosure won't cost them opportunities, affect how their work is assessed, or change the way they're treated. That trust is built through consistent, visible behaviour from the top of the organisation downwards.
Focus on adjustments, not diagnosis
You don't need to know whether someone has a formal BPD diagnosis to make reasonable adjustments. Flexibility around communication styles, consistency in management approach, clear and predictable feedback, and a low-stigma environment benefit everyone and are particularly important for people living with emotional dysregulation.
Watch for burnout and overperformance
Many employees with BPD work exceptionally hard to prove their worth and avoid the rejection they fear. Paradoxically, they can appear to be coping well right up until the point they aren't. Regular, genuine check-ins, not tick-box ones, matter.
The bigger picture
A workplace that actively works to reduce stigma around BPD/EUPD doesn't just help those employees. It sends a signal to everyone that complexity is welcome here, that people aren't reduced to their worst moments, and that struggling doesn't mean failing.
That kind of culture doesn't happen by accident. It takes intention, consistency, and, crucially, the right support.
Ready to build a workplace where every employee feels safe to show up as they are?
At Mental Health in Business, we support organisations in building psychological safety, manager confidence, and an inclusive culture that makes genuine wellbeing possible, not just in policy, but in practice.
Our webinars are a flexible, accessible way to raise awareness across your wider workforce — with sessions including Women's Mental Health, Psychological Safety: Creating Spaces for Trust and Innovation, and Compassionate Connections: Supporting Others Through Mental Health Challenges, available.
For deeper work with managers and leaders, our two-hour workshops, including Techniques for Handling Difficult Conversations and Mindful Leadership: Leading with Empathy and Emotional Intelligence, provide practical, interactive skill-building.
To find out more about how we can support your organisation, visit mhib.co.uk or get in touch at info@mhib.co.uk.
