The Role of Doctors in Supporting People with BPD: A Compassionate Clinical Perspective By Dr. Antti Rintanen MD, The Internet Doctor

As a person for whom relationships can be particularly hurtful or especially restorative, depending on how they feel and their dynamics, communication is a topic close to my heart. One aspect of communication that fascinates me the most is that between healthcare professionals and patients. These interactions are often laden with vulnerability and therefore, when working well, hinge upon empathy and a strong sense of trust.

So when Dr. Antti Rintanen MD, from the The Internet Doctor, got in touch with me I was keen for him to share his perspective on the doctor-patient relationship for people with a diagnosis of BPD. In this post, Dr. Rintanen shares a nuanced exploration of why doctor-patient relationships might mean so much to people with BPD.

He also gives specific examples of what doctors can do—and say— to support individuals to feel safe enough to share parts of their lives that might make them feel vulnerable. Thank you Dr. Rintanen for this piece— you raise some excellent points, especially relating to the interpersonal sensitivities of people with this diagnosis.

The Role of Doctors in Supporting BPD Recovery: A Compassionate Clinical Perspective By Dr. Antti Rintanen MD, The Internet Doctor

For those living with borderline personality disorder (BPD), recovery isn’t just about therapy or medication—it’s also about relationships. One of the most impactful relationships is often with a doctor.

Unfortunately, many individuals with BPD report feeling misunderstood, dismissed, or even stigmatized in healthcare settings. Studies confirm that stigma and miscommunication remain widespread in interactions between healthcare providers and people with BPD [1], [2]. This can damage trust and make it harder for patients to engage in care or seek support in the future.

As a doctor, I believe our responsibility is not only to treat, but to connect—to listen, respect, and build trust. When we show up with empathy and awareness, we can be a meaningful part of someone’s healing journey.

Communication: The Foundation of Healing

People with BPD often experience heightened emotional sensitivity and interpersonal awareness. This sensitivity—rooted in both biological and psychological factors—can lead to intense emotional responses and strong attunement to others’ behaviors, especially in relationships [3]. While this can be a strength, it also means that the nuances of clinical communication matter deeply. Body language, tone, and even microexpressions can carry more weight than we realize.

Studies have shown that individuals with BPD often feel dismissed or emotionally unsafe in healthcare interactions [1]. A trauma-informed approach emphasizes creating a space where people feel heard rather than judged. That might mean pausing to reflect a patient’s emotions (“It sounds like this has been incredibly overwhelming for you”) or simply making eye contact and offering time.

These small adjustments can shift the dynamic from clinical detachment to genuine care.

The Harm of Clinical Misinterpretation

Language influences not only how we think but also how we relate to others. In clinical settings, behaviors like intense emotional expression, repeated requests for reassurance, or recurring moments of crisis may sometimes be perceived as overwhelming or difficult to manage. However, these responses often reflect deep emotional pain and a need for support, rather than intentional disruption.

These impressions can quietly inform provider attitudes and ultimately shape how care is delivered. Research confirms that such assumptions—when unexamined—can lead to negative biases, reduced empathy, and lower quality care [2], [4]. For individuals with BPD, such experiences can deepen the sense of being misunderstood or of having emotional needs that feel overwhelming to others.

Instead of jumping to conclusions, clinicians can ask: What is this person trying to communicate? Often, these behaviors are rooted in emotional pain, fear of abandonment, or difficulty regulating distress—not a desire to cause disruption.

Navigating Power Dynamics

Doctor–patient relationships are inherently shaped by power imbalances. This can feel especially pronounced for people with BPD, many of whom have histories of relational trauma or invalidation.

Being aware of this dynamic is critical. Even small acts—rushing an appointment, using medical jargon, or making decisions without the patient’s input—can reinforce feelings of powerlessness.

Instead, we can strive for collaboration. This means:

• Using clear, accessible language to explain diagnoses and treatment options.

• Asking for input: “What would feel helpful for you right now?” or “How do you feel about this plan?”

• Owning our role: If we realize we’ve come across as dismissive or unclear, we can say, “I may not have explained that as well as I could have—let me try again.”

  
  

These moments of transparency and humility build trust, especially when trust has been difficult to establish in the past [5].

Consistency and Emotional Safety

Continuity of care matters. People with BPD are often particularly sensitive to perceived abandonment. When providers change frequently or care is abruptly discontinued, it can feel like rejection—even if that’s not the intention.

A study reviewing structural stigma in BPD care found that service fragmentation and unclear discharge processes were commonly experienced as harmful [1]. If transitions in care are necessary, we must:

• Communicate them early and clearly.

• Acknowledge the emotional impact.

• Provide follow-up options and warm handovers.

• Inconsistencies in care systems may not be within an individual doctor’s control, but how we handle them certainly is.

Being Trauma-Informed

Trauma-informed care means recognizing that many individuals with BPD have experienced trauma, especially in relationships, and adjusting our approach to create safety and empowerment.

Key principles include:

• Promoting physical and emotional safety.

• Building trust through consistency and honesty.

• Supporting autonomy and collaboration.

• Acknowledging the person’s lived experience without pathologizing it [5].

  
  

Trauma-informed care is not just a set of practices—it’s a mindset that centers respect and humility. For doctors, this might involve pausing to check in on how a patient is feeling emotionally, not just physically, or inviting a patient to define their own goals for treatment.

Seeing Strengths, Not Just Struggles

Too often, people with BPD are defined by their challenges. But many also show extraordinary insight, emotional depth, and resilience.

In clinical settings, we can reflect back these strengths to counterbalance a history of invalidation. For example:

• “You’ve clearly thought deeply about this.”

• “You’ve made incredible progress in understanding what triggers you.”

• “Your self-awareness is a real strength.”

  
  

These affirmations don’t deny the difficulties—they provide a fuller, more accurate picture of the individual’s inner world.

A Shared Journey

Supporting someone with BPD doesn’t mean fixing them—it means walking beside them. Our clinical tools are important, but the healing often happens in the relationship itself.

This means being emotionally present during difficult moments, being willing to repair ruptures in communication, and showing up consistently over time.

The journey is not linear. There will be ups and downs. But when we meet people with empathy and openness, we become part of what makes recovery possible.

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People with BPD deserve compassionate, respectful, and trauma-informed care. As doctors, we have the opportunity—and the responsibility—to counter stigma, build trust, and support recovery not just through what we prescribe, but through how we relate.

Recovery doesn’t happen in isolation. It happens in relationships. And every appointment is a chance to get that right.

About the Author

Dr. Antti Rintanen is a licensed doctor and the founder of The Internet Doctor, where he writes about health, trauma-informed care, and how doctors can support recovery through empathy and evidence-based strategies.

References

[1] P. Klein, A. K. Fairweather, and S. Lawn, “Structural stigma and its impact on healthcare for borderline personality disorder: a scoping review,” Int J Ment Health Syst., vol. 16, no. 1, p. 48, 2022. https://ijmhs.biomedcentral.com/

[2] D. U. Ukwuoma, K. A. Ajulu, D. Wang, S. Golovko, J. Marks, and L. Leontieva, “Psychiatric providers’ attitudes toward patients with borderline personality disorder and possible ways to improve them,” CNS Spectr., vol. 29, no. 1, pp. 65–75, Feb. 2024. https://pubmed.ncbi.nlm.nih.gov/

[3] R. W. Carpenter and T. J. Trull, “Components of emotion dysregulation in borderline personality disorder: A review,” Curr Psychiatry Rep., vol. 15, no. 1, p. 335, 2013. https://www.researchgate.net/

[4] C. Papathanasiou and S. Stylianidis, “Mental health professionals’ attitudes towards patients with borderline personality disorder: The role of disgust,” Int. J. Psychiatr. Res., vol. 5, no. 1, pp. 1–13, 2022. https://www.scivisionpub.com/

[5] D. Rodwell and H. Frith, “Using a trauma-informed care framework to explore social climate in forensic settings caring for patients with borderline personality disorder,” Int J Ment Health Nurs., vol. 33, no. 4, pp. 1049–1061, 2024. https://pubmed.ncbi.nlm.nih.gov/