Debunking the BPD "Manipulation" Myth: A Therapist's Perspective

In my twenty-five years of treating individuals with Borderline Personality Disorder (BPD), I've encountered one persistent and deeply harmful misconception more than any other: that people with BPD are manipulative. This belief doesn't just stigmatize an already vulnerable population—it actively prevents recovery and perpetuates suffering.

Today, I want to share what I've learned from working with many clients with BPD, backed by current research and clinical evidence. It's time we replace judgment with understanding, and myths with facts.

The Manipulation Myth: Where It Comes From

As an intern in a county mental health clinic, I heard from other clinicians many of the negative stereotypes about people with BPD, including that they are manipulative and difficult to work with. BPD behaviors can appear calculated from the outside. A client might threaten self-harm when facing abandonment, engage in what seems like attention-seeking behavior, or display intense emotional reactions that feel disproportionate to the situation.

But here's what changed my perspective: spending time with these individuals, listening to their stories, and understanding the neuroscience behind their experiences. What I discovered was profound emotional pain masquerading as manipulation.

What the Science Actually Shows

Let me share some facts that fundamentally changed how I approach BPD treatment:

Neurobiological Reality: Brain imaging studies consistently show measurable differences in people with BPD. The amygdala (our brain's alarm system) is hyperactive, while the prefrontal cortex (responsible for emotional regulation) shows reduced activity. This isn't a character flaw—it's a neurobiological condition with observable brain changes.

Childhood Trauma: Research indicates that 70-80% of individuals with BPD experienced significant childhood trauma, abuse, or chronic invalidation. What we often label as "manipulative" behaviors are actually adaptive responses that helped them survive impossible situations as children.

Treatment Success: If BPD were simply about manipulation or character defects, evidence-based treatments like Schema Therapy and Dialectical Behavior Therapy (DBT) wouldn't work. Yet we see significant improvement and recovery with proper BPD treatment. You can't therapy your way out of being a "bad person"—but you can heal from trauma and learn new skills.

Reframing "Manipulation": What's Really Happening

In my practice, I've learned to translate what others call "manipulation" into what's actually occurring. When they say "She’s being manipulative.” I see emotional dysregulation in crisis.

Sarah, a 28-year-old client would call or text me repeatedly during emotional crises, sometimes multiple times a day. Other providers labeled this "manipulative attention-seeking." But when I looked deeper, I saw someone whose emotional pain literally felt life-threatening in those moments. Her brain's alarm system was firing as if she were facing actual death—because emotionally, she was.

Marcus would pick fights with his partner and push them away whenever he sensed emotional distance. To many, it looked like he was sabotaging his relationship. In reality, his trauma history taught him that people always leave, so he was unconsciously testing the relationship's stability. The "drama" was his way of asking, "Will you still be here when I'm at my worst?"

Jessica had never experienced consistent, validating attention as a child. An invalidating childhood environment is seen as one of the key conditions that leads to BPD in adulthood. Her seemingly "attention-seeking" behaviors were actually attempts to answer a fundamental question: "Do I exist? Do I matter?" When you've been invisible or invalidated your entire life, even negative attention can feel like proof of your existence.

Marsha Linehan, creator of Dialectical Behavior Therapy (DBT), often refuted the idea that people with Borderline Personality Disorder are manipulative. She argued that their behaviors, while often challenging for others, are often desperate and unskillful attempts to meet their emotional needs. Linehan explains that true manipulative behavior is both subtle and skillful, which is not characteristic of BPD symptoms like outbursts, suicide attempts, or self-harm. 

Linehan believed that the symptoms of BPD are rooted in deficits in regulating emotions, tolerating distress, and interpersonal effectiveness, and that treatment should focus on developing these skills. She emphasized that people with BPD are doing the best they can with the skills they have, and that treatment should aim to help them learn more effective behaviors. 

The Neuroscience of Emotional Intensity

Imagine if every emotion you felt was amplified tenfold, lasted three times longer, and felt like a life-or-death situation. That's the daily reality for someone with BPD. BPD has also been called an “emotional intensity disorder”, where the negative emotions feel like they are always at full volume, like a radio that is always turned all the way up.

Dr. Mary Zanarini and her colleagues examined 50 dysphoric feelings and thoughts in clients with and without BPD. Clients with BPD scored higher than clients without BPD on all 50. Clients with BPD reported suffering with these uncomfortable feelings for high percentages of time:

v  Feeling overwhelmed             61%

v  Feeling worthless                                59.5%

v  Very angry                                           52.6%

v  Lonely                                                  63.5%

v  Misunderstood                                    51.8%

v  Feeling abandoned                            44.6%

v  Betrayed                                              35.9%

v  Feeling evil                                          23.5%

v  Out of control                                      33.5%

v  Like a small child                                 39.1%

v  Like hurting or killing self                    44%

Research by Dr. Marsha Linehan (who has BPD herself) describes it as having "third-degree burns over 90% of your body." Everything hurts. Every emotional touch feels like agony. When someone is in that much pain, their behavior reflects desperation, not calculation.

The Devastating Cost of Stigma

The "manipulation" label isn't just inaccurate—it's actively harmful. Studies show that healthcare providers who view BPD patients as manipulative provide lower quality care and show less empathy. This stigma literally prevents people from getting help. The average person with BPD sees multiple providers before receiving proper diagnosis and treatment, often because of provider bias. Meanwhile, they're suffering unnecessarily.

When my clients are constantly told they're manipulative, they begin to believe it. I've watched intelligent, caring individuals internalize this shame and act out the very behaviors society expects from them.

BPD has one of the highest suicide rates of any mental health condition—up to 10%. Stigma increases isolation and hopelessness, literally costing lives.

What Recovery Actually Looks Like

In my practice, I've witnessed incredible transformations when we approach BPD with understanding rather than judgment. Let me tell you about Emma.

Emma came to me after being labeled "too challenging" by three previous therapists. She'd been hospitalized multiple times, had a history of self-harm, and her relationships were chaotic. By traditional standards, she fit every "difficult patient" stereotype.

But when I approached her with respect and validation instead of suspicion, everything changed. We worked on understanding her triggers, developing emotional regulation skills, learning to think about herself and the world in healthier ways, and healing her trauma. Today, several years later, Emma is in a stable relationship, manages her emotions effectively, and is able to hold down a job and do volunteer work.

The "manipulative" person was actually someone in tremendous pain who simply needed the right tools and a therapeutic relationship built on trust, not suspicion.

A Call to My Fellow Professionals

To my colleagues in healthcare and mental health: our biases matter. When we approach BPD with the assumption of manipulation, we create adversarial relationships that prevent healing. Many people with BPD are also highly sensitive to the feelings of others, and know when a therapist is afraid of them, or doesn’t really want to work with them.  When instead we approach it as a trauma-related condition requiring compassion and skill-building, we see remarkable recoveries. I challenge you to examine your own reactions to BPD clients. Notice when you feel frustrated or manipulated, and ask yourself: "What might this person be trying to communicate beneath their behavior?"

To Friends and Family Members

If someone you love has BPD, please understand that their intense behaviors stem from intense pain. They're not trying to control you—they're trying to survive emotionally in a world that feels constantly threatening. Your consistent, boundaried compassion can be healing. Set limits when needed, but don't assume malicious intent behind their struggles.

To Individuals with BPD

You are not manipulative. You are not too much. You are not broken beyond repair. You are someone who developed adaptive responses to impossible situations, and those responses may no longer serve you. With proper treatment, understanding, and self-compassion, recovery is not only possible—it's probable.

From Stigma to Understanding

The path forward requires all of us to challenge our assumptions and biases. Instead of asking "How is this person trying to manipulate me?" we must ask "What is this person trying to communicate?" Instead of "How do I protect myself from them?" we should ask "How can I respond with both compassion and appropriate boundaries?"

BPD is not a character judgment—it's a complex mental health condition with biological, psychological, and social components. It's treatable, manageable, and recovery is real.

As a therapist who has witnessed many recoveries, I can say with certainty: the people I treat with BPD are some of the most sensitive, creative, and empathetic individuals I know. Their intensity, when channeled through healing, becomes their superpower.

It's time we stop seeing BPD through the lens of manipulation and start seeing it through the lens of healing. Lives depend on it.

Mat Chirman, LMFT, LPCC. Copyright May 2025