I think it's kind of a contensious issue right now. When I worked in Los Angeles, they were starting to go through and reevaluate all the BPD patients in the public clinic to see what was really going on. A large number, maybe half improved greatly with medications for Bipolar disorder, but still had some of the characteristics for BPD that wereenough to cause them significant problems in life. about a quarter walked out on the meds (meaning taking them) with, essentially, no diagnosis of BPD any longer but with a shiny new BP diagnosis. A smaller number came away with PTSD who had been basically branded with BPD because they were female, and what was left was a much smaller core of "true BPD". For a long time, it was what you diagnosed a woman with if you couldn't figure out what else was wrong and you had a history of trauma.

We are dealing with something similar when it comes to diagnosing children with ADHD and bipolar. It comes to basically this: if they get worse on the stimulants, they are probably bipolar. With teenagers, if they get worse on the standard psychopharmocicals, than they might well be ""emotionally unstable" PD in the making. Some kids just get a heck of a lot more grief from their inner workings
For me, it's really frustrating. It doesn't always feel really clear cut, since all we do is diagnose symptoms, not the real illness. And symptoms, well, everyone describes those just a wee bit differently. HUGGS all.