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One of the most common ways of characterizing patients diagnosed with borderline personality disorder is that they are manipulative. Clinical usage of the term varies widely but clearly carries a pejorative meaning. Furthermore, behaviors that look similar to those called manipulative in clinical contexts are not called manipulative in broader society. It is crucial to become clear on what manipulation is, because studies show that carers routinely perceive BPD patients as manipulative and so have less empathy for them. In this paper the concept of manipulativity is clarified and its scope narrowed by distinguishing it from a number of related concepts, and a number of reasons why manipulating others is morally objectionable are suggested. I argue that, while some BPD patients may be manipulative, much of their behavior can and should be understood in a different light. Moral and clinical values are conflated in carers' judgments of manipulativity, and clinicians and researchers need to clarify when and why manipulative behavior is dysfunctional, and when it is merely morally wrong. Separating these two domains will enable carers to be more empathetic and less blaming of their patients' behavior.
Manipulativity is not a diagnostic criterion for borderline personality disorder (BPD); nevertheless, it is ubiquitous in the literature when discussing and describing patients and this disorder. In fact, "so frequently does the word crop up in conversations and discourse about such patients, that it might wrongly be thought of as the major problem that such patients pose to psychiatric services, or the major defining criteria of their disorder" (Bowers, 2003, p. 323). Typical of the literature is the following description of the behavior of BPD patients.
[Their] behavior was judged as unadaptive to the interview. They did things to hinder the interview, such as asking questions irrelevant to its purpose, getting up and changing chairs, or refusing to answer questions. They behaved in predominantly angry ways, expressing anger toward a variety of targets, including the interviewer. They were argumentative, irritable, and sarcastic. Without tact or consideration, they were demanding and attempted to manipulate the interviewer to acquiesce to their wishes. (Perry & Klerman, 1980; p. 168)
The described behaviors are at least different in degree, if not in kind, from self-injurious behavior or suicide threats, the sine...