The Stigmatization of Borderline Personality Disorder

Borderline personality disorder is often considered among the most emotionally painful (for sufferers and those affected by them) personality disorders. BPD is often diagnosed on the basis of quite a few symptoms and behaviors. BPD is a serious mental disorder with a characteristic pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image.(Lancet 2004) It is known to affect about 1-2% of the general population.

Borderline personality disorder causes severe impairment in the sufferer’s life. They struggle daily with controlling their emotions, thoughts, and actions. They often describe having wild mood swings, making it difficult to describe their exact feelings at any given moment. Their opinions and outlook on life situations are prone to change rapidly and uncontrollably, making it hard for them to maintain a positive or consistent outlook on almost anything, especially when it comes to social relationships. They tend to exhibit a behavior which  is known as “splitting”, in which they will view every situation in black and white, rather than with gray areas, like a neurotypical individual. This is especially evident in their interpersonal interactions. They can go from idolizing or being absolutely infatuated with someone, to hating them in a split second. While this is out of their control, it is especially painful for those close to them. They also tend to have difficulty managing these thoughts, which tends to make them feel out of control or to self label themselves as “crazy” or “insane”. This can make it hard for sufferers to feel like they even know themselves, and have a hard time establishing their own identity, which is rapidly shifting and unstable.

Those afflicted with this disorder tend to seek professional help, especially in times of great crisis. According to Robert S. Biskin’s academic article The Lifetime Course of Borderline Personality Disorder, Sufferers of BPD are often seen only when in times of crisis, if they are not already part of a long time treatment program. This leads many to have the impression that those with BPD are constantly in crisis and are never recovering, which in turn causes mental health professionals to stigmatize these individuals and give them little to no real treatment. However, research shows the opposite of this.

In the McLean Study of Adult Development, a group of 290 patients originally hospitalized at McLean Hospital with a diagnosis of BPD, were assessed 6 months after the start of the study, and then annually for 10 years. By the end of the study, 85% of patients described a 12 month or longer period of symptom remission and improvement. This proves that with proper care and treatment, sufferers of borderline personality disorder do have the potential to make significant progress and live better lives.

In a similar study by the American Journal of Psychiatry, a group of 38 patients diagnosed with borderline personality disorder were placed in either partially hospitalized care, or standard psychiatric, appointment based care. Both groups were measured on their frequency of self harm or suicide attempts, number of inpatient admissions, and their own measures of depression, anxiety, and interpersonal function. The partially hospitalized group of patients showed substantially decreased negative symptoms when compared to the group met with standard psychiatric care. This shows that specialized care for these individuals is key to helping them improve their condition significantly and properly. 

According to Lindsay Sheehan’s psychiatric article The Stigma of Personality Disorders, stigma can be described as a range of a lack of eye contact, to complete ostracization of an individual belonging to a stigmatized group. Due to public attitudes towards mental illness, the mentally ill are often seen as to blame for their behaviors, as if it is their conscious choice to act out. Not only is BPD among the most stigmatized of all personality disorders, but it is also the most researched in terms of Stigma.(Sheehan 2016) When asking nurses in Israeli psychiatric hospitals about their views of different mental health patients, they showed the most negative attitudes towards those with Borderline Personality Disorder. Another study showed that psychiatrists tend to exhibit the least empathy towards those with BPD. 

This is a very complicated issue not only because of the poor treatment, but for the reason that this knowledge completely discourages sufferers from seeking help. Why would you seek help, when you know the person helping isn’t going to do their job? This is the kind of helpless mindset that those with BPD often have not only towards their lives in general, but also their healthcare providers. There needs to be established trust and transparency between patients and mental health specialists, as this is the only way effective treatment can occur.

In Amanda Vandyk’s original article titled Why go to the emergency department? Perspectives from persons with borderline personality disorder, she states that most healthcare providers describe that patients with BPD are “difficult” and “a pain in the ass”. This kind of attitude shows that a portion of clinicians clearly dread dealing with these patients. They have also been found to describe patients as “attention-seeking” and “manipulative”. Those with BPD suffer from intense feelings of loneliness, despair, and fear of abandonment. This directly triggers an emotional response due to these fears. 

The most important thing to remember about individuals with BPD is that they never choose to act the way that they do. The symptoms of BPD are extremely intense and uncontrollable. Sufferers struggle to survive in their own skin with these symptoms, which is why they seek licensed professionals to help them. If they could control these feelings, thoughts, and behaviors, they wouldn’t be in a psychiatrist’s office multiple times a week looking for assistance. Understanding and acknowledging the struggles of those with borderline personality disorder is imperative to treating them. Healthcare professionals need to take the time to evaluate these people respectfully and develop better strategies to treat and handle them. With a personality disorder mainly characterized with a fear of feeling hopeless and alone, turning a sufferer away rather than helping them pushes them down a hole they will have a very hard time climbing out of on their own.

References

Bateman, A. Fonagy, P., Iliakis, E. A., Scott, N. P., Lohman, M. C., . . . Gabbard, G. O. (1999, October 01). Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.156.10.1563

Biskin, R. S. (2015). The Lifetime Course of Borderline Personality Disorder. The Canadian Journal of Psychiatry,60(7), 303-308. doi:10.1177/070674371506000702

Lieb, K., Zanarini, M. C., Schmal, C., Linehan, M. M., & Bohus, M. (2004, July 31). Borderline personality disorder. Retrieved March 7, 2021, from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.625.4235&rep=rep1&type=pdf

Sheehan, L., Nieweglowski, K., & Corrigan, P. (2016, January 16). The Stigma of Personality Disorders. Retrieved March 7, 2021, from https://www.bpdcommunity.com.au/static/uploads/files/2016-sheehan-the-stigma-of-pds-wfcdbbajayss.pdf

Vandyk, A., Bentz, A., Bissonette, S., & Cater, C. (2019, January 13). Why go to the emergency department? Perspectives from persons with borderline personality disorder. Retrieved March 7, 2021, from https://www.researchgate.net/profile/Amanda-Vandyk/publication/331202392_Why_go_to_the_emergency_department_Perspectives_from_persons_with_borderline_personality_disorder/links/5e0eac9592851c8364add2e9/Why-go-to-the-emergency-department-Perspectives-from-persons-with-borderline-personality-disorder.pdf