The Stigma of Borderline Personality Disorder
Despite how cruel the stigma of this mental health affliction is, it doesn’t exist for no reason. People with BPD are admittedly uncontrollably troublesome, incessant, and hard to control. The frequency of their suicide attempts is often seen as attention seeking, and people hospitalized from their BPD are often discharged faster than any other group of patients in a hospital. (Sheehan 2016) This is because of their emotionally extreme and outrageous behaviors.
Those with BPD have a lot on their plate, as we already know. They can’t control their emotional responses nearly as well as an average person, and their moods never settle to a stable position for very long. They have to hide their diagnosis out of fear of people finding out and labelling them crazy, or distancing themselves from them. With a constantly cluttered mind and dysregulated emotions, they are like a time bomb waiting to explode any second into impulsive behaviors galore.
We see insanely high rates of hospitalization from this group of mental health patients. They make up 9% of all psychiatric emergency room visits in the US. (Hong 2016) Despite being stigmatized, these individuals still seek the care of emergency providers. It may seem counterproductive to do this, but the answer is depressing, but unfortunately true. These people have absolutely nowhere else to go when they NEED help. The critical emotional state that BPD sufferers are internally capable of reaching is very dangerous. While in this state, they can and will make very impulsive decisions. This can include sex, rampant drug use, or even attempted suicide. They can’t be trusted to be left alone. For this very reason, they need to be observed, protected, and controlled for the time that they are hospitalized. This makes the stigma they receive almost unavoidable, which makes a double edged sword: Go to the ER to protect your own life while being treated like a nuisance, or stay home and risk hurting yourself or even others.
One of the reasons that ER staff become so irritated, annoyed, and tired of borderline personality disorder patients is due to the frequency of visits, comorbidity of symptoms, and their attitudes. According to Victor Hong MD’s journal Borderline Personality Disorder in the Emergency Department: Good Psychiatric Management, “High rates of comorbidity (mood disorders, anxiety disorders, substance use disorders, and eating disor- ders) among BPD patients further complicate matters. BPD patients are often advised to visit the ED when in crisis and when safety is in question, but experiences in the ED can dam- age the patient and undermine treatment progress.” BPD related visits often end up becoming seriously complicated due to either misdiagnosis, or other conditions presenting themselves. BPD sufferers often present symptoms of various other mental health conditions. This includes Obsessive Compulsive Disorder, Chronic Depression, and Attention Deficit Hyperactivity Disorder. This can make treatment and diagnosis very tricky and complicated for doctors.
BPD patients are also very frequently showing up to the ER. BPD remains one of the most common hospitalized mental health conditions. Those with BPD have a very hard time functioning on their own, and need to rely on emergency services when they need it. Symptoms of BPD fluctuate in severity from patient to patient, but anyone who is previously untreated is going to have much more intense and prevalent symptoms than someone who has been in therapy before.
In author Cameron Hancock’s article The Stigma Associated with Borderline Personality Disorder, he claims “Individuals experiencing BPD are also frequently labeled as “treatment resistant” and dropped as patients. But when this happens, it reinforces the common misconception that reaching out for help is hopeless. It can also intensify symptoms that caused an individual to seek help in the first place…” Knowing this, it makes it no surprise that sufferers keep coming back for more. BPD patients go to the emergency room when it is absolutely necessary for their survival. This means that they are in an emotionally vulnerable state in every single way possible. They already have a hard time communicating when they aren’t even necessarily in crisis, so this is magnified by a considerable amount when they are barely hanging on to their lives. This can make it very difficult for doctors to help them, as they might try and refuse help from the doctor. At some point, the effort might seem meaningless or futile to a doctor and he/she may just give up on the patient. “The emotional dysregulation and hypochondriasis so com- mon in BPD patients can lead to hostility and dysregulation in their mental health providers. The often inadequate in- terview spaces, lack of appropriate disposition options, and limited time with which to assess patients in the psychiatric ED only heighten the tension.” (Hong 2016) Doctors can also end up even being hostile towards patients. Not only is the BPD patient feeling potentially hostile, but this can spark that behavior in the doctor out of pure frustration. This dynamic can be very dangerous physically, mentally, and emotionally. From this situation, the displayed behaviors from the patient will only escalate further and further. In their most critical time, they are expecting to be given tender and gentle care to help get them back to health. When a doctor responds in such a hostile manner, it can seriously damage the patient’s ability and willingness to continue with the given care.
Even if this is wrong from a professional or moral perspective, it does make sense. Possibly the worst part of these situations is that it just reinforces the BPD sufferer’s distorted worldview of perceived abandonment, making them even harder to treat in the future. This cycle continues to repeat, doctor after doctor, until the person in question has absolutely no idea of where to go from there. With clear causes identified as to why BPD patients are stigmatized, we may be able to begin to help both doctors and patients find a healthy middle ground when it comes to treatment.
Hong, V. (n.d.). Borderline Personality Disorder in the Emergency Department: Good Psychiatric Management. BPDcommunity. Retrieved March 28, 2021, from https://www.bpdcommunity.com.au/static/uploads/files/2016-bpd-in-the-emergency-dept-wfouhjdgxack.pdf.
Sheehan, L., Nieweglowski, K., & Corrigan, P. (n.d.). The Stigma of Personality Disorders. BPDcommunity. Retrieved March 28, 2021, from https://www.bpdcommunity.com.au/static/uploads/files/2016-sheehan-the-stigma-of-pds-wfcdbbajayss.pdf.
The Stigma Associated with Borderline Personality Disorder. (n.d.). Retrieved from https://www.nami.org/Blogs/NAMI-Blog/June-2017/The-Stigma-Associated-with-Borderline-Personality