Borderline Personality Disorder

Background: Borderline Personality Disorder (BPD) is a disorder characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image. The cause of this personality disorder is only somewhat known currently, but it seems to stem from physical, emotional, and sexual abuse as a child. About 1-2% of the general population is affected by this disorder, and about 10% of people with BPD commit suicide. This is a very high number of people considering how that number relates to the total number of individuals that have it. Individuals with BPD require significantly more mental health resources than those with other common mental health disorders, because BPD causes severe psychosocial impairment and makes it hard to live a normal, functioning life. 

How I used it: I used this source to detail what characterizes Borderline Personality Disorder. I identified most of the diagnostics for the disorder, and touched on the causes of the disorder developing in early childhood. I also identified how common the disorder is, and how many people commit suicide as a result in order to paint a picture of just how severe BPD can be for sufferers. This helps me emotionally appeal to my reader and make it a point that those with BPD suffer intensely.

The Lifetime Course of Borderline Personality Disorder

Background: When people with BPD are not seen in a formal mental health treatment setting, they are often seen when in times of crisis. This leads people to believe that those with BPD are constantly in crisis and are never recovering. The truth is that while those with BPD do suffer intensely a lot of the time, their condition is proven to improve over time with proper treatment. BPD can be effectively treated with Dialectical Behavior Therapy (DBT). Being that BPD stems from childhood trauma, it can be reliably and validly diagnosed in adolescence. Risk factors for developing BPD in adolescents include maternal-child discord, maternal BPD, and depression. In a 10 year study of 668 patients, researchers found that the patients had improved with their condition over the 10 year period while being treated. 

How I used it: With this source my goal was to identify the stigma, and help neutralize it with facts. Those with BPD are stigmatized because they are believed to be in crisis at all times. But this is not the case. They tend to improve with time and therapy, therefore the stigma is much less valid. I also identified that BPD can be diagnosed in childhood, since it develops in early childhood, in order to show that treatment can begin at a young age and potentially completely reverse the process before it becomes too ingrained in one’s personality.

Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

Background: Researchers took 38 patients that were diagnosed with BPD and placed them into two different groups. One group received partially hospitalized care, while the other group received standard psychiatric care. The measures that they were looking for included frequency of suicide attempts and self harm, inpatient visits and their duration, depressive symptoms, anxiety, interpersonal function, and social function. At the end of the study, they found that psychoanalytically focused partial hospitalized treatment was significantly more effective than standard psychiatric care. Patients in the partially hospitalized group showed significantly less frequent self harm, and much improved depressive symptoms.

How I used it: This study shows that there is a definite change in the severity of Borderline Personality Disorder symptoms with proper treatment. This reduces the validity of the stigma towards these individuals by showing that they can recover and learn to behave differently with proper treatment. I wanted to use a study that shows the direct comparison between effective and ineffective treatment in order to prove my point that there is help out there that works. I wanted to logistically appear to my reader by showing that there are effective treatment plans to steadily help BPD sufferers.

The Stigma of Personality Disorders

Background: Borderline Personality Disorder is shown to be the most stigmatized mental disorder, and also has the most research related to its stigma. Individuals with mental illness are viewed to be at fault for their mental illness, and it is portrayed that they somehow choose to exhibit these symptoms. Despite efforts to combat this stigma, research shows that the situation has not improved over time, and people still continue to stigmatize the mentally ill. Some of those with personality disorders are afraid to seek treatment for their mental illness in order to avoid being labelled as “crazy”. This creates a very hard life for those who are struggling, as they are afraid to even get help in the first place. Those with BPD are shown to “self-stigmatize” and view themselves as insane, or unhelpable. This causes them to have great shame in their disorder and for their lives in general. Research shows that some psychiatrists may avoid telling their patient that they have BPD, in order to help them avoid stigmatization from the system.

How I used it: I wanted to highlight a specific part of the stigma that can easily be debunked in order to strengthen my argument. The argument that people with BPD are at fault for their behaviors can be quickly debunked by analyzing the symptomatology of someone with BPD. They struggle with impulse control and emotional regulation, therefore they can’t be blamed for most of the times that they act out or feel out of control. I also wanted to appeal emotionally to my reader by highlighting the shame that these people feel as a result of the stigma and their distorted perception of themselves.

Click to access 2016-sheehan-the-stigma-of-pds-wfcdbbajayss.pdf

Why go to the emergency department? Perspectives from persons with borderline personality disorder

Background: Those with BPD are treated differently by healthcare professionals due to their diagnosis. Sulzer (2015) found that healthcare providers describe patients with BPD as “difficult” and a “pain in the ass”. They will stigmatize patients for the very behaviors that they are trying to correct, such as manipulative, attention seeking, and suicidal tendencies. These things are outside of the patient’s control, and they wouldn’t be in the doctor’s office if they could help it on their own. Those with BPD have a very limited ability to cope with intense emotions, and this can make them hard to treat. When they are blamed for these behaviors, it perpetuates the stereotype that those with BPD are just attention seekers and choose to act the way that they do. BPD is characterized with feelings of intense loneliness and fear of abandonment, so when healthcare providers make this worse by giving sufferers less than adequate service, it just exacerbates these awful feelings.

How I used it: With this source I wanted to identify the perpetrators of the stigma: the healthcare system. By directly quoting nurse’s statements on BPD sufferers, it shows how cruel healthcare professionals can be regarding BPD sufferers, which makes my reader feel bad for them. I also wanted to identify that these behaviors are outside of the patient’s control, which makes it even worse for someone to call them “a pain in the ass”. I made sure to point out that denying service to someone with BPD just makes their symptoms worse, and creates a vicious cycle.

Borderline Personality Disorder in the Emergency Department: Good Psychiatric Management

Background: Borderline Personality Disorder patients are frequent visitors to the emergency room. They represent a whopping 7% of all ER visits. They represent a unique set of challenges. This is because they are easily frustrated, and have a hard time communicating their feelings properly. They are likely to present recurrent suicidality, making them repeat visitors to the ER. They are often advised to visit the ER when their safety is in question, but this can sometimes be counterproductive due to the stigma surrounding them in the healthcare system.

How I used it: I used this source to show how wide reaching this stigma is. Being that 7% of all psychiatric ER visits are made up of BPD patients, it shows how large and serious this issue is. If almost all of these patients are experiencing stigma from healthcare professionals in their most dire time of need, they will get sucked into the vicious cycle and never get the help that they need. I wanted to show that these people are stuck in between a rock and a hard place when it comes to their treatment. I used this to appeal emotionally and logistically by showing how the suffering of BPD patients continues, and how many individuals the stigma can affect.

Click to access 2016-bpd-in-the-emergency-dept-wfouhjdgxack.pdf

The Stigma Associated with Borderline Personality Disorder

Background: Healthcare professionals have been shown to either limit the amount of BPD patients that they see, or refuse to treat them altogether. Professionals sometimes treat patients with BPD, without the proper training to treat someone with BPD. Not only do patients leave feeling misjudged and improperly cared for, but professionals may feel as though they are inadequate in their abilities. This is an important thing to note about the source of the stigma. Patients are also sometimes labelled as a treatment resistant, and dropped as patients. This is because the doctors aren’t trained to handle them and understand them.

How I used it: I wanted to show how the stigma can also affect the doctors as well by making them feel inadequate. This further shows the damage that a general stigma can cause. I also wanted to identify a point of improvement, where doctors should be specially trained to deal with BPD patients if there are so many of them showing up for help. If doctors aren’t trained to help someone, they can’t effectively do so. 

Evil Genes

Background: The writer claims that crimes are often committed by those with severe personality disorders. Those with antisocial personality disorders commit deliberate acts of cruelty towards others. Borderline personality disorder sufferers are categorized in a more complicated way. They have intense feelings of love, and tend to use this to their advantage to make people they are close to vulnerable. 

How I used it: I wanted to disprove the notion that people with borderline personality disorder are inherently violent. They typically get grouped in with other personality disorders, and this is unfair. They are often confused with ASPD sufferers, and are wrongly identified as violent. Those with BPD tend to make social interactions harder for themselves, and manipulate people emotionally. They aren’t normally violent on their own. ASPD sufferers on the other hand are almost always violent, and can often be considered psychopaths. This is an important distinction to make.

“Evil Genes”

Personality correlates of criminals: A comparative study between normal controls and criminals

Background: This study tries to find the answer to the question of whether or not criminals are born with their tendencies, or if it comes later down the line. It is believed that individuals who do not get much social interaction tend to develop antisocial personality disorder, and thus are more prone to psychopathy. A person’s personality is the main factor that dictates how they think and act according to their internal thoughts and emotions.

How I used it: I wanted to further highlight the differences between ASPD and BPD. This author identified the violent tendencies of ASPD sufferers, and the cause of the disorder. I used this to show how the development of these two disorders is highly different, and the results are therefore different.

Personality disorders and violence: What is the link?

Background: Antisocial personality disorder and borderline personality disorder have been found to be strong correlates in the propensity of crime. These two personality disorders tend to exist comorbidly at a higher rate than most other personality disorders. These personality disorders tend to cause irresponsibility, failure to conform, and deceitfulness. When there is a comorbidity between these two disorders, individuals have a hard time externalizing and internalizing emotions at the same time, which can in return cause them to feel violent and act out.

How I used it: I wanted to point out the fact that BPD alone does not inherently make someone violent, but comorbidity with ASPD almost always does. While both disorders share some symptoms in common, they are not the same. However, when they both exist in one person, it can make someone act extremely irrationally and uncontrollably. This proves my point that the stigma towards BPD specifically is not rational if there are other disorders to blame in a comorbid diagnosis.

https://bpded.biomedcentral.com/articles/10.1186/s40479-015-0033-x