Fighting the stigma of Borderline Personality Disorder

From Lydia Parkhill.

Working as a Behaviour Advisor for Accomplish, a large care provider, I support many people in our mental health services with a diagnosis of Borderline Personality Disorder (BPD). I am writing this letter to once again highlight the stigma that is attached to BPD and to advocate for more research, so that the people who have been diagnosed with one of the most misunderstood, misdiagnosed and stigmatised conditions can gain the help they desperately need.

I’m sure most psychologists would agree how challenging the concept of BPD is. We have failed to arrive at an adequate definition of the term ‘self’, but define ‘personality disorders’ as disturbances in a person’s experience of self (Moorey et al., 2008). With this vague diagnosis, it is somewhat understandable where the stigma has derived from, however, what I find most perplexing, is how Personality Disorder is included in the national service framework for mental health, yet there are people diagnosed with BPD who are passed from pillar to post with no mental health practitioners wanting to accept responsibility for their care. Dr Steve Hinder, a psychiatrist for Birmingham community health care, recognises this and in a recent interview described how the diagnosis of BPD tends to place people into a ‘black hole’ where no one knows how they can help the person.

For me, the ‘black hole’ which Dr Hinder described became evident when a person I support with a BPD diagnosis was informed by a mental health practitioner that their presentation didn’t meet the criteria for support because they were showing behavioural rather than mental health difficulties. I found this explanation very challenging; especially considering the very definition of BPD is ‘emotional instability, disturbed patterns of thinking, intense but unstable relationships with others and impulsive/self-destructive behaviour e.g. self-harm and binge drinking’.

Personally, I felt this explanation was dismissive and inadequate, and after performing a literature review to establish if there was question about BPD being a behavioural or mental health difficulty, the practitioner’s unwillingness to help which I suspected this person experienced was evidenced. What was also evident was the amount of research highlighting the stigma attached to a BPD diagnosis. In a recent study, Rusch et al. (2006) found that patients with a diagnosis of BPD are vulnerable to high stigmatisation in comparison to patients with other psychiatric disorders, including other types of personality disorder. Rusch et al. (2006) argue that this stigmatisation is the result of the severity of their conditions, interpersonal difficulties and visible devaluating signs, such as self-mutilation scars. It was also evident from the study that the widespread idea that the behaviour of patients with PD is deliberate and within their control also contributes to the judgemental and rejecting attitudes that people with BPD face.

Considering how much our knowledge of mental health has developed, I’m sure you’ll agree that the existing stigma is unacceptable. Together we need to help fight this stigma and call for more research to be done to encourage a movement towards a more understanding, accepting society.

Lydia Parkhill

Moorey, J., Davidson, K., Evans, M., & Feigenbaum, J. (2008). Psychological theories regarding the development of personality disorder. In M. J. Sampson, R. A. McCubbin, & P. Tyrer (Eds.), Personality Disorder and Community Mental Health Teams: A Practitioner’s Guide. Chichester, England: John Wiley & Sons, Ltd.
Rüsch, N., Hölzer, A., Hermann, C.,  et al. (2006). Self-stigma in women with borderline personality disorder and women with social phobia. The Journal of Nervous and Mental Disease, 194(10), 766-773.

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This is so true, and cannot be talked about enough at this point. In my experience, there is also often a reluctance to provide an explicit diagnosis of BPD too - most likely for the reason stated, as it could impede treatment.