Borderline Personality Disorder; Stigma In Society And Among Professionals
Borderline personality disorder (BPD) is a type of personality disorder. People might be diagnosed with a personality disorder if they have difficulties with how they think and feel about themselves and other people, and are having problems in their life as a result.
“Having BPD is like the emotional version of being a burn victim. Everything in the world hurts more than it seems to for everyone else and any 'thick skin' you are supposed to have just isn't there.”
When is it diagnosed?
People might be given a diagnosis of BPD if they experience at least five of the following things, and they've lasted for a long time or have a big impact on their daily life:
??They feel very worried about people abandoning them, and would do anything to stop that happening.
??They have very intense emotions that last from a few hours to a few days and can change quickly (for example, from feeling very happy and confident to suddenly feeling low and sad).
??They don't have a strong sense of who they are, and it can change significantly depending on who they’re with.
??Theh find it very hard to make and keep stable relationships.
??They feel empty a lot of the time.
??They act impulsively and do things that could harm themselves (such as binge eating, using drugs or driving dangerously).
??They often self-harm or have suicidal feelings.
??They have very intense feelings of anger, which are really difficult to control.
??When very stressed, they may also experience paranoia or dissociation.
“The worst part of my BPD is the insecure relationships...when I am attached to someone, they are my whole world and it is crippling. I care so deeply about how long they take to reply to an email, or their tone of voice, because I’m so afraid of losing them.”
BPD is one of the most heavily stigmatised mental health conditions a person can experience. This rampant stigma has both tangible and emotional consequences that can worsen existing difficulties with BPD. In the form of judgments, blame, negative assumptions and discrimination, stigma can lead a person experiencing BPD to feel ashamed and hide their suffering. This leads to further negative emotion (shame, loneliness, fear) and attempts to suppress distress. Suppression of distress and self-invalidation typically results in further emotion dysregulation, dysregulated thinking and out-of-control behaviour.
Even if individuals are determined enough to push through the stigma and seek treatment, they may encounter even more stigma. Some mental health professionals are reluctant, or even refuse, to diagnose and/or treat BPD even when a person clearly meets diagnostic criteria.
Evidence demonstrates that BPD is a highly stigmatised condition. A number of studies(e.g. Markham & Trower, 2003, outlined below; Markham, 2003) suggest that the diagnosticlabel of ‘BPD’ elicits particular negative beliefs and emotions in psychiatric nurses relating to sympathy, rejection, and optimism. This seems to stem from inaccurate beliefs about how stable and controllable the cause of behaviour and behaviour itself are in people with BPD, and how dangerous people with BPD are.
While labels may have different meanings for members of different groups (Link et al. 1987), it is important to point out that other mental health clinicians also endorse negative beliefs and feelings about people with BPD. Other studies (e.g. Black et al. 2011; Bodner et al. 2015; Liebman & Burnette 2013) suggest that these beliefs extend to other staff, such as psychologists, psychiatrists and social workers, although nurses seem least empathic and optimistic about care, perhaps because they see the most people with BPD of all these groups, spend the most time with them, or see clients when they are struggling most and require inpatient care. Nursing staff may also be provided with the least support and supervision in working with this client group.
Clinicians’ negative beliefs may then guide behaviour, becoming the ‘guiding imagery for action’ (Scheff 1966, p82) and result in discrimination against those with BPD. In the only study we could find relating to discriminatory behaviour, Fraser and Gallop (1993) reported that nurses observed on an inpatient unit interacted with people with BPD with greater negative intensity and less empathy than those with schizophrenia, being ‘more indifferent and impervious’ towards those with BPD. This study, however, left a number of variables uncontrolled, including previous knowledge of the client, such that further evidence is required to fully support these conclusions.
Young people with BPD are also stigmatised. Inpatient nursing staff in Reiss and Gannon (2015, reviewed below) working with young people reported a range of difficulties, including negative emotions, in this work. Liebman and Burnette (2013, reviewed below) report that clinicians had particularly negative beliefs about younger people with BPD. Young people with BPD also report a high subjective sense of being stigmatised (Catthoor et al. 2015, reviewed below).
Clinicians need to challenge these stereotypic pejorative self-stigmatising labels with people with BPD and help that person develop a good fulfilling life.
Further reading
References
Aviram, R.B., Brodsky, B.S., & Stanley, B. (2006) Borderline personality disorder, stigma, and treatment implications. Harvard Review of Psychiatry, 14, 249-256.
Black, D.W., Pfohl, B., Blum, N., McCormick, B., Allen, J., North, C.S., Phillips, K.A., Robins, C., Siever, L., Silk, K.R., Williams, J.B., & Zimmerman, M. (2011) Attitudes toward borderline personality disorder: A survey of 706 mental health clinicians. CNS Spectrums, 16, 67-74.
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Bodner, E., Cohen-Fridel, S., Mashiah, M., Segal, M., Grinshpoon, A., Fischel, T., & Iancu, I. (2015). The attitudes of psychiatric hospital staff toward hospitalization and treatment of patients with borderline personality disorder. BMC Psychiatry, 15, 1-12.
Catthoor, K., Feenstra, D.J., Hutsebaut, J., Schrijvers, D., & Sabbe, B. (2015) Adolescents with personality disorder suffer from severe psychiatric stigma: Evidence from a sample of 131 patients. Adolescent Health, Medicine and Therapeutics, 6, 81-89.
Chanen, A. M. (in press). Borderline personality disorder in young people: are we there yet? Journal of Clinical Psychology 2015.
Chanen, A.M., Jackson, H.J., McCutcheon, L.K., Jovev, M., Dudgeon, P., Yuen, H.P., Germano, D., Nistico, H., McDougall, E., Weinstein, C., Clarkson, V., & McGorry, P.D. (2008) Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: Randomised controlled trial. British Journal of Psychiatry, 193, 477-484.
Chanen, A. M., & McCutcheon, L. K. (2013). Prevention and early intervention for borderline personality disorder: current status and recent evidence. British Journal of Psychiatry, 202(S54), s24-s29.
Clarke, S., Taylor, G., Boldsterson, H., Lancaster, J., & Remington, B. (2014) Ameliorating patient stigma amongst staff working with personality disorder: Randomized controlled trial of self-management versus skills training. Behavioural and Cognitive Psychotherapy. DOI: 10.1017/ S1352465814000320
Corrigan, P.W., & Watson, A. (2002). The paradox of self- stigma and mental illness. Clinical Psychology: Science and Practice, 9, 35-53.
Fraser, K., & Gallop, R., (1993). Nurses’ confirming/ disconfirming responses to patients diagnosed with borderline personality disorder. Archives of Psychiatric Nursing, 7, 336-341.
Furnham, A., Lee, V., & Kolzeev, V. (2015) Mental health literacy and borderline personality disorder (BPD): What do the public ‘make’ of those with BPD? Social Psychiatry and Psychiatric Epidemiology, 50, 317-324.
Griffiths M. Validity, utility and acceptability of borderline personality disorder diagnosis in childhood and adolescence: survey of psychiatrists. The Psychiatrist 2011; 35: 19–22.
Gulliver, A., Griffiths, K.M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help- seeking in young people: A systematic review. BMC Psychiatry, 10, 113-122.
Gunderson, J.G., Stout, R.L., McGlashan, T.H., Shea, M.T., Morey, L.C., Grilo, C.M., Zanarini, M.C., Yen, S., Markowitz, J.C., Sanislow, C., Ansell, E., Pinto, A., & Skodol, A.E.
(2011). Ten-year course of borderline personality disorder: Psychopathology and function from the Collaborative Longitudinal Personality Disorders Study. Archives of General Psychiatry, 68, 827-837.
Hayes, S.C., Strosahl, K., & Wilson, K.G. (1999) Acceptance and commitment therapy: An experiential approach to behaviour change. New York: Guilford.
Knaak, S., Modgill, G., & Patten, S.B. (2014). Key ingredients of anti-stigma programs for health care providers: A data synthesis of evaluative studies. Canadian Journal of Psychiatry, 59, S19-S26.
Knaak, S., Szeto, A.C.H., Fitch, K., Modgill, G., & Patten, S. (2015) Stigma towards borderline personality disorder: Effectiveness and generalizability of an anti-stigma program for healthcare providers using a pre-post randomized design. Borderline Personality Disorder and Emotion Dysregulation, 1-9.
Koehne, K., Hamilton, B., Sands, N., & Humphreys, C. (2012). Working around a contested diagnosis: Borderline personality disorder in adolescence. Health, 17, 37-56.
Liebman, R.E., & Burnette, M. (2013) It’s not you, it’s me: An examination of clinician- and client-level influences on countertransference toward borderline personality disorder. American Journal of Orthopsychiatry, 83, 115-125.
Linehan, M.M. (1993) Cognitive behavioral treatment of borderline personality disorder. New York: Guilford.
Markham, D. (2003) Attitudes towards patients with a diagnosis of ‘borderline personality disorder’: Social rejection and dangerousness. Journal of Mental Health, 12, 595-612.
Markham, D., & Trower, P. (2003). The effects of the psychiatric label ‘borderline personality disorder’ on nursing staff’s perceptions and causal attributions for challenging behaviours. British Journal of Clinical Psychology, 42, 243-256.
Mehlum, L., T?rmoen, A.J., Ramberg, M., Haga, E., Diep, L.M., Laberg, S., Larsson, B.O., Stanley, B.H., Miller, A.L., Sund,
A, M., & Gr?holt, B. (2014). Dialectical behaviour therapy for adolescents with repeated suicidal and self-harming behaviour: A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 1082-1091.
Nehls, N. (1998). Borderline personality disorder: Gender stereotypes, stigma, and limited system of care. Issues in Mental Health Nursing, 19, 97-112.
Reiss, R., & Gannon, K. (2015) How do nurses experience working with adolescents with a diagnosis of ‘personality disorder’ or ‘emerging personality disorder’? Journal of Psychiatric and Mental Health Nursing, 22, 244-250.
Rickwood,D.J., Deane, F.P., & Wilson, C.J. (2007). When and how do young people seek professional help for mental health problems? Medical Journal of Australia, 187, S35-S39.
Rossouw, T.I., & Fonagy, P. (2012) Mentalization-based treatment for self-harm in adolescents: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 1304-1313.
Sawyer, M.G., Arney, F.M., Baghurst, P.A., Clark, J.J., Graetz, B.W., Kosky, R.J., Nurcome, B., Patton, G.C., Prior, M.R., Raphael, B., Rev, J.M., Whaites, L.C., & Zubrick, S.R. (2001). The mental health of young people in Australia: Key findings from the child and adolescent component of the National Survey of Mental Health and well-being. Australian and New Zealand Journal of Psychiatry, 35, 806-14.
Scheff, T.J. (1966). Being mentally ill: A sociological theory. Chicago: Aldine.
Schuppert, H.M., Timmerman, M.E., Bloo, J., van Gemert, T.G., Wiersema, H.M., Minderaa, R.B., Emmelkamp, P.M.G., & Nauta, M.H. (2012) Emotion regulation training for adolescents with borderline personality disorder traits: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 1314-1323.
Shanks, C., Pfohl, B., Blum, N., & Black, D.W. (2011). Can negative attitudes toward patients with borderline personality disorder be changed? The effect of attending a STEPPS workshop. Journal of Personality Disorders, 25, 806-812.
Thornicroft, G., Rose, D., Assam, A.K., & Sartorius, N. (2007). Stigma: ignorance, prejudice, or discrimination? British Journal of Psychiatry, 190, 192-193.
Yap, M.B.H., Reavley, N., Mackinnon, A.J., & Jorm, A.F. (2013). Psychiatric labels and other influences on young people’s stigmatizing attitudes: Findings from an Australian national survey. Journal of Affective Disorders, 148, 299-309
Thank you so much for mentioning us! We really appreciate it! I actually have a BPD Support Group meeting tonight at 6pm(CST)! Anybody can come!! It's really comfortable and safe. Just gotta go to www.meetup.com/bpdsupportgroup
Mental Health/Neurodiversity Consultant | Counselling Psychotherapist l Credentialed Mental Health Nurse | MSc Psychology Cand. Disability specialist | DEIB Warrior | Actually Autistic ADHD PDA ??????????????????????
3 年National Education Alliance for Borderline Personality Disorder
Mental Health/Neurodiversity Consultant | Counselling Psychotherapist l Credentialed Mental Health Nurse | MSc Psychology Cand. Disability specialist | DEIB Warrior | Actually Autistic ADHD PDA ??????????????????????
3 年BORDERLINE PERSONALITY DISORDER SUPPORT CORPORATION
Mental Health/Neurodiversity Consultant | Counselling Psychotherapist l Credentialed Mental Health Nurse | MSc Psychology Cand. Disability specialist | DEIB Warrior | Actually Autistic ADHD PDA ??????????????????????
3 年Full photo