It has been said that Borderline Personality Disorder is one of the most stigmatized of all mental health conditions. People with BPD experience strong bias not only in the public arena but among  mental health professionals as well/. In fact, BPD was once referred to as the “leprosy of mental health” and therapists were cautioned against treating patients with that diagnosis.

To understand why that is, its useful to explore the word stigma itself.

Stigma is the Greek expression for a mark that was cut or burned into the skin of criminals, slaves and traitors; a brand that readily could identify the worst members of society – the outcasts who should be kept at arms length. In time the use of the term expanded to include any person considered unworthy of civic inclusion for any reason, but particularly those who were severely ill, disabled or disfigured.

Such a stigma was attached to Borderline Personality Disorder almost as soon as it was first described as a mental disorder in 1938..Over the next 40 years BPD remained little understood and poorly treated. Given that BPD was extremely difficult to treat and held little promise of recovery, many therapists  believed it was better to avoid treating those patients.

That belief – and the attached stigma – remained widespread for 30 years until the early 1980’s when cadre of pioneering psychiatrists and psychologists began to unravel the mysteries of BPD. Most notably, Marsha Linehan developed a treatment for BPD that actually worked – Dialectical Behavior Theory. Other researchers and clinicians made additional advances in the understanding of BPD and other treatment approaches arrived. But the stigma persisted, not just in the US, but in the UK, Australia. Israel and other countries around the world

In July 2018, John M. Grohol, Psy.D. the founder and Editor-in-Chief of the respected online journal Psychcentral.com addressed this lingering problem in a blog he wrote: Why Do Therapists Stigmatize People with Borderline?

Others have reported similar findings:

— The 1999 US Surgeon General’s report on mental health identified stigma as the primary barrier to effective treatment

— A 2009 Time magazine article on BPD reported that “Borderlines are the patients psychologists fear most.”

— The authors of a seminal book about BPD, I Hate You-Don’t Leave Me, note in their revised edition that many mental health therapists see BPD as too difficult to treat and avoid taking on clients with that diagnosis.

How does that happen?  Interesting insight into the origins of clinician bias against people with  BPD is described in the 2014 doctoral dissertation published by Lindsay K. Heightman of Smith College.

Similarly, Nicole Romero, a graduate student in Clinical Psychology at Antioch College, wrote an article in the school’s newspaper about her experiences with the biases she encountered from the mental health community.over her 10 years of seeking treatment for her BPD diagnosis.

“I have dealt with BPD stigma from psychiatrists, case managers, psychiatric nurses, emergency mental health team members, and more. In a decade of living with the diagnosis, I was only able to get help for BPD symptoms once.”

It is estimated that between 14 and 18 million people in the US have experienced borderline personality disorder in their lifetime. They.and their families and friends represent a significant block of advocates for improving awareness and spreading knowledge about BPD, not only to the community at large, but to those who are entrusted to heal the unseen wounds caused by mental illnesses like BPD.

But we may be at tipping point. Greater awareness of BPD, deeper understanding of its causes and specifically designed therapies- both talk and medication- may finally drag BPD out of the dark corners and into the light where it can be more openly and effectively addressed. And people don’t have to feel ashamed.

Robert O. Friedel, MD, author of the landmark book on BPD, Borderline Personality Disorder Demystified, has been treating people with BPD for decades, recently shared his views on this issue with me.

“This not was not taught well in medical schools. There’s some large cities that still don’t have doctors who have significant– or any— expertise in the treatment of borderline disorder. And that’s a shame, considering the amount of people who are in the population. But we’re seeing changes in that.

“We’re entering a new era of the treatment of borderline disorder. We’re stepping past where we’ve been for the last couple of decades, and now viewing this considerably different.  We’re seeing that evolve into something where the model is becoming more consistent with the models that we use for other branches of medicine. It’s very heartening”

Let’s let Nicole Romero have the last word on this topic

“Bringing awareness and education to BPD is a critical social justice issue. I encourage anyone who may know someone with BPD to speak up about the lack of support and resources”.

 

 

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