Across the Borderline
marsha 2015smThe results of a research study conducted in Israel indicate that mental health providers’ attitudes towards people with Borderline Personality Disorder may be shaped by their own fears, particularly about death and suicide. It seems that preoccupation about death, including their own, correlates with higher levels of negativity towards patients with BPD.

The researchers gathered survey responses from 120 Israeli psychiatrists about their attitudes towards death in general and to suicide in particular, as well as their personal feelings about patients diagnosed with BPD. What did they learn? Turns out that psychiatrists’ fear of death greatly contributed to negative emotions toward BPD.

“Among the psychiatric diagnoses, suicide mortality in borderline personality disorder (BPD) is similar to that of mood disorders. However, while clinicians perceive mood disorders as curable and sympathy-evoking illnesses, BPD patients are considered more problematic, and are held accountable for their suicidal behaviors. Such patients often tend to undermine the therapeutic process, may turn members of staff against each other, have high drop-out rates from therapy, and exhibit acting out episodes that may cause psychiatrists a sense of professional impotence.” (Bodner, et. al. 2015)

It’s important to note that in Jewish religious teaching suicide is forbidden, so a cultural bias may have influenced the outcomes. Regardless, it is not uncommon for mental health providers to have negative attitudes toward people with BPD.

This article brought to mind an interview we conducted with Marsha Linehan about the development of Dialectical Behavior Therapy, or DBT, her groundbreaking treatment for people who have BPD. In addition to patient facing concepts, Dr. Linehan felt it was necessary to build a team support component in the treatment protocol.

“I took the team and made it part of the treatment.  In DBT therapists meet weekly and the meeting is to keep the therapists doing the treatment essentially by the manual, which is very flexible. So it’s keeping them in the treatment frame, so to speak, and with borderline personality disorder that’s unbelievably important.

First, because they’re often highly suicidal. Highly suicidal people scare therapists and therapists tend to fall out of their treatments. Second, individuals who meet criteria for borderline can be very angry. (With) clients who are very angry at therapists, therapists can start trying to appease the client and fall out of the treatment. And third, people who meet criteria for borderline personality disorder suffer so intensely, and are in such unbelievable pain, and have so many awful things happening to them a lot of the time, that therapists can fall into the pool of grieving and hopelessness and it is very easy to get hopeless.

And I thought, we have to keep therapist from attacking the patient, which they often want to do. We have to keep them from falling into the pool of grief and hopelessness with the patient, which they often would do. We have to keep them from dumping the patient on somebody else because they’re too afraid to treat them, which they often are.  We just have to have a team– and the team’s job is to keep the therapist in the story, so to speak. So, that’s what the treatment really is.”