Borderline Personality Disorder

As we come out of an era when mental health was not taken seriously or was overlooked, it is crucial that we now educate neurotypical individuals of society with newfound research and information. Borderline personality disorder (BPD) is a personality disorder that is widely stigmatized. This stigma, like all stigmas are formed, comes from the fact that people don’t understand and are not educated on what they are stigmatizing. Sometimes, even psychologists are wrong in their diagnoses; they might overlap BPD with Axis 1 disorders, such as CPTSD. Additionally, psychologists also contribute to the stigma surrounding the name of BPD. Many opinions have been formed by psychologists on whether or not clinicians should disclose a diagnosis of BPD or not. The goal of diagnosing BPD is to give sufferers a solution to problems that have been a mystery to them, give patients a solution for future endeavors, and give them a sense of closure around the problems that they have been facing, this should not be a debate, and clinicians should without a doubt be disclosing BPD diagnoses to sufferers.

Borderline personality disorder is classified as an axis 2, cluster B, disorder. BPD does not mean manipulation, full-fledged psychotic symptoms, or being a dangerous person as the stigma claims. In fact, BPD leaves affected individuals with a distorted sense of self, fear of abandonment, self-harm issues, unstable relationships, and most of all, displayed dysregulation of emotions. The ‘borderline’ from BPD comes from doctors claiming that individuals affected by BPD were on the border of neurosis and psychosis, though there is another debate about renaming this disorder due to the increased knowledge of the complexities of diagnosis. While the complete cause of it is uncertain, researchers suspect a majority of individuals with BPD have it in their genetics and the result of severe trauma (nhs, 2019) elicits the phenotype of the gene.

In order to combat the stigma of this disorder, we need to normalize the name and educate neurotypical individuals. The problem does not lie in the diagnosis, it lies in how people view the disorder based on how well educated they are on it. Many people do not understand what BPD is and everything that BPD entails, such as where it might stem from, their views on themselves, or why people have a hard time finding treatment. When individuals are educated and have knowledge of subjects like personality disorders, they are less inclined to contribute to the stigmas surrounding diagnoses. It is not the fault of the individuals affected by BPD for the ignorance that people exude, rather, it is the fault of those who stigmatize and promote false, uneducated claims. A person who faces no stigma for actions without a diagnosis does not just completely change once there is a diagnosis to their experiences.

Already having it hard enough as is, these individuals now not only need to worry about societal stigmas, but clinical stigma as well. Clinicians are reluctant to diagnose not only for those reasons, but also for the reason of the stigma surrounding the name; however, it might not be the same way that you think stigma affects the patient. These individuals already have the fear of abandonment and are incredibly sensitive to rejection (Aviram 2006), so when clinicians stigmatize these individuals, it pushes the patient further away, making pursued treatment stagnant and ineffective. Many clinicians believe that BPD is untreatable, or that they don’t have the resources to help the affected patient (Paris, 2007). According to Dr. Ron Aviram, clinicians even go as far as distancing themselves from their clients and how they tolerate affected individuals.

Nevertheless, clinicians are not obligated to keep patients that the clinician feels as though their patient is beyond the scope of their license or competence (Leslie 2008). In fact, therapists are also able to terminate when they are unable or unwilling to provide their services for appropriate reasons (Leslie 2008). With this knowledge, we are aware that those therapists who feel strongly against individuals affected by BPD can refer those clients to a DBT therapist. Depending on the DBT therapists’ experience, they will have more knowledge on how to handle patients with BPD, as many BPD patients use DBT as an effective treatment. Clinicians then have no reason as to why they should keep a patient's diagnosis from them if those individuals can avoid the stigma that some clinicians contribute simply by addressing their disorder with a more qualified and accepting clinician.

When patients are aware of a BPD diagnosis, if they decide to switch to a different clinician, they are able to disclose their diagnosis with that clinician. This makes therapy with the new clinician more effective much earlier on, as the clinician will know how to best handle what their patient might be going through. This is especially important because most patients with BPD, specifically 47%, leave therapy prematurely (Salters-Pedneault 2021); once clinicians and patients are aware of the diagnosis, they have more awareness of this habit of ‘quitting’ and can conquer that habit by incorporating it into their therapy plans.

Understanding the concept of a diagnosis, which is a label that allows patients to find proper treatment for that diagnosis, proves even further as to why we need to disclose a diagnosis for BPD patients. By giving patients a diagnosis, they are directed to proper treatments to make their lives with their disorder easier and more manageable. The most popular forms of therapy are psychodynamic and cognitive behavioral therapy (CBT) (Harvard 2011). This might lead patients who are feeling as if they need therapy to the wrong kind of therapy if they do have BPD. According to NAMI, dialectical behavioral therapy (DBT) is the best form of therapy for individuals affected by BPD, giving patients skills to regulate their emotions better, handle crises, and be more aware of their thinking patterns that might harm themselves or others around them. If a patient is unaware that they have BPD due to a clinician choosing to not disclose a diagnosis, then the patient might seek the wrong form of therapy for their disorder.

Adding onto why it is so important for individuals affected by BPD to be aware of their diagnosis, BPD is a personality disorder, meaning that this is a significant part of who they are. Everybody deserves to know who they are, and if you hold the key to the side of a person that that person is unaware of, it is only fair that you let them know who they are. BPD is a disorder that is ingrained into a person, yet that person is usually unaware of what they are dealing with. If you were met with an invisible monster, which you know something is wrong yet cannot pinpoint what, it would be a lot easier to throw ink on it to reveal it and conquer it from there. It is the clinicians job to use the ink from their pens and write the diagnosis of a person’s BPD to reveal this invisible monster to their patient so that the patient can rewire themselves to battle against this monster.

Closure is something that many of us need, especially individuals affected by mental health. Being looked at and treated differently with phrases such as “You’re too sensitive” or “Why do we always have to walk on eggshells around you?” being said towards you and you don’t know why is incredibly emotionally taxing. By giving a diagnosis, you are giving closure to the person who does not understand why people view them differently, and while a diagnosis is no excuse, that closure is usually all that is needed for a person to start their journey of healing.

It is important to disclose a diagnosis for genetic and reproductive reasoning. If a woman is diagnosed with BPD, they are 46% more likely to pass BPD onto their children (Salters-Pedneault 2022). If a woman is unaware of their BPD and they choose to have children, this can do the child an injustice because a mother who is aware of their diagnosis might be more inclined to research for their own sake and even for their child's sake. When a mother researches for their child, they might find ways to handle or lessen symptom intensity, and perhaps in reference to multifinality, mothers might even be able to prevent the expression of DPYD and PKP4 genes (Bence 2021).

By combating the stigma surrounding a BPD diagnosis, it opens up many opportunities for those diagnosed individuals. Patients might be less wary of seeking treatment, or speaking up about what they might be going through since they would no longer have to worry about outsiders’ judgments. It might also make treatment more tolerable for these individuals, where a possibility could be that clinicians who combat the stigma become more open and accepting with their patients who come to them with BPD. Once more people are educated on the stigma vs the reality of the disorder, the stigma will slowly diminish and there will be more understanding for affected individuals. Ultimately, this might mean that individuals with BPD will have more opportunity for amelioration through treatment, societal support, and proper knowledge.

As someone affected by BPD, I can confidently say that my diagnosis has helped me better myself and has given me the closure that I have been seeking throughout my life. My diagnosis gave me an answer to why I was feeling the way that I was, and why other diagnoses just didn’t match up properly. Once I had gotten my diagnosis, I was able to effectively handle what I was going through since I understood it and was able to learn about it and what direction I should be pursuing in order to make living with this disorder easier. Though I might have fallen subject to the ‘therapy hopping’ and other dramatic symptoms, my diagnosis gave me a foundation to work off of. I am grateful that my clinician was clear and direct with me and my diagnosis, that she never gave up on me, and that my life had drastically improved due to her disclosure and her guidance through therapy. Even though I might face the harmful generalization and stigma at times, I have the closure that I had been looking for my whole life and my diagnosis was the first step in overcoming my personal battle with BPD.

Works Cited

Paris, Joel. “Why Psychiatrists Are Reluctant to Diagnose: Borderline Personality Disorder.” Psychiatry (Edgmont (Pa. : Township)), Matrix Medical Communications, Jan. 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC2922389/.

Hubbard, Simon, et al. “Emotional Intensity Disorder: The New Name for Borderline Personality Disorder?” Borderline Personality Disorder Treatment, 19 Mar. 2018, www.borderlinepersonalitytreatment.com/emotional-intensity-disorder.html.

nhs. “Causes- Borderline Personality Disorder.” NHS Choices, NHS, 2019, www.nhs.uk/mental-health/conditions/borderline-personality-disorder/causes/#:~:text=being%20a%20victim%20of%20emotional,drink%20or%20drug%20misuse%20problem.

Dingfelder, Sadie F. “Personality Disorders--Treatment for the 'Untreatable'.” Monitor on Psychology, American Psychological Association, Mar. 2004, www.apa.org/monitor/mar04/treatment.

Aviram, Ron V., et al. “Borderline Personality Disorder, Stigma, and Treatment Implications.” Harvard Review of Psychiatry, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/16990170/.

Harvard. “Types of Psychotherapy.” Harvard Health, 1 Aug. 2011, www.health.harvard.edu/mind-and-mood/types-of-psychotherapy#:~:text=There%20are%20many%20forms%20of,therapy%20and%20cognitive%20behavioral%20therapy.

NAMI. “Treating Borderline Personality Disorder.” NAMI, www.nami.org/Blogs/NAMI-Blog/June-2017/Treating-Borderline-Personality-Disorder#:~:text=Skill%2DBuilding%20Through%20DBT,cope%20with%20their%20difficult%20symptoms.

Salters-Pedneault, Krystalyn. “Questions to Ask Yourself before Quitting Therapy for BPD.” Verywell Mind, Verywell Mind, 16 Apr. 2021, www.verywellmind.com/want-to-quit-therapy-425341.

Leslie, Richard. “Duty to the Patient – Termination of Treatment and Understanding Your Patient – Therapist Relationship and Expectations.” CPH & Associates, Oct. 2008, www.cphins.com/termination-and-referral-when-does-the-duty-to-the-patient-end/.

Salters-Pedneault, Kristalyn. “How Can You Lower Your Risk of Inherited Bpd?” Verywell Mind, Verywell Mind, 18 Feb. 2022, www.verywellmind.com/i-have-bpd-does-this-mean-my-kids-will-get-bpd-too-425161.

Bence, Sarah. “Is Borderline Personality Disorder Genetic?” Verywell Health, Verywell Health, 6 Aug. 2021, www.verywellhealth.com/is-borderline-personality-disorder-genetic-5191970#:~:text=Current%20research%20supports%20the%20theory,and%20bipolar%20disorder%20risk%2C%20too.