If you were to look it up, you’d find that Borderline Personality Disorder (BPD) is characterised mainly by persistent mood instability, lack of clear self-definition, difficulty in maintaining stable interpersonal relationships, “black-or-white” thinking and erratic high-risk behaviour. However, the exact definition of Borderline Personality Disorder, a long-standing mental illness which is believed to affect anywhere from 1.6% to 5.9% of the world population, remains somewhat skewed in terms of public perception.
The statistics surrounding the treatment and behaviour of people with BPD have played a huge role in crafting the damaging branding image of the illness. Pop culture lent an unwarranted hand in this with films such as ‘Girl, Interrupted’, ‘Fatal Attraction’ and possibly even ‘Silver Linings Playbook’ (in which Tiffany’s mental health condition remained unnamed but is speculated to have been BPD); the critical acclaim of which cannot eclipse their aid in the construction of a “crazed, manic and uncontrollable” individual as the face of BPD.
The truth of the matter is that people with BPD are in fact known to lash out, threaten or even manipulate those around them and, while this is extremely harmful, it’s important to recognise that this is symptomatic of their mental illness and not their true nature. One can condemn their destructive actions and take the necessary precautions to distance oneself from potentially hazardous scenarios while also recognising that they are not awful people, but individuals in need of help. So it is worrying that we now see a stereotype of people with BPD as toxic or unmanageable.
Disturbingly, this is a stereotype that even therapists contribute to. People with BPD have been labeled as the most unresponsive to treatment, often “testing” their therapist and pushing the limitations of the therapeutic relationship. The illness, therefore, requires a unique approach to therapy and it is now recognized that people with BPD are most receptive to a cognitive-behavioral treatment called Dialectical Behaviour Therapy (DBT). However, since therapists are legitimately allowed to turn away a patient seeking help if they feel they do not possess the necessary skill-set to help, they often do not undergo the specialized training required to ethically use DBT so as to avoid the associated “trouble” that comes along with BPD patients. Painful online accounts exist which chronicle the fear that people with BPD experience when seeking out treatment as they are aware that they are considered a “lost cause” and may not be taken seriously.
People with BPD require a very particular type of help and the stigmatization of them within the mental health profession as well as society at large needs to stop. It is the same stigmatization that we’ve seen surrounding depression and anxiety, a stigma that we are only in recent times making progress to address – millennials have been regarded as “the anxious generation” and this has fostered an encouraging discussion among youth surrounding their mental health. However, there is notably less representation for people with BPD who do not make up as high a percentage of the population as those suffering from depression and/or anxiety. In addition, people with BPD often go undiagnosed.
“People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.”
― Marsha M. Linehan (Author of ‘Cognitive-Behavioural Treatment of Borderline Personality Disorder‘)
Initially, people with BPD were believed to be “on the border” between neurosis and psychosis, displaying neurotic symptoms such as anxiety or depression yet simultaneously exhibiting signs of the dissociative thinking typically correlated to psychosis in which they lose touch with reality. An originally inexact diagnosis, BPD has gone on to have more structured bounds within the fields of psychiatry and psychology; however, it remains a somewhat “catch-all” judgment. That is to say, therapists often reserve the diagnosis of BPD for patients who are the most resistant to treatment. Consequently, this means that people with BPD often undergo various misdiagnoses and mistreatments before a correct classification – a particularly dangerous notion when considering that BPD is the only mental illness that lists suicidal or self-injurious behaviour among its diagnostic criteria and, as such, the error of a misdiagnosis could be potentially life-threatening (this, of course, applies to misdiagnoses of various other mental illnesses as well). As of 2015, the recorded suicide rate among those with BPD is alarmingly high, estimated at between 4% and 9%.
The seclusion and stigmatization faced by people with BPD is unnerving, whether it be from social peers who label them as a nuisance or mental health professionals who often do not treat them with the respect they deserve. Inevitable questions begin to creep into mind: how much of this pain could be avoided if health care professionals were more willing to treat and engage with BPD patients? How much isolation could be prevented if the negative connotations surrounding people with BPD were broken down through discussion and awareness?