By Lynn Ayoub | Staff Writer
“If you end up in the emergency room for a medical disorder, for God’s sake, do not tell them you meet criteria for borderline personality disorder; do not tell anybody.” That is what Marsha M. Linehan, an American psychologist and author who created dialectical behavior therapy—a specific type of cognitive therapy used to treat BPD—tells her patients. She explains that she does this because there is such a stigma, and the patient will be treated differently most of the time, whether it was a physical issue or a mental one. Marsha emphasized, “Many, many, many mental health practitioners will not see a person that meets criteria for borderline personality disorder.” She adds, “Watch TV sometimes; they have a mass murder: borderline personality disorder!” A lot of mental health disorders are stigmatized; however, BPD is considered to be one of the most stigmatized disorders, if not the most. This stigma endorsing this disorder is so understated, and it goes back to certain causes. It’s portrayed by both society and health practitioners and experienced tremendously by patients.
Borderline Personality Disorder is stigmatized because it calls into question the very nature of what it means to be human. People who function normally are successfully capable of overcoming the idealization of early childhood, where everything seems perfect, romanticized, and reverenced, they accept life as it is with all its compromises. People with BPD on the other hand are stuck still looking for that perfection they’ve once experienced.
This stigma, the negative perception of BPD, originated from the discrepancy between a good prognosis and the negative way in which people view those affected. Mary Zanarini, a psychologist at Harvard Medical School, notes that this negative perception, especially among health professionals, often stems from their first encounter with the patient in the ER, where the patient is usually at their worst. She emphasizes that this is similar to how an oncologist might feel when a patient has a cancer recurrence; while personal feelings are inevitable, it doesn’t mean that the oncologist would take it upon himself to stop taking cancer patients.
John Gunderson, professor of psychiatry at Harvard and director of the borderline center at Mclean Hospital, explains that mainly this stigma is because of two main reasons. First of all, it’s the professionals’ fault, it’s either they treated patients wrong due to misdiagnosing them or even not knowing the ideal way to treat them, so they just try approaches and medications that might harm a BPD patient even more. Furthermore, they might not put the right amount of effort into treating that patient, and that is attributed to the idea that BPD is untreatable.
Another source of the stigma says Gunderson is inherent in the disorder. “We can’t say it’s something that somebody superimposed on themselves, rather it’s who they are in a basic way,” said Gunderson in an interview with Borderlinernotes. He emphasizes that this makes it harder to adopt a disease model that the person is afflicted with and to have sympathy for them. This damnatory that surrounds this patient based on his diagnosis is something that is shaped by both the environment and the treatment.
Overdiagnosing and misdiagnosing are seen in very high amounts when it comes to Borderline Personality Disorder. “They throw it around to tell someone they are annoying,” Antonia New, a professor of psychiatry at Icahn School of Medicine, mentioned in one interview showing how stigmatizing BPD leads to just tossing around a diagnosis to refer to an annoying person. This stigma created a negative notion about how BPD patients are “self-indulgent”, “weak-willed”, “unstable”, “dangerous”, and “too immature” to make their own decisions.
Gunderson once mentioned that there are mental health professionals who are actually scared to take BPD patients, especially at the start of their career, because they are afraid of challenging interactions with the patient, where the patient would go from opening up to losing control over their emotions. Additionally, there’s a societal tendency to misunderstand individuals with BPD, wrongly labeling them as “attention seekers”.
As a result, BPD patients become reluctant to seek treatment, they start avoiding appointments and they stop keeping up with their treatments because they are scared and ashamed to be discovered. Harassment and bullying are common experiences that BPD patients often face because of the stigma surrounding them. They are treated as though they are immature and are often told to “get a grip and grow up”, that “it’s a phase everyone goes through” and they are just being “dramatic”.
People tend to distance themselves from those individuals as they feel that they’re walking on thin ice around them. In reality, however, this stigma and this cloud of darkness hovering above BPD patients makes them the ones always walking on thin ice as they try to prove that they are worthy of love and worthy of living like any other human being.
References:
Aviram RB, Brodsky BS, Stanley B. Borderline personality disorder, stigma, and treatment implications. Harv Rev Psychiatry. 2006 Sep-Oct;14(5):249-56. doi: 10.1080/10673220600975121. PMID: 16990170.
THE DR. LINDA MINTLE SHOW, Walking on eggshells: Borderline Personality Disorder (BPD) Dr. Linda Mintle on February 19, 2022
Why We Need to Talk About Borderline Personality Disorder,November 20, 2019(Clearview treatment programs )