People with BPD need compassion yet even clinicians stigmatise them

By Sara Rose Masland and Hannah E A Peeples: For Complete Post, Click Here…

ngd- I’ve observed that People viewed as annoying and iritating are commonly more devalued than people with a limited hiostory of violence…

For many years, you struggle with impulsive and self-harming behaviours, and with intense emotional reactions – including when you perceive any signs that someone might be rejecting or abandoning you. You see psychologists, psychiatrists and other clinicians, but find no relief. Each clinician gives you a different diagnosis, and each diagnosis leads to a different treatment. You try what feels like a relentless string of medications.

Then, finally, a therapist diagnoses you with borderline personality disorder (BPD), and suddenly the pieces fit together. The diagnosis makes sense, and the treatment approaches designed for BPD start to help. You wonder why you weren’t told before that you had it. And while the diagnosis connects you with useful treatment and helps you understand your problems, you soon find that some healthcare providers seem to have negative reactions when you tell them about it. For example, they may seem less trusting of you, more distant or less willing to help.

Unfortunately, the scenario we’ve placed you in is anything but hypothetical for many people with BPD, and some readers will surely relate to it. As it turns out, BPD – which affects approximately 1 to 2 per cent of the general population – is one of the most highly stigmatised mental illnesses, even among mental health clinicians. Although stigma significantly impacts people with other psychiatric diagnoses, such as depression, schizophrenia and eating disorders, the stigma around BPD is particularly pernicious and worrisome. No disorder is met with more pejorative attitudes held both by clinicians and the public.

When people see mental health clinicians, they expect them to be nonstigmatising sources of knowledge and help. Yet the experiences of many people with BPD may not line up with those expectations. In past research, clinicians have reported feeling less optimism, less empathy and more hostility in relation to patients with BPD, compared with patients with other disorders. These negative attitudes and ideas may result in less effective care and lead some clinicians to avoid working with patients who have BPD. These patients already struggle with significant shame, negative self-concept and rejection sensitivity – stigma from clinicians is likely to exacerbate these problems.

Often, BPD is undiagnosed or misdiagnosed for many years due to this clinician stigma and misunderstanding. Some clinicians do not believe that BPD is a real disorder; others may be reluctant to give the diagnosis due to concerns that it could expose patients to stigma from others. The disorder can be diagnosed in both young people and in adults, and it is associated with significant distress as well as a substantial risk of premature death – by one estimate, around 10 per cent of people with BPD die by suicide. Early intervention is ideal. However, one study with structured assessments found that about a quarter of people diagnosed with bipolar disorder should actually have been diagnosed with BPD. In another study, the average gap between the onset of BPD symptoms and the time of diagnosis was 15 years. This suggests that if a person’s symptoms start to appear at age 15, they may not receive an appropriate diagnosis until they are 30. In that span of time, they will have spent most of their teenage years and young adulthood without a diagnosis that would have helped them conceptualise their problems and find treatment.

Leave a Reply