Despite the fact that around ‘seven in every 1,000 people in the UK have Borderline Personality Disorder (BPD)[1]’ it is still a condition that is not only misunderstood, but also extremely stigmatised.
In recent years, we have come a long way in the destigmatisation of many mental illnesses, and we no longer view them as weakness, but rather treat them as the debilitating conditions that they so often are. However, our attitudes toward BDP are lagging behind and this is in part due to the way the condition is framed and indeed, because of the name itself.
Perhaps if instead of looking at BDP as a personality disorder, we saw it as a complex response to trauma, much of the stigma that currently exists would be reduced. Most individuals suffering from BDP have some sort of history of trauma, often originating in childhood. This may include abandonment and neglect, physical and sexual abuse and separation or loss of parents and loved ones. ‘Multiple studies have reported that a history of physical and sexual abuse in childhood has a high prevalence among patients with borderline personality disorder, with some studies finding that abuse is a nearly ubiquitous experience in the early lives of these patients.[2]’
Despite the ever substantiated link between trauma and BDP, the DSM-V does not class trauma as a diagnostic factor for the disorder. This only serves to perpetuate the stigma of the disorder. Due to its similarities to complex PTSD, it isn’t unreasonable to suggest that it be regarded in the same light – as a trauma spectrum disorder as opposed to a personality disorder. Individuals suffering with both PTSD and BDP struggle to regulate their emotions, both experience sensations of shame, guilt and feeling of emptiness and they both have an elevated risk of suicide. ‘At least three-quarters of… patients [with BDP] attempt suicide and approximately 10% eventually complete suicide.[3]’
Link Between the Name and the Stigma
In the 1930s borderline was used by psychoanalysts for patients who were bordering psychosis and neurosis. However there is an interpretation by some today that the “border” within the name signifies the bordering on being a real illness or not. Essentially there is an invalidation of the true suffering in the name of the illness. As one of the symptoms of BDP is not feeling validated as a person, the name may serve to enhance the feelings of invalidation the suffer already struggles with. Added to this is the concept many have that a personality disorder is not dissimilar to a personality flaw. There is not enough education around the term and this may lead sufferers of BDP to view themselves more negatively, and even more harmful – it may lead those close to them to do the same. All perpetrating the cycle and exacerbating their sense of worthlessness. Unfortunately it is not only the uneducated who discriminate against those suffering with BDP, clinicians and professionals, even within the mental health fields have been known to act frustrated with patients suffering with BDP as they can often struggle to engage.
Changing the Name
Diagnostic labels are meant to describe symptoms and answer the question of what is wrong with a patient. However this is often not the case which reduces the usefulness of diagnostic labels as a whole, but also may be harmful when the label actually denigrates and potentially invalidates a person’s suffering.
Changing the name to something that shines a light on the root cause of the condition, such as complex trauma disorder, could change the stigma surrounding borderline personality disorders from people who are “misbehaving” or not having a “real” condition, to viewing them as survivors of trauma. This could lead to better treatment engagement and better outcomes, even if it was just a change that was made informally.
If you have a client, or know of someone who is struggling to find the right help for borderline personality disorder, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).
Sources:
- Coid, Jeremy & Yang, Min & Tyrer, Peter & Roberts, Amanda & Ullrich, Simone. (2006). Prevalence and correlates of personality disorder in Great Britain. The British journal of psychiatry : the journal of mental science. 188. 423-31. 10.1192/bjp.188.5.423.
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Golier JA, Yehuda R, Bierer LM, et al.: The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events. Am J Psychiatry 2003; 160:2018–2024
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Black, Donald & Blum, Nancee & Pfohl, Bruce & Hale, Nancy. (2004). Suicidal Behavior in Borderline Personality Disorder: Prevalence, Risk Factors, Prediction, and Prevention. Journal of personality disorders. 18. 226-39. 10.1521/pedi.18.3.226.35445.