The Stigma Associated with Borderline Personality Disorder

Even though mental health advocates actively fight stigma associated with mental illness, Borderline Personality Disorder (BPD) remains one of the field’s most misunderstood, misdiagnosed and stigmatized conditions. Studies show that even some mental health professionals have more stigmatizing views about BPD than any other mental health condition: As some choose to limit the amount of BPD patients they’re “willing” to see or refuse to treat people with BPD altogether.

For those mental health professionals who do treat BPD, they often do so without the proper training, making sessions frustrating and uncomfortable for everyone. Patients may leave feeling misunderstood and judged, while providers may feel ineffective and inadequate.

Individuals experiencing BPD are also frequently labeled as “treatment resistant” and dropped as patients. But when this happens, it reinforces the common misconception that reaching out for help is hopeless. It can also intensify symptoms that caused an individual to seek help in the first place—particularly for those living with Borderline Personality Disorder. When someone who experiences an intense fear of abandonment—a common symptom of BPD—is “abandoned” by a person who should be helping them overcome that fear, it may leave them feeling even worse than when they began treatment.

Making StigmaFree Mental Health Professionals

To combat stigma associated with BPD in clinical settings, new interventions have been developed to improve mental health professionals’ attitudes towards their patients. These interventions are typically implemented through workshops designed to:

• educate and correct common misconceptions of the disorder;
• teach new skills that promote positive treatment outcomes; and
• encourage a deeper understanding, through social interactions and personal stories of individuals living with BPD.

One study found that a one-day professional workshop on BPD —called Systems Training for Emotional Predictability and Problem Solving (STEPPS)—significantly improved clinicians’ attitudes toward patients with BPD and their desire to work with them. Another study found that a similar, three-hour workshop on BPD and Dialectical Behavior Therapy (DBT) also significantly reduced stigma and increased empathy.

While these courses are promising, anti-stigma programs currently available in the U.S. are still limited and underutilized. Mental health professionals should strive to challenge any preconceived notions they may have and initiate further education on their own, as alternative options to these in-person courses do exist:

1. Behavioral Tech offers resources for providers, which includes training and treatment tools for professionals looking to learn more about DBT.
2. NEA.BPD’s free, online course for professionals.
3. bpdvideo’s training DVDs for professionals.

These interventions, while varying in form, all strive to accomplish the same thing: quality care and a better, more supportive environment for those seeking treatment for BPD.

Finding the Right Treatment Team

The most important part of any treatment team is the partnership between the mental health professional and the individual seeking treatment. There is no “one size fits all,” and it’s important to find a mental health professional that makes you feel comfortable and heard. While stigma can make this challenging if you live with BPD, there are things you can do to find the right provider for you:

Check credentials. You have the right to know whether any therapist you are considering working with is licensed in your state. You can also find out the therapist’s education and training.

Assess experience. Ask the therapist questions about his or her history working with people with BPD. For example: “How many patients with BPD have you treated?” and “Do you feel like you helped your previous patients with BPD lead better lives?”

Listen to language. When discussing BPD, the therapist’s language should reflect a well-informed and nonjudgmental attitude towards the mental health condition.

Point out stigma. If you feel insulted or misunderstood by a care provider, let them know. Since BPD is such a highly misunderstood condition, they may say something offensive without realizing it. If you’re comfortable with it, let them know when this happens.

Walk away. If you feel uncomfortable with your provider, if you feel like they don’t understand you, or if you feel they don’t fully understand BPD, it’s okay to leave. You don’t have to settle for a provider who isn’t meeting your treatment needs. It may take more effort to find the right fit, but recovery is worth it.

Many individuals living with BPD look for therapists who specialize in DBT. Some therapists have adopted DBT-based techniques, but aren’t technically certified in DBT. TARA (an organization that focuses on offering help to those affected by BPD) has developed guidelines to help you choose a DBT therapist.

The reality is that BPD is treatable. With evidence-based treatment, along with compassionate and supportive mental health professionals, individuals living with BPD can and do get better.

Cameron Hancock is HelpLine coordinator at NAMI.