Thea Soleil “Nine” Dona
Where Emotions Flow
12/10/2024
The Stigma of Borderline Personality Disorder: Perspectives from Healthcare Providers, Society, and Beyond
Borderline Personality Disorder (BPD) is a serious psychiatric disorder and presents an estimated prevalence of 1.6%-5.9% across the general population (APA 2022). The disorder is characterized by pervasive emotional dysregulation, fear of abandonment, impulsivity, and patterns of unstable relationships. Much stigma surrounding BPD remains a barrier to effective treatment and social acceptance, promoting adverse outcomes such as delayed diagnosis, treatment avoidance, and social isolation. This paper discusses sources and effects of stigma about BPD from the perspectives of healthcare providers, societal attitudes, and individuals themselves.
Abstract
Borderline Personality Disorder is a complex mental disorder characterized by intense emotional dysregulation, unstable relationships, and impulsive behavior. Despite great strides in the understanding of BPD, stigma continues to impact the lives of those diagnosed with the disorder, leading to adverse treatment and social outcomes. The three major standpoints from which stigmatization of BPD may come-implications for health professionals, a look at societal attitudes in that regard, and self-perception-all are discussed here with various plans laid out for reducing stigma while engendering greater awareness and acceptance of BPD.
Stigma from Healthcare Providers
Misunderstanding and Bias
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Healthcare providers often contribute to the stigma surrounding BPD, viewing patients as "difficult" or manipulative. On this note, Sheehan et al. (2016) find that many mental health professionals hold negative attitudes toward people with BPD, often leading to substandard care or outright dismissal of their concerns.
Consequences of Provider Stigma
Provider bias may lead to underdiagnosis, misdiagnosis, and a lack of empathy in the therapeutic setting. This stigmatization discourages them from seeking treatment or adherence (Thylstrup et al., 2020).
Social Stigma
Negative View
People usually perceive BPD as mysterious or unintuitive, with beliefs suggesting a person suffering from BPD is emotional, unpredictable, or even dangerous. It is because the portrayal shown by media has often been sensationalized (Paris, 2019).
Social Exclusion
People with BPD commonly face discrimination from a personal and professional perspective. According to Lawn and McMahon (2015), social stigma results in the consequences of social exclusion, difficulty in finding jobs, and interpersonal relationships. Self-Stigma and Internalized Shame
The Weight of Self-Stigma
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Internalized stigma, or self-stigma, is when people with BPD accept societal stereotypes and devalue themselves. It can result in feelings of shame, lower self-esteem, and reluctance to seek treatment (Rüsch et al., 2016).
Impact on Recovery
Self-stigma reinforces the symptoms of BPD, making a vicious circle that negatively impacts recovery. Psychoeducation and therapy regarding self-stigma are important for treatment outcomes (Livingston et al., 2012).
Decreasing Stigma
Education and Training
Educational initiatives for healthcare providers can reduce stigma by fostering empathy and improving understanding of BPD. Studies show that structured training programs significantly improve attitudes and reduce bias (Thylstrup et al., 2020).
Media Advocacy
Advocacy efforts to promote accurate representations of BPD in media can challenge societal stereotypes and foster a more compassionate public view (Paris, 2019).
Empowering Individuals
Peer support groups and advocacy programs for individuals with BPD have demonstrated the potential to reduce self-stigma and facilitate recovery (Rüsch et al., 2016).
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Conclusion
The stigma surrounding BPD remains a pervasive problem with far-reaching consequences for individuals, health systems, and society in general. To approach stigma, efforts in education, advocacy, and systemic change are all part of the multi-faceted approach that will be required. Greater awareness and acceptance of BPD hold promise for improving the lives of those affected and reducing barriers to effective care.
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References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Lawn, S., & McMahon, J. (2015). Experiences of care by people with BPD from mainstream mental health services: A qualitative study. Journal of Psychiatric and Mental Health Nursing, 22(7), 442-453. https://doi.org/10.1111/jpm.12205
Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107(1), 39-50. https://doi.org/10.1111/j.1360-0443.2011.03601.x
Paris, J. (2019). Treatment of Borderline Personality Disorder. 2nd Edition. American Psychiatric Publishing.
Rüsch, N., Corrigan, P. W., Bohus, M., Jacob, G. A., & Lieb, K. (2016). Self-stigma, empowerment, and perceived legitimacy of discrimination among women with mental illness: The influence of personality disorders. Personality and Mental Health, 10(4), 294 – 306. https://doi.org/10.1002/pmh.1351
Sheehan, L., Nieweglowski, K., & Corrigan, P. W. (2016). The stigma of personality disorders. Current Psychiatry Reports, 18(11), 11-17. https://doi.org/10.1007/s11920-016-0740-3
Thylstrup, B., Andersson, H. W., Skogen, J. C., & Hesse, M. (2020). Healthcare workers' stigma and attitudes toward patients with substance use disorders. Nordic Studies on Alcohol and Drugs, 37(2), 169-183. https://doi.org/10.1177/1455072519895859
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