Psychiatry Discriminates Against People with Borderline Personality Disorder




Anti_Stigmatization.jpgBorderline Personality Disorder (BPD) is characterized by a pattern of unstable relationships, a self-image that is always changing, and poor impulse control. The person suffering from BPD fears abandonment and will go to any lengths to prevent this, including threats of suicide. Self-harm is a characteristic.

There may be no other psychiatric diagnosis more laden with stereotypes and stigma than Borderline Personality Disorder. People who live with this label — the majority being female — often have problems accessing good mental health services. (1) Unlike the stigmatization that society puts on mental illness, the stigma associated with BPD often comes from mental health professionals and their patronizing attitudes.

Many psychiatrists will not treat BPD patients, or they may limit the number of BPD patients in their practice or drop them as ”treatment resistant.” Often attempts to treat borderlines fail, and some professionals blame the patient for not responding to treatment. (2) It is often undiagnosed, misdiagnosed, or treated inappropriately. According to Dr. Joel Dvoskin, former Commissioner of the New York State Office Of Mental Health,

“Why would psychiatry and psychology turn so viciously against people they call mentally disordered? Apparently the greatest sin a client can commit is poor response to treatment. What is apparently so wrong about these unfortunate souls is that they have yet to demonstrate the ability to get better in response to our treatment. Thus, they don’t make us feel very good. With a few notable exceptions, we have simply given up on helping people who desperately need us to do a better job of helping them.” (3)

Many mental health professionals discriminate against BPD patients because of what their co-workers have said about them. They watch other professional people “rolling their eyes” when someone mentions BPD. This is just evidence showing others that “everyone knows that people with BPD are horrible people and hard to manage”. (4)

Clients who come to services with a diagnosis of BPD “may already be disliked before they have even been seen. Clients in treatment are often embroiled in clinician attitudes which are derogatory or denying the legitimacy of their right to access resources. Studies have demonstrated clinicians having less empathy for people meeting diagnostic criteria for borderline personality disorder than other diagnostic groups and making more belittling comments.” (5)

Support services for consumers and families are woefully inadequate. The public is generally unaware of the disorder due to the lack of educational materials available from various mental health organizations. No celebrity has yet come forward to put a face on BPD, probably because BPD is the most stigmatized of all mental illnesses today. (6)

Recent research studies have demonstrated the effectiveness of individual cognitive behavioral therapy along with group psychoeducation and skills training that teach emotional regulation skills, distress tolerance, improved interpersonal relationship behaviors and awareness (mindfulness). This, combined with careful medication management, may allow the patient to achieve significant progress. (7)

Effective treatment can reduce symptoms and improve quality of life. There is also considerable short-term fluctuation in symptoms and distress, and the long-term outcome for many patients is often better than originally thought, even without treatment. (8) A fairly new psychosocial treatment termed dialectical behavior therapy (DBT) which was developed specifically to treat BPD is available. But without willing professionals, people with BPD are denied the help they need.

References

(1) Nehls, N. Issues Mental Health Nursing. “Border Personality Disorder: Gender Types, Stigma and Limited System of Care“. Abstract. Entrez PubMed.

(2) Bogod, Elizabeth. Mental Health Matters. “Borderline Personality Disorder Label Creates Stigma“.

(3) CAMI Journal on BPD, Vol 8 cited by TARA Association, “Understanding Borderline Personality Disorder“.

(4) Fleener, Patty, M.S.W. BPD Today. “Stigma and Borderline Personality Disorder“. (2002).

(5) Krawitz, Roy and Watson, Christine. Mental Health Commission Occasional Publications: No. 2. “Borderline Personality Disorder: Pathways to Effective Service Delivery and Clinical Treatment Options.” (October, 1999).

(6) Porr, Valerie. TARA Association. How Advocacy is Bringing Borderline Personality Disorder Into the Light“. (Nov. 2001).

(7) TARA Association, “Understanding Borderline Personality Disorder“.

(8) Livesley, W. John, M.D. The Canadian Journal of Psychiatry. Editorial: “Progress in the Treatment of Borderline Personality Disorder”. (July 2005).

  • http://www.callcruncher.com Call Cruncher

    Thanks for all the great information on BPD. I think it is somewhat misunderstood and I appreciate the post.

  • MedStudent

    Sure, Borderlines are discriminated against by many people in the profession. I’ve heard things such as “don’t have more than two in your practice” and other things from mental health professionals. But, I have also heard of people LIKING borderlines compared to bipolars or schizophrenics because they may eventually get better with intensive therapy and medication. Of course, it takes a long time and can be frustrating. But it depends on your definition of frustrating.

    • elizabeth

      Schizophrenics and bi polars also can improve with medication. I’ve never heard of a medical professional actually liking borderlines. Tolerating maybe but liking no.

  • Sue Clark-Wittenberg

    I am Sue Clark Wittenberg from Ottawa, Ontario, Canada I was psychiatrized in Ontario for 18 years from 1972 to 1990.

    I was given many different psychiatric labels and psychiatric medications.
    I started to ask myself, what is this all about?

    I decided to live without psychiatry in 1990, and for 17 years I have been
    free from psychiatric wards and hospitals and psychiatric pills.

    I have a huge website documenting my recovery as well as the work I do
    to help end electroshock universally.

    My website URL is:

  • LODI

    What I just read is no new to me. I was diagnosed with BPD in 2003, at first I had no clue to what it was, as the doctor who was seeing me at the time came to the conclusion after yet another “behavioral test”. I had to find out through friends and the net. My friends were great help, most of them had suffered from depression and other psychological disorders. But when it came to my on psychiatrist, it seemed he was unwilling to learn, listen and participate. To him I was just the next patient on the daily list. Every visit, which I was paying out of my pocket as I was non insured, became even more traumatic than the disease itself. He sometimes would just go off on me because according to him; I was being difficult, and was not following his recommendations, stubborn and even stupid. I had several fights with him, because the medication he was prescribing were making me feel even worse. I was not only having emotional distress, but also my body was going through a roller coaster of gaining weight and losing weight, having no sexual desire, to becoming a maniac when it came to sex. After going through so much from the person who was suppose to help me, I finally took the matter into my own hands and asked for the director of the clinic and my social worker to be present at one of my doctors appointments. This was after I found out my own social worker, working alongside with my doctor had said at one point; Oh, Lodi is just being a drama queen as usual, do not pay much attention to what he says”. This was a betrayal of trust from both my social worker and my doctor. I still suffer from BPD and have yet to find the right combination of drugs, it doesn’t help I left the states 17 months ago, and where I live now mental health system is non existent. I must say though that Dialectical Behavior Therapy was great help for me, it gave me the tools to cope with BPD. And last but not least, I want to tell of of those reading, to never allow your doctor to become the judge and jury and executioner of you life, with time you know yourself better than any test they can perform on you, so demand for your rights, and for your voice and opinion to be heard.
    Sincerely
    Lodi Mirdita

  • Distressed guy

    The situation is just as bad in the UK. I have virtually begged for CBT(which I have a little of, in a limited fashion), but in the end I got this initial help from an employment program and not my healthcare service in Bromley, England. Which is like: “yeah, great, some progress, but I’ve spent ten years talking to actual professionals and they were useless”

    The attitude of professionals here is pretty much “I shouldn’t have to put up with these aggressive outbursts”. Which is fine, if you just work in an office, but naively I thought these guys were trained to deal with it, not to bundle people out of the door.
    They are more concerned with their own feelings than yours, which seems strange. Why become a mental health professional if you can’t emotionally deal with unpleasant situations? Doesn’t it go with the territory?

    They may find me unpleasant, but it seems they never work from the position of “whatever I feel, it’s worse for them, and I have a duty”. They have to protect themselves, but I’m not physically violent, just pretty bad tempered, and abrasive. Partly because my treatment has gone nowhere.

    There needs to be a distinct advocacy and lobbying group for this…

    • Anna

      The same happened to me with bad treatment at the hands of the health system & with incompetent therapist.they kept on acting shocked or over reacting to someone with intense angry outburst like it was a crime rather then see it as a feature.They say oh we’ve never dealt with someone like you and yet there are tones of angry & homicidal features written in the BPD literature.

      They treat u like a prisoner needing to be told off & disciplined like you’ve done something wrong. Yet they are so not accountable for their own mistakes.The act like you have no rights or reason to be respected,they take away your voice as if your imput doesn’t need to be consulted with.

      They all back each other and withdraw help & treat u like some dangerous insignificant that is meant to be feared.They say they are mindful but are so full of judgment. Time & time again they make the same mistakes and do not learn what part they keep playing in with their own counter transference.

      Its funny they refer to themselves as experts in certain specialties and yet they are are equally broken & lost as the client.They cause just as much harm towards clients with their assumptions. The therapist also participate in stigma because of their own fears & inability to connect& pick up vital cues.

      If the client doesn’t fit the kinds of diagnosis that they are used to, the therapist panics & make incompetent knee-jerk decisions & reactions. Therapist are at a loss outside their protective system of rules & regulation.Its understandable when clients take retribution on therapist to even up the humiliation & violation the therapist has cast.

      Some therapists should be struck off and de-registered for the pain the have caused from their lack of skills.Too many go into the profession ill fit for helping.

    • Pam Boyson

      Hi
      I totally agree with what you are saying.I live in lincolnshire and was diagnosed last year having seen the professional for half an hour and i suppose the CPN must have helped her to come to this conclusion.I became really ill having been bullied at work.As a result my psychiatrist then decided to inform ofsted of the diagnosis and I cannot now get registered to work with children which is making my return to employment harder.I dont really have many angry outbursts (anymore than anyone else).The letter sent to Ofsted doesnt refer to me but simply lists all of the symptoms such as prone to violence etc.. and states that it generally remains for a five year period ? I havent had any Dialectal therapy as none available and my CPN wouldnt accept it when I informed her that suicide was higher in this condition than many other mental health issues-maybe she should look at statistics.The crisis team have been quite judgemental telling me during a crisis that they couldnt help or not turning up when they promised to.I hate the stigma,the discrimination of the mental health team and how much this has destroyed my life.My attempts for a second opinion are being ignored and lets face it denial is part of the condition so why would they listen? My family and friends dont understand this diagnosis and why they didnt talk to them before diagnosing me.I have some symptoms such as suicide attempts and self harming.I doubt myself and lack self esteem and confidence.As far as relationships though I have many friends that I have had long relationships with but also some relationships that i have ended.I now wonder whether the relationships that havent worked were all my fault or whether this is just what so called normal people do.I have never been promiscuos and have been married 25 years.I did drink too much when I first left work following the bullying,my weight has fluctuated as when I first left work I lost two stone going down to 6 stone but now i am at my normal weight again.i wonder whether my diagnosis was made too soon after my work issues which did devastate me as I was worried about the financial strain it would put on my family and felt I had let them down as I have always supported them.i would love to know if others with this diagnosis are working with children!

      pam

  • KM

    Borderline personality disorder = drama queen asshole syndrome.

    • Moxie

      How insightful and witty. Really, tell us more.

      • KM

        Don’t let any psychiatrist tell you that you have borderline personality disorder. It is a 100% pejorative diagnosis given to patients they consider ‘difficult’ or resistant to treatment. Complete bull****.

        • EveryOneElse

          ..you mean like if they conclude you are an ASSHOLE?

        • 00000

          Kim, you are sad. You have no understanding of what it’s like. Be thankful you never will. Really, learn empathy.

          • Anonymous

            Hi 00000

            Do you know any forums online for persons diagnosed with BPD that is active and good?

          • Not cool

            @00000: Said the one who gave a personal attack. Practice what you preach, hun.

    • Pam Boyson

      n you explain your comment please?

  • http://www.mentalhealthkb.com/mentalhealth/ kevin blumer

    i got treated just a little bit diffrent my care coordanator actualy had a soft spot for me dont wory dont get that up north it takes a long time to be treated up here and there not that sympothetic and they dont like helping you till you do something the probelem with her having a soft spot created trouble in itslef because it affected her judgement or i belive that i was diagnosed with BPD back in july after many diagnoses

  • wendy

    My experience has been just what is described in the article, and as bad and worse than many of the commenters here. Bad therapists, ones who withheld the diagnosis, ones who actually made up a FAKE diagnosis, many who blamed me, being hospitalized against my will for no good reason, being told by multiple professionals NOT to get a diagnosis, being treated like an annoyance, being threatened with involuntary incarceration for standing up to a nurse who was telling boldfaced lies about factual situations.
    Being rejected from a women’s shelter, and, being told before that I was morally obligated to go live in one because I was having problems where I am living, the only safe place I have. Imagine! the only place I have to live, and this “therapist” tells me in our first session not only that I am to blame for all my problems, that I am immoral for staying where I live.
    Never much mention of getting better, that’s for sure. So I continue to suffer this horrible disorder. I am not that bad. I know I can get better with proper treatment. Without it, there’s not much hope. The mental health system sure taught me that.

    • Pam Boyson

      I think the only way out of this is to keep in your head that you know yourself better than anyone else.The lies by those in authority is a result of them often doing things they shouldnt have done and wanting to wriggle out of it.The gp who told me to phone if i was in a crisis and he would always interupt what he was doing to help then the receptionist who said i couldnt talk to him and the duty doctor doubting that i was promised this states on my notes”was angry”yes i was angry as i was promised support when desperate it was nornmal to feel angry about this.tening to the police laugh at me down a radio as they thought i couldnt hear and telling me i was a waste of time yes i was tearfull is normal.Keep that beleif in you it really helps!!

  • http://www.agatacardoso.co.uk Agata

    I can relate a lot these posts.

    I have suffered from BPD symptoms since the age of 8.Finally diagnosed with BPD when i was 24, I went through DBT therapy which I found really unhelpful, patronising and in the end damn right dangerous….so many rules in terms of access to help that I ended up in hospital because my therapist would not pick up her phone.She would cut me off if i was not using skills…..I went through three therapists because I was deemed too ‘difficult’, eventually I was discharged because I was ‘labeled’ ‘treatment resistant’ patient.
    I was sent back to my psychiatrist, I am now being seen by him and a care manager at the personality disorder services….I feel so let down that I constantly feel suicidal, losing touch with reality and it really does not help being an artist, as i can’t cope with constant rejection.
    The worst thing is I find myself constantly lying about my condition when I have to explain my condition, I tell people that i am Bipolar as I feel that it is a more acceptable diagnosis,and it makes me feel like dirt.

    • Anonymous

      wow I can so much relate to your comments . The only thing I am older with bpd. I find DBT frustrating and patronizing too . IF I rang the outpatient psych services ,in a crisis I would get go an watch some tv or your breathing exercise’s. ALSO had patronizing remarks too from my case manager about my clingiest to the service under severe stress . This just made my condition worse and worse . Now Im told psychologists deal with bpd instead of psychiatrists .

    • Iva

      Hi

      Why on earth give others your diagnoses?
      The professor that gave me mine said:” you have to be a experienced expert with personality disorders to set this diagnoses”.

      Do you really think people have any idea at all what it means when you tell them you are diagnosed BPD!? They do not.

      We loose when share diagnoses with friends,family and health workers. And it will not make them understand us more,often quite the opposite.

      It is naive to think others know what borderline is all about and how it destroys life’s .

      It is nothing to be ashamed of,but so very few will understand even if you tell your diagnoses. Instead you loose friends,scare health workers away because they lack knowledge and are misinformed and belIve all the ugly myths and lies.

  • Anonymous

    The police took me to the detainee and my doctors for trying to hang myself. I knocked officers down the stairs because they were trying to take off my noose and hold me up. I specifically told the doctors that I was going to die that day and as soon as they turned their backs I would do it. They rolled their eyes and let me roam free. The police were disgusted when they found out of course as they knew I was not of sound mind at all, on appearance I’m just a normal vunerable looking young woman. Of course I ran off to get hundreds of sleeping tablets and lay on a beach in hiding from the police who were now looking for me. They believed I needed help. When they found me they were nice to me and couldn’t believe the mental health. They went above my doctors and the detainee, sectioned me themselves and carted me off to a mental hospital where I was put in a padded cell (Very odd). I became tired and calmed down, especially as I never thought I’d ever end up in a padded cell. Three doctors came to see me, one of which knew me. They looked completely uncomfortable and sighed. They told me I had to go home alone, that I didn’t belong there. Now…to this day I really don’t know what to make of it. When I entered that hospital I had no diagnosis. Later that week the home treatment team who had been watching me and my CPN pulled me to the side and slipped a paper in my hand, after I begged to know what was wrong with me. They whispered “this is the one” and left. The paper of course had Borderline personality disorder on it. I’ve been in hospital many times since and was nearly wiped from mental health services altogether. I am embarrassed by my diagnosis. I have begged for an alternative. I was with the mental health for years before this diagnosis and from the moment word got out I’ve been shunned and treated like a piece of crap. I’m not an aggressive bpd either. They just hate me because “You just won’t improve Kate”. Well I’m so damn sorry but wonder how they think I feel. Ahhh so much better getting it out

  • Faith

    I sure can relate to several of the posts here. After I spent years in treatment for PTSD, I asked for better medications due to previous allergies to other meds and I asked for better treatment. Well, why did I do that? I sure have suffered ever since I did voice my opinions because one Psychologist labeled me as having BPD. Now, in private therapy, my counselor says that I have Bi-Polar II. What upset me was that he wrote a letter stating my diagnosis in a letter to the Leasing Office where I live to see if they could put me in a one-bedroom. Do you know how that made me feel? On top of that, some of the leasing people have told my neighbors and have allowed one of their maintenance men to harass me. Writing and calling the Corporate office has not helped me. I do not want to be homeless because I have both a cat and dog. Was in a good place a couple years ago financially, etc., but am scared now what will happen to me. Do have someone who does Healing Touch while they are at home and I am at my home. It seems to help me quite a bit, but I would like to be able to help myself better and quicker!

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