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Stigma around BPD is Preventing Treatment

Updated: Sep 7, 2023

Stigma in Mental Health. It’s one of the topics I am most passionate and outspoken about.

Recent events in my life have reminded me of how prevalent stigma still is in the mental health field and even amongst mental health practitioners. This stigma is especially prevalent in my area of expertise - Borderline Personality Disorder and self harming behaviours. We all know the stigma surrounding being ‘crazy’, right? Those beliefs that people who are struggling with their mental health are just too sensitive, or lazy, or just not trying hard enough to get better. We like to think we would never be in that position- that we are somehow too smart, or educated, or ‘strong’ to suffer from a mental illness. But this is an illusion. Mental illness does not discriminate, it can affect anyone at anytime in their lives.

Some people are genetically predisposed, which may increase their chances of having mental health symptoms. Others may suffer trauma which manifests as mental illness later in life. Some people experience an episode of intense stress, or chronic stress, which results in a breakdown of their mental health. We can all be in that position and the statistics show at least 1/4 of the population will be diagnosed with a mental health disorder in their lifetime.

So for something so common, why do we still have so many out-dated ideas about mental illness?

I work mainly with people who are diagnosed with borderline personality disorder (BPD) and complex trauma. Many of these people present with deliberate self harm or suicidal urges. They may also have other difficult behaviours and trouble in relationships. This group of people are the victims of more stigma than any other mental health group. There are many harmful beliefs about people with BPD. Things like they are ‘manipulative’; ‘attention-seeking’; ‘treatment-resistant’; ‘malingerers’. The list could go on. None of these things are true of people with BPD. Yet, even within the mental health field, I see this stigma acted out by mental health and health care clinicians.

In a recent dialectical behavioural therapy (DBT) group, aimed at young people with BPD or similar symptoms, the group had many discussions about their negative experiences with health care providers where they felt stigmatised. They described presenting to the emergency department (ED) with suicidal thoughts, only to be told they couldn’t be helped and sent home. They described how staff treated them with care and kindness until they read their history and diagnosis and the kindness made way for contempt. They described the hopelessness of presenting to a mental health service, struggling with mental health symptoms, only to be ‘risk-assessed’ and sent away. I have witnessed ED staff refuse to care for a patient’s cuts because they were self inflicted. I have encountered private practitioners who screen for BPD and refuse to see these clients in their practice. I’ve encountered practitioners who falsely believe people with BPD are dangerous and become ‘too attached’. Where are these people supposed to go if mental health services won’t help them? I have worked with BPD in my private practice for over 10 years, yet I have never had any of the problems cited above. In fact, my clients are overly worried about intruding on my private time. I encourage them to text me if they need help using therapy skills but most don’t because they feel they will be imposing.

Why does this stigma around BPD exist so strongly? I believe it’s because most health care providers, including mental health clinicians don’t know how to effectively work with BPD. We fear what we don’t understand. This is not an intentional failing of any clinician, but to change the stigma, we have to admit we need to learn more about how to effectively help these people. BPD has one of the highest mortality rates of any mental illness - 10% of people with BPD will end their lives. This is not acceptable, particularly when there are evidence-based, effective treatments for BPD.

The core treatment for BPD is dialectical behavioural therapy (DBT). This model of therapy helps people reduce problem behaviours, such as self harm, and increase their ability to tolerate strong emotions. DBT also recognises the importance of the therapeutic relationship. People need to know their therapist is not going to reject or abandon them. They need to feel their therapist understands what it’s like for them and cares genuinely about their wellbeing. I believe that even clinicians who have brief interventions with people with BPD, such as ED staff, can use DBT concepts to create better outcomes for patients and provide a much less invalidating experience of help-seeking.

If you or someone you care about is struggling with BPD, or self harm, myself and my team can help. Get in touch with us at Mindful Recovery Services and ask about our intensive group DBT program.

You are not broken or crazy - we can help you to heal.


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