Debunking the Stigma Behind Borderline Personality Disorder
In Crazy Ex-Girlfriend Season 3, Episode 6, Rebecca Bunch finds out she has Borderline Personality Disorder (BPD). Even though her doctor specifically tells her she’s better off not searching the symptoms online, she does it anyway, and finds a barrage of awful things, including: “One of the most stigmatized diagnoses,” “many psychiatrists refuse to treat patients with BPD,” and “10% of all patients with BPD eventually commit suicide.”
BPD is classified as a personality disorder, which according to the American Psychiatric Association, is “a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.” For example: while an individual with BPD feels an intense fear of abandonment and longing for fulfilling relationships, their attempts frequently fail due to their intense mood swings and inappropriate rage. This rage can manifest itself as dangerous behavior ranging from self-harm to suicide attempts.
While researchers are still trying to find the exact cause of BPD, the U.K.’s NHS states that the disorder has been linked to a childhood history of abuse/neglect and/or genetics and brain abnormalities — which could be the malfunction in the release of mood-regulating chemicals like serotonin.
Symptoms of BPD often include fear of abandonment, a pattern of unstable relationships, rapid changes in self-worth and identity, impulsive and risky behavior, paranoia, self-harming behavior, volatile mood swings, feeling emptiness, stress, inappropriate amounts of rage and suicidal ideation. Currently, diagnosis for BPD is carried out after a detailed interview with a doctor or mental health provider, a psychological evaluation that may include completing questionnaires, a medical exam and further discussion of signs and symptoms. Children and teenagers are not given BPD diagnoses as their symptoms have higher chances of disappearing as they grow older.
BPD is seen as a complex disease to treat due to its sheer number of symptoms and because many of these symptoms are mental health disorders treated individually. A therapist and/or a psychiatrist treat anger issues and suicidal ideation individually as mental health disorders, but in BPD, they must treat both simultaneously.
Treatment is done via psychotherapy, medication, and hospitalization (only during serious breakdowns). Dialectical behavior therapy — Accepting the Challenges of Exiting the System (DBT-ACES) — was specifically developed to treat BPD and is focused on providing individuals with mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance. The success rate for this particular form of psychotherapy is promising.
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There are egregious misconceptions associated with Borderline Personality Disorder, which paint all people suffering from it as dramatic, manipulative, attention-seeking, incapable of stable relationships and abusive. Though there is complexity, the stigma against individuals with BPD is such that even psychiatrists who are supposed to treat them refuse to do so due to both the complexity of the disease and how treatment-resistant patients often are.
The ‘treatment resistance’ comes from the continuous relapse of dysfunctional behaviors, which often makes therapists think the individual with BPD does not want to get better. While this sort of negative response from a clinician could be for self-preservation, individuals with BPD are likely to also take this particular rejection hard and could harm themselves.
Often, the cause for this relapse in dysfunctional behaviors comes from a sense of low self-worth; people with BPD don’t believe they’re good enough to get better. This means they need merely to believe they can heal, with support from their loved ones.
While Borderline Personality Disorder might present itself as a terrifying, complex disease, it is treatable, and there are mental health professionals who can treat this disorder effectively. While there is no ‘cure’ for BPD, being completely symptom-free is a realistic, achievable goal.