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Thank you for visiting. Content MAY BE TRIGGERING ESPECIALLY FOR THOSE WHO HAVE EXPERIENCED ABUSE, STRUGGLE WITH SELF-INJURY, SUICIDE, DEPRESSION OR AN EATING DISORDER. Contains graphic descriptions of suicidal thoughts, self-injury and emotional, physical and sexual abuse. Do not read further if you are not in a safe place. If you are triggered, please reach out to your support system, a mental health professional or call 911.

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Disclaimer: Although I have worked with persons with mental illness for twenty years, I do not have a Master's Degree or a license. This is not meant to be a substitute for mental health care or treatment. Please obtain professional assistance from the resources listed on the right of the page, if needed. And call 911 if you or someone is in immediate danger.

A key word that you will see:

Fragmentation: a mental process where a person becomes intensely emotionally focused on one aspect of themselves, such as “I am angry” or “no one loves me,” to the point where all thoughts, feelings and behavior demonstrate this emotional state, in which, the person does not or is unable to take into account the reality of their environment, others or themselves and their resources. This is a term that my therapist and I use and is on the continuum of dissociation.

Wednesday, May 26, 2010

Borderline Personality Disorder Stigma...Why?

In the past, I have written about the stigma of borderline personality disorder and some of the reason for it. However, Brain Blogger: Topics from multidimensional biopsychosocial perspectives, has one of the best articles, Psychiatry Discriminates Against People with Borderline Personality Disorder, that I have read and I want to share it with you.  I will later follow up with posts on abandonment, self-image and the brain. 

The stigma regarding Borderline Personality Disorder is probably the highest out of all mental illnesses combined.  While in college and in my career, my colleagues and I have often groaned when I find out one of my clients are diagnosed as such.  When I was diagnosed with it, I was quite scared because of the stigma which is clearly explained in Brain Blogger: Topics from multidimensional biopsychosocial perspectives.  As explained in the article, many professionals will not treat those individuals with borderline personality disorder.

However, I believe that there is hope.  For me, I have learned to manage my symptoms and understand them.  But, it has taken a very long-time and psychiatric hospitalizations and medication.  I continue to improve. My therapist is very committed to my becoming healthy and treats me as a person first and explains what behavior, thinking and emotions are common in people with borderline personality disorder.  I takes a huge commitment one the patient and professionals regarding borderline personality disorder.

Brain Blogger: Topics from multidimensional biopsychosocial perspectives, is a fantastic site and one that I follow one a consistent basis.  It addresses professional issues and psychological issues from many disciples in a way the someone not in the mental health permission can understand. Okay, I'll stop rambling and let you read the article. With permission the following is an article reprinted for this post:

Psychiatry Discriminates Against People with Borderline Personality Disorder
By Elise Stobbe


Borderline 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).

So what is your experience with being diagnosed with borderline personality disorder or what have you known about the stigma surrounding this disorder?

Don't forget to check out Brain Blogger: Topics from multidimensional biopsychosocial perspectives.  You will be glad that you did. Follow it for a while to see the vast number of posts including funny research.  Thank you for Brain Blogger for giving me permission to post their article.

10 comments:

Shen said...

This is quite a good article with so much information. For me, when I first read about BPD - I wish I could remember that book, now, but it was a few years ago - I picked it up because I thought that's what my father has. The more I read, the more convinced I became that he does have BPD, and the more fearful I became because so much of what I read sounded like me.

My therapist at the time told me he didn't think I had BPD, but that I had some of the behaviors. I am still not clear how one can exhibit the behaviors and not have the disorder... but my current therapist has also told me I do not have this.

I was terrified because I didn't want to be like my father - in this way specifically: It wasn't just that my father was selfish, out of touch with reality, and determined to make everything about him - it was his complete innability to see these behaviors in himself. I was terrified because I was afraid I was not aware of my own behavior, I was scared of being as out of touch as he was. I thought, If I can't even see what is real, how will I ever get better?

So that is where the stigma came from in my mind.

Since that time, I have concluded that my father may well have BPD, but that is not the only thing he has. I have heard that the behaviors I have that are associated with BPD are learned behaviors, and I believe that to be true. (My question about that is - arent't they always learned behaviors? Are people born with BPD?) I have also come to believe that I am not like my father in many important ways.

I don't believe BPD is hopeless... I believe that anyone who is willing to put in the time and really wants to get better, can. I think part of the problem may be, as I said, if the person is unwilling or unable to try to get better it would be pretty frustrating to work with them. I can tell you right now, I could not imagine having to work with someone like my father in any capacity.

But you don't seem like him at all. For one thing, you are able to step outside yourself and see others, clearly. For another thing, you are aware that there are issues in your life and want to work on them.

I hope nothing I've said here is offensive to you. I was trying to explain where my own prejudices came from, but none of this is about you personally - and that truly is the most important part, isn't it? The individual....

Just Be Real said...

Clueless, even though I do not suffer with BPD, your post shares very good points. Thanks for taking the time to share. Blessings dear one.

Judy said...

Interesting indeed, Clueless. In a nutshell (no pun intended), after discovering Tami Green's website, borderlinepersonalitysupport.com, so encouraged by her recovery and positivity, I went on a search to find help for my mild-moderate BPD. And NOW, because of your post, I understand why I did not find any! I contacted over 30 therapists. I am back to self-help, and the book The Angry Heart is very useful. My previous MFT agreed to allow me to discuss my progress with her. She has no training in treating BPD.

Judy

Clueless said...

Hi Shen,

Thank you for your comment. I'm glad that you did and for sharing personally. One can have some borderline features, we all have them to some extent...it is just the degree that it impacts one's life. And, still not be diagnosed. Either way, I hope you don't get caught up in the diagnosis...it is just a label for a cluster of symptoms.

I am sorry that your father was BPD. My mother still is and right now I am not having any contact with her. I did a whole borderline personality series which if you click on the borderline picture on the right side bar it will take you to the articles that focus on BPD. I did one post that focus being raised with a parent that was BPD. This is the link to that post. http://clinicallyclueless.blogspot.com/2008/07/growing-up-with-mother-with-borderline.html

My understanding is that the origin of BPD is complicated and consists of genetics, enviornment, attachment, and early childhood abandonment. Many behaviors are learned usually as a way of coping with the world when we are young, but cease to be helpful and become harmful as adults. But, not all.

Thank you for the compliments...I've worked very hard to get to where I am. My therapist said that no one could pay him enough to work with my mother!!! And, that he doesn't even have a referral.

Nothing at all offensive...please don't ever be afraid of offending me. I like your comments.

Take Care,
CC

Clueless said...

JBR,
Thank you. I'm glad that you read the post as was able to learn something.

Blessings,
CC

Clueless said...

Judy,

I'm so glad that you found my blog and made a comment. How unfortunate that you were unable to find someone that would take you that would make me feel worthless and hopeless. But, there are automatic assumptions. My therapist didn't have any training, but was committed to my progress. He had only had his license for three weeks before he started working with me...he says that he has learned a lot from working with me and now is really able to work effectively with BPD, but really needs to limit the number on his caseload.

Good luck and healing on your journey. Please visit again. Oh, A.J. Mahari has excellent information about BPD.

Take care,
CC

Stacy said...

One of the considerable issues involved in developing this disorder, or traits of it, is living a life of being devalued and invalidated. It's it ironic that the mental health system seems to be unable to move past further reinforcing the same treatment.

Anonymous said...

Unethical Practice & Stigma inside a DBT program:

After 7 months of DBT I got kicked out I have never in all my experienced of therapy been treated with such stigma& judgment and knee jerk reaction. The rigid scrutiny was almost like a cruel punishment of control freakism.

When u are with an outside one on one therapist for 10yrs what ever you trust in confidence(verbally or in writing or e-mail) in the other remains private between 2 and is kept in context.With any ambiguities at least asked & questions clarified rather than acted hastily on.Doesn't matter if its the inevitable topics of hate or rage or suicide or murderous thoughts come up -its kept in perspective as passing phases.

No not in the case where the program is attached to a government public health system. Its like a nazi security boot camp everything that gets said is vetted and u even get sent to a disciplinary board if you seem to be too verbally abusive.

They would ostracize me by comments like 'we've never had a person like you in this program we usually refer them on'. Or in all our 3 yrs running this DBT program we've never had any trouble till now why do u think that is?'

Never mind that my seemingly shocking upset reactions were often been triggered by counter transferences & counter over reactions to my expressive vocal ways.

Time again my trauma was re-triggered,my voice & consent was waivered, I was ridiculed humiliated& violated by all my thoughts/feelings aired to peer review team.-most of the time never warning me or omitting irrelevant personal feelings/material.

Every time i kicked up a stink about privacy & asking/checking with me first to consult with me on decisions.When i pointed out this constant disrespect that kept puncturing out trust by their irrash actions. The therapist in this program was over literal,naive and surprised at my reaction then changed nothing of the detrimental way she & the peer team were unethically treating me.

At the end of it all I was spat out back on my own with no support or follow up by a cowardly good bye good luck message left on my answering machine.

talk about non judgmental or non mindful or forgetting to use skills & over reacting in crisis situations.something they were teaching us.

This experience leaves me cold & angry and thirsty for revenge. the health system get away with so much these so called skilled specialists.

Anonymous said...

After 7 months of DBT I got kicked out I have never in all my experienced of therapy been treated with such stigma& judgment and knee jerk reaction. The rigid scrutiny was almost like a cruel punishment of control freakism.

When u are with an outside one on one therapist for 10yrs what ever you trust in confidence(verbally or in writing or e-mail) in the other remains private between 2 and is kept in context.With any ambiguities at least asked & questions clarified rather than acted hastily on.Doesn't matter if its the inevitable topics of hate or rage or suicide or murderous thoughts come up -its kept in perspective as passing phases.

No not in the case where the program is attached to a government public health system. Its like a nazi security boot camp everything that gets said is vetted and u even get sent to a disciplinary board if you seem to be too verbally abusive.

They would ostracize me by comments like 'we've never had a person like you in this program we usually refer them on'. Or in all our 3 yrs running this DBT program we've never had any trouble till now why do u think that is?'

Never mind that my seemingly shocking upset reactions were often been triggered by counter transferences & counter over reactions to my expressive vocal ways.

Time again my trauma was re-triggered,my voice & consent was waivered, I was ridiculed humiliated& violated by all my thoughts/feelings aired to peer review team.-most of the time never warning me or omitting irrelevant personal feelings/material.

Every time i kicked up a stink about privacy & asking/checking with me first to consult with me on decisions.When i pointed out this constant disrespect that kept puncturing out trust by their irrash actions. The therapist in this program was over literal,naive and surprised at my reaction then changed nothing of the detrimental way she & the peer team were unethically treating me.

At the end of it all I was spat out back on my own with no support or follow up by a cowardly good bye good luck message left on my answering machine.

talk about non judgmental or non mindful or forgetting to use skills & over reacting in crisis situations.something they were teaching us.

This experience leaves me cold & angry and thirsty for revenge. the health system get away with so much these so called skilled specialists.

Clueless said...

Hi Anonymous,

Thank you for sharing your experience. I have mixed feelings about DBT. It works for some and not for others. I like the basis about development and some of the techniques. I sounds like you had a therapist that was not helpful more than problems with DBT. Just my thought.

take care,
CC

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