Borderline Personality Disorder, Stigma, and Treatment Implications

Abstract

Borderline personality disorder (BPD) is often viewed in negative terms by mental health practitioners and the public. The disorder may have a stigma associated with it that goes beyond those associated with other mental illnesses. The stigma associated with BPD may affect how practitioners tolerate the actions, thoughts, and emotional reactions of these individuals. It may also lead to minimizing symptoms and overlooking strengths. In society, people tend to distance themselves from stigmatized populations, and there is evidence that some clinicians may emotionally distance themselves from individuals with BPD. This distancing may be especially problematic in treating patients with BPD; in addition to being unusually sensitive to rejection and abandonment, they may react negatively (e.g., by harming themselves or withdrawing from treatment) if they perceive such distancing and rejection. Clinicians' reactivity may be self-protective in response to actual behavior associated with the pathology. As a consequence, however, the very behaviors that make it difficult to work with these individuals contribute to the stigma of BPD. In a dialectical relationship, that stigma can influence the clinician's reactivity, thereby exacerbating those same negative behaviors. The result is a self-fulfilling prophecy and a cycle of stigmatization to which both patient and therapist contribute. The extent to which therapist distancing is influenced by stigma is an important question that highlights the possibility that the stigma associated with BPD can have an independent contribution to poor outcome with this population. A final issue concerns the available means for identifying and limiting the impact of stigmatization on the treatment of individuals with BPD.

Personality disorders

“…38,41 Estudos recentes têm identificado altas taxas de remissão (78-99%) ao longo do seguimento de 16 anos de pacientes com TP, com recuperação de 40 a 60% entre pacientes com diagnóstico de borderline e 75 a 85% entre os outros TP. 39 Embora parte desse resultado possa ser atribuído à presença de sintomas transitórios na caracterização de alguns TP e à consideração de que os critérios diagnósticos vigentes apresentam baixa confiabilidade, é relevante reconhecer que a evolução dos TP pode ser favorável e, sendo assim, exige investimento no seu tratamento. 39,40 No entanto, o curso dos TP ainda necessita ser melhor compreendido.…”

“…39 Embora parte desse resultado possa ser atribuído à presença de sintomas transitórios na caracterização de alguns TP e à consideração de que os critérios diagnósticos vigentes apresentam baixa confiabilidade, é relevante reconhecer que a evolução dos TP pode ser favorável e, sendo assim, exige investimento no seu tratamento. 39,40 No entanto, o curso dos TP ainda necessita ser melhor compreendido. Tendo em vista que os pacientes apresentam trajetórias altamente heterogêneas, não estão claros os fatores associados ao progresso observado e há manutenção de comprometimento psicossocial muito tempo depois de remissão sintomática.…”

Borderline Personality Disorder in Adolescence

“…9 BPD is highly stigmatized among professionals, 88 and it is also associated with patient "self-stigma." 89 Although concerns about stigma are genuine and the response is well intentioned, this practice runs the risk of perpetuating negative stereotypes, reducing the prospect of applying specific beneficial interventions for the problems associated with BPD, and increasing the likelihood of incorrect diagnoses, inappropriate interventions and iatrogenic harm (such as polypharmacy).…”

Using Functional Neuroimaging to Refine the Diagnostic Construct of Borderline Personality Disorder

“…Many clinicians find that the interpersonal style characteristic of BPD is qualitatively different, and particularly challenging to treat, relative to other psychiatric disorders [41]. Disturbances in interpersonal relationships in BPD have been recognized since the inception of the diagnosis [42,43].…”