Recovered Voices: Experiences of Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a severe mental illness characterized by extreme dysregulation of emotions, behavior, interpersonal functioning, self (identity), and cognition (Linehan, 1993). Individuals with BPD often engage in a variety of risky behaviors (e.g., non-suicidal self-injury, suicide attempts, substance abuse, risky sexual behaviors) that can be understood as both causes and perpetuators of the chaos typically associated with this disorder. An unfortunate consequence of these behaviors is that individuals with BPD are often labeled as manipulative, attention-seeking, or other similarly pejorative terms (see Nehls, 1998; Westwood & Baker, 2010, for reviews). Indeed, Rivera-Segarra and colleagues (2014) investigated stigmatization experiences of individuals living with BPD in Puerto Rico and found that the participants reported experiences related to social isolation, reduced support, discrimination, and a great deal of personal responsibility (e.g., the idea that these individuals just need to try harder to be well) in their everyday lives, by their families, and by their intimate partners. The authors found that the experiences reported were consistent with stigmatization typically associated with severe mental illnesses (e.g., being out of control) as well as that which is associated with less severe forms of mental illness (e.g., over-reacting). These authors uncovered a powerful, dialectical dilemma that individuals with BPD may experience: they are simultaneously viewed as if they are both out of control and as if they can control their behavior. I propose that the continued stigmatization of individuals with BPD may be perpetuated, in part, by faulty assumptions about "borderline" behavior associated with failure to view such behavior within its context. For example, self-injurious behaviors may be interpreted as "attention-seeking" rather than as a maladaptive means of regulating emotions and/or a behavior that has been reinforced over time by an extremely dysfunctional and invalidating environment (i.e., biosocial theory; Linehan, 1993). Recent literature supports the notion that individuals with BPD are viewed in a particularly negative light, even within the healthcare community. For example, Markham and Trower (2003) found that nurses were significantly more likely to rate examples of challenging patient behavior as within the control of the patient when the diagnostic label was BPD, as opposed to schizophrenia or depression. The authors investigated sympathy of nurses related to diagnostic label and found that, "staff were not only less sympathetic towards patients with a diagnosis of BPD, they were actually reporting being unsympathetic" (Markham & Trower, 2003, p. 251). The authors also found that nurses reported less optimism related to patient change and more negative personal experiences related to working with patients with the BPD diagnostic label. Similarly, Bourke, and Grenyer (2010) found that therapists exhibited significantly more negative emotional valence in their responses toward clients with BPD as compared with those diagnosed with Major Depressive Disorder. Finally, Bodner, CohenFridel, and Iancu (2011) found that nurses, psychiatrists, and psychologists reported frustration, impatience, anger, and agitation related to treatment of individuals with BPD. They note that these findings were mainly explained by the challenges of managing suicidal behavior, which are perceived by professionals as "risky and dangerous" and potentially infuriating, resulting in "negative feelings towards these patients" (Bodner, Cohen-Fridel, & Iancu, 2011, p. 553). Stigma related to BPD also has the potential to impact a therapist's ability to provide effective treatment. Aviram, Brodsky, and Stanley (2006) note that stigma associated with BPD may interfere with treatment by setting up a self-fulfilling prophecy through which the therapist develops "a priori negative expectations about the course of treatment" (p. …