Why a BPD Diagnosis is so Stigmatizing

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Many of us find ourselves receiving a BPD diagnosis following a hospitalization because of a suicide attempt. In most cases, the diagnosis won’t be troublesome until we go searching for a new psychiatrist. Often when the new psychiatrist reads through the chart we soon discover that we have become radioactive. Sometimes the new psychiatrist will refuse to take on a new BPD patient entirely or give the patient so many conditions for treatment that the chances of forming a therapeutic alliance are next to nil. Why is this the case?

Where do we encounter stigma?

We encounter stigma not only from psychiatrists but the greater world at large. In the case of a psychiatrist creating distance between themself and the patient, it is often because they feel a need to be self-protective. They do this because of what they have learned about how difficult BPD patients are to treat -- the acting out behaviour scares them, the strong transference responses BPD patients have to treatment scares them, they don’t know how to properly treat a BPD patient so they put distance between themselves and the patient. But this can, in fact, actually exacerbate the patient’s symptoms and increase their propensity for self-harming behaviour in the forms of cutting, suicide attempts or other maladaptive behaviour such as gambling or binge drinking. The BPD patient who is looking for validation from the therapist may interpret this behaviour from the therapist as rejecting and that may, in turn act as a trigger to us and cause us to withdraw from treatment prematurely.

Why do those working in the mental health field hold negative views toward people with BPD?

Studies have shown that many in the mental health field hold negative attitudes towards BPD patients. These negatives attitudes are born from a series of stereotypes and folklore in the world of clinicians because we are viewed as being untreatable, demanding, and manipulative attention-seekers. Clinicians are thus led to believe that certain types of behaviors associated with BPD are the nature of the individual as opposed to being tied solely to the pathology of the disorder.

Many people with BPD are first diagnosed with Bipolar disorder. That was the case with me as well. I was first put on lithium which, of course, did nothing to alleviate my symptoms. Sometimes we are misdiagnosed because the therapist wishes to spare us the stigma of having a BPD diagnosis. For most of us with BPD, receiving a BPD diagnosis is like being diagnosed with psychiatric cancer. In fact, I wrote in a book I published, “I have cancer in my soul.” So, sometimes a clinician will assign the more benign, less stigmatizing diagnosis of Bipolar disorder but that means that the patient is denied access to the treatment that is generally recognized as the gold standard treatment for BPD: Dialectical Behavioral Therapy.

Other contributing factors to BPD stigma

Another thing that contributes to the stigmatizing of BPD patients is the thought on the part of many psychiatrists that their patients are just making everything up. When someone says to the BPD patient, “It’s all in your head,” that is, in many cases very true. But that’s because of the way we think and process stimuli. And that is why DBT is a life-saver for those of us with BPD because it teaches us to think differently, see things differently. Brain studies are starting to be able to pinpoint the subtle differences in the way the BPD brain functions which is different from the brain of a person without BPD.

Movies such as “Fatal Attraction” and “Girl, Interrupted”, and “Misery” did nothing to help dispel the myth of the evil, vengeful BPD patient. In fact, I think they contributed much to the general population’s viewpoint of those of us with BPD as being inherently dangerous and twisted dragon people who are to be feared and shunned.

What you can do to reduce your feelings of stigmatization

How do we counter this kind of negative stereotyping? I think one of the most important things we can do is to “come out” to our friends and families. Explain to them about the disorder and tell them how they can help you when you are in crisis. Talk to them about your therapy and how it helps you and what you are working on to decrease negative behaviors. And then really work on doing that. Having said that, I recognize just how difficult this can be. I lived with my disorder for years before I “came out” to my friends. All of them certainly knew something was wrong but I never addressed the issue with them. It took me years before I felt the courage to do this. Once I did, though, I discovered that they were, by and large, very understanding and compassionate. Doing this actually helped them put the puzzle pieces together and it gave me an opportunity to talk to them about they could actively help me when I was having difficulty. One of them said to me that it felt like such a relief because watching me struggle and not knowing how to help only mead them feel helpless.