Borderline Personality Disorder, Stigma, and Treatment Implications

Ron B. Aviram · Beth S. Brodsky · Bárbara Stanley

402 citations0/0 files storedHarvard Review of Psychiatry

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Personality Disorders and Psychopathology Mental Health Treatment and Access Psychotherapy Techniques and Applications

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.

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References

1958Social Theory and Social Structure 1993Cognitive-Behavioral Treatment of Borderline Personality Disorder 1958Social Theory and Social Structure.2001Stigma as a Barrier to Recovery: The Consequences of Stigma for the Self-Esteem of People With Mental Illnesses 2013Reducing Prejudice and Discrimination 1974The nonverbal mediation of self-fulfilling prophecies in interracial interaction 2001Treatment Utilization by Patients With Personality Disorders 2004Mentalization-Based Treatment of BPD

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2014Borderline Personality Disorder in Adolescence 2008Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes 2016The Stigma of Personality Disorders 2013Prevention and early intervention for borderline personality disorder: current status and recent evidence 2019Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs?2015

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