Mental Disorders, though have been a type of illness that has existed since the break of civilization, still are a highly misunderstood factor tainted with the ill-assumption of people. However, some specific mental disorders are even more stigmatized than others. Borderline Personality Disorder (BPD), was formerly referred to as ‘Borderline Schizophrenia,’. It was once regarded as a condition situated between a neurotic and psychotic state of mind. This by any standard is one of the most overlooked disorders with a negative connotation. Another term used for it is ‘Emotionally unstable personality disorder’. This tells us the key component of it, which is, poor emotional regulation abilities.
A relatively high population shuns mental disorders. However, when it comes to BPD, even practitioners who have had years of training display judgment and often refuse to work with clients, suffering from the same as they consider them very hard to work with leading to the magnification of the stigma surrounding it.
The Stigma around BPD
This rather heavy judgment around the diagnosis is not recent. Throughout the history of studying mental illnesses, the ignorance and stigma towards BPD have been present. It also used to be casually called ‘Latent Schizophrenia’ which meant that they appeared like a cover-up for psychotic symptoms with normal social behaviours. BPD had been, for the lengthiest time, considered a “wastebasket” disorder with no practitioners/researchers investing enough time to study it. Moreover, most of the patients who did get diagnosed with BPD were women, treatment for whom was never given importance. With so many women showing up with BPD symptoms, it also started to be known as a “women’s disorder” meanwhile disregarding the patients suffering from it.
After years of research, It was established that BPD isn’t a “women’s disorder” nor is it a “wastebasket” disorder. After a lot of studies on the symptoms, nine criteria for the diagnosis were proposed. Out of those nine criteria, if even five are met, the diagnosis would be confirmed.
However, the problem is, that these nine criteria could present themselves in diverse ways. Therefore, it is extremely subjective to determine a diagnosis.
It also leads to a significant number of misdiagnoses, becoming one of the reasons mental health professionals avoid taking up cases of even suspected borderline personality disorder. My personal experience while working as a junior counsellor intern in a psychiatric hospital, revealed the bias that’s been talked about till now. I was assigned the case of a 26-year-old woman who was admitted to the emergency ward due to impulsive self-harm. Her mother brought her in along with her child.
A Case of Borderline Personality Disorder
I was asked to interview the family first. I requested them to talk about the incident and took a comprehensive case history. Post which I met the client. She was lethargic but willing to talk about herself. She identified herself as a victim of the emotional turmoil put on by her husband which was contrasting to what the family informed me. The patient blamed her mother for not being there to fulfil her emotional needs as she teared up talking about her father’s suicide. She had no one to talk to her about how to healthily express emotions and how to maintain boundaries with people.
The patient said, “I didn’t know how to just be”. She also reported being overly aggressive sometimes at home and would often threaten to kill herself. She attempted suicide a year after her father had died. That was the first time she was admitted to a psychiatric hospital and was diagnosed with Borderline personality disorder. Even after the treatment was initiated by the previous doctor, her self-harming tendencies with attempts didn’t stop. It got shifted from cutting herself to excessive drug intake and impulsive sex.
While she was already in an uncertain state, she decided to get married in haste to her then-boyfriend because she “loved him a lot”. After they got married, even the slightest of things caused an unproportionate amount of anger from her side, and she was convinced at those moments that she despised him “from the bottom of her core.”
Realizations
The positive findings of mental status examinations showed her thoughts and emotional process to be dichotomous. Her mood drastically swung during the session. By observing, we noticed the presence of grief, but the symptoms of depression were mild in scale. For my supervisor’s note, I gave her a provisional diagnosis of BPD.
The session swayed me overwhelmed and I felt exhausted. My supervisor clearly stated not to take “these people” seriously. The supervisor said not to agree with their words at face value because they are manipulative and will play with your emotions like a rolling ball. Within a moment, made that struggling woman sound like a vicious culprit. I was appalled, which is an understatement compared to what I felt. But it made me realize the stigma, even we as trained professionals carry with us when it comes to certain disorders. This isn’t an isolated event and happens more frequently.
The Challenges of Recognizing and Understanding BPD
We need to acknowledge that establishing a diagnosis of any personality disorder is very challenging. This is due to the criteria being pretty vague and loose. It requires thorough observation over a long time. However, we as practitioners lack that time and with the medical model we follow. We subjectively see the chalked-out criteria and give the diagnosis.
While working with clients, it can be difficult to empathize or fully grasp their experiences. This difficulty often arises from the distortion in their perception of reality, which, in turn, stems from the impact of the devastating events they’ve endured. People with BPD are frequently called manipulative but most of the time what might come out as manipulative behavior to others, who have a better sense of reality, mostly is the unconscious effort of the patient to protect the reality they live in.
People with BPD experience emotions intensely and deeply to the point it incapacitates them. The impulsive nature of presenting with BPD equally contributes to the negation of the illness. They are not impulsive for the fun of it. They are impulsive because they perceive life as in the dichotomy of ‘going all in or not playing at all’. That is what trauma does to a person. It alters the way they process their thoughts, emotions, and impulsivity.
The need for support
A diagnosis, BPD, isn’t who a person is. It’s not something that they acquire like diseases such as diabetes or cancer. BPD barely exists the way other conditions do because of soft-edged and extremely subjective criteria. Most of the time people and even professional practitioners use the label “BPD” as an accusation or as a showdown. To come up with a reason that would warrant not working with them. Because, in their minds, they had already decided that the patients are trouble, more than their worth.
People with BPD need help and support to get out of the loop of destructive behaviours and then replace those behaviours with something, that would neither harm them nor their close ones. The last thing that they need is ignorance and accusations.
We need to realize that diagnosis is just a label that aids us in navigating our way through the treatment. It’s one of the initial steps but definitely not the end. The people behind those labels are who we treat. Even with the little awareness that we have, we need to be mindful that our internal stigmas and biases don’t come in the way that results in the mistreatment of people who are already going through a roller coaster of emotions.
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