BPD is better defined, understood as a reaction to trauma
Borderline personality disorder (BPD) is a frequently misunderstood condition affecting millions globally. People with this condition are vulnerable, impulsive, and highly susceptible to criticism – ultimately being denied access to timely, quality care. BPD is characterised by emotional dysregulation, poor self-esteem, difficulty forming relationships, and repeated self-harming behaviours- around 75% of BPD patients attempt suicide at some point in their life, and one in ten are usually successful.
BPD is seen in about 1-4% of Australians, but participants of a recent Australian research incorporating semi-structured qualitative interviews described mixed experiences across mental health treatments – often misaligned with the target recovery model for BPD. The Australian mental health system is apparently poorly designed to meet the needs of BPD patients.
The persistent – and incorrectly diagnosed – “Personality disorder” translates in many people’s minds as a personality flaw, and this can exacerbate a BPD patient’s poor self-esteem and negative impressions from other people. Clinicians often harbour negative attitudes towards people with BPD, viewing them as manipulative or unwilling to help themselves, as do medical staff who react with frustration or contempt.
Other patients known to have difficulty regulating their emotions – persistent feelings of emptiness, shame, guilt and have a significantly elevated risk of suicide – are those with PTSD. BPD should then be thought of as a trauma-spectrum disorder similar to PTSD, as negative attitudes are much less observed from clinicians treating complex PTSD or other trauma-spectrum disorders.
However, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) does not mention trauma as a diagnostic factor in BPD, despite numerous links between BPD and trauma. Thus, BPD remains a personality disorder. US psychiatric researcher Ron Aviram and colleagues have said the misunderstanding may eventually perpetuate a “self-fulfilling prophecy and a cycle of stigmatisation to which both patient and therapist contribute.”
While treating BPD is difficult, thinking about its underlying cause instead of its symptoms would enhance treatment and reinforce the importance of preventing child abuse and neglect in the first place. BPD is a complex response to trauma – this changed perception could alleviate most of the stigma and associated harm that goes with the diagnosis, leading to better treatment engagement and better outcomes.
