“Dysfunctional beliefs live by untruths and thrive in the dark —the unchallenged and unexplored parts of your BPD. To challenge and change them, you have to shine a light on them” (Fox).

In 1990, Andrea Rosenhaft was diagnosed with Borderline Personality Disorder (BPD). When Rosenhaft received her diagnosis, she was recovering from her second suicide attempt in a hospital bed, surrounded by her family. During this uncertain time, her parents trusted that the hospital’s psychiatrists would prioritize their daughter's needs, and provide her with the best treatment available. They were sorely mistaken. Upon their return to Rosenhaft’s room, psychiatrists encouraged her parents not to hold out hope for their daughter. Fortunately, those professionals were wrong to underestimate Rosenhaft. She took control of her recovery and spent months in a monitored residence while going to a BPD day program (Rosenhaft). Rosenhaft has since become a clinical social worker and founded “BWellBStrong,” a treatment consultation service —there was hope for her after all. In her article, “We Are Still Fighting the Stigma of Borderline Personality Disorder,” Rosenhaft struggles to put into words the devastation her parents felt when they encountered such a dismal attitude at the hospital. However, she exhibits no difficulty in writing that the mistreatment of those with BPD by the medical system continues to be prevalent. 

The medical world has historically viewed BPD as a “highly disabling disorder,” that is associated with dangerous people (Biskin). The medical definition of “BPD” reveals that this negative perception of the disorder continues to be the dominant viewpoint. According to the National Institute of Mental Health (NIMH), BPD is characterized by emotional dysregulation, bouts of depression, impulsivity, and unstable relationships. While these symptoms are alarming, it is imperative that healthcare workers view individuals with BPD beyond that set of characteristics. This is especially important during the treatment process so that those with the disorder are perceived as humans deserving of help, opposed to dangerous “borderlines” —the label used by the majority of medical professionals to classify patients who have BPD (Krauss Whitbourne). In her article, “Why People With Borderline Personality Disorder Are Treated So Poorly,” clinical psychologist, Dr. Susan Krauss Whitbourne, explains utilizing the term “borderline” is one the most common ways doctors dehumanize patients who suffer from BPD. The use of that term perpetrates the act of “noun labeling,” in which one’s condition is implied to be permanent, and they are stripped of their personhood due to being categorized by their mental illness (Krauss Whitbourne). Beyond noun labeling, the mistreatment of those with BPD has become normalized by the healthcare system. In 2023, the International Journal of Mental Health Systems found that patients with BPD often encounter systematic difficulties when they seek out treatment. This stigma ranges from medical professionals refusing to administer treatment, or —as in the case of Rosenhaft— exhibiting a pessimistic, dismissive attitude towards patients who display symptoms of BPD. It appears as though the healthcare system’s perception of BPD has become so warped by stigmatized beliefs that medical professionals now view helping individuals with BPD as pointless.

“Don’t define yourself in terms of something which even many highly trained and gifted professionals do not fully understand” (Saks).

In 2009, TIME magazine published the subhead “Borderlines: the disorder doctors fear most.” Fifteen years later, this statement is still an accurate observation. This “fear” is seen when therapists refuse to even try and comprehend BPD sufferers’ problems. When those with the disorder seek out therapy, they are frequently labeled as “treatment resistant” in order to be dropped as patients (Hancock). Although the refusal of treatment can be detrimental in the long term for those with the disorder, the constant rejection from healthcare providers in itself is incredibly damaging to them. As the National Alliance on Mental Illness (NAMI) articulates, being dropped as a patient or refused treatment can “intensify” symptoms of BPD, and reinforces the idea that trying to reduce their symptoms is futile. The intensification of BPD symptoms may result in those with the disorder experiencing an increased suicidal ideation and desire to commit self-harm (National Institutes of Health). Additionally, the flawed treatment process for BPD has forced individuals with the disorder to fall into somewhat of a self-fulfilling prophecy. The intensification of BPD symptoms may cause those with the disorder to live up to the stereotypes surrounding them —which only affirms the false impression that they are beyond help. By denying treatment to people with the disorder under the justification that they are “afraid” of BPD, medical professionals have created this prophecy at the expense of BPD sufferers. It is time those professionals recognize the damage their stigmatized beliefs towards BPD have caused countless people. Furthermore, it is equally important that healthcare workers admit that it is beyond time for the treatment process for BPD to be reassessed and destigmatized. 

Changing the typical treatment procedure for BPD begins with a change in how the healthcare system views the disorder and those who have it. While this is certainly a daunting task, the process of changing this perspective can begin with an acknowledgement of a fact as simple as that there is hope for individuals with BPD. On top of the success stories of people such as Rosenhaft, symptoms of BPD naturally become less prevalent over time with the largest decrease in prominence seen in patients older than 44 (Netherton and Rohr). The issue is ensuring that medical professionals perceive the disorder in a better light, so that BPD patients receive the help they need in order to reach that age. According to NAMI, clinicians’ perceptions of BPD can become more positive and factually based, after they attend short workshops on BPD. Although investing in these workshops will not immediately change the treatment process individuals struggling with BPD go through, it may help medical professionals view BPD in a more positive light. In turn, this more informed perception will likely deter healthcare workers from mistreating those with the disorder. However, medical professionals will still have to put in some legwork; the effectiveness of these workshops is largely contingent upon how willing those in the healthcare field are to allow their perception to change.

To properly acknowledge this contingency, I want to make it clear that I am not expecting an overnight change in the way BPD is viewed by the healthcare system. I recognize that it is difficult for one to leave behind a viewpoint that they have held onto and been surrounded by for so long. What I do expect of you, and anyone else who may read this paper, is that you question the stigma surrounding BPD and examine the consequences it has for real people. I ask that you push back against the pressure to think about BPD negatively. Instead, consider the consequences of viewing someone with BPD through a stereotypical lens on a moral level, and decide for yourself if that is the standard you want to support. While we may not be able to instantly change the entire healthcare system’s perception of BPD, we, individually, can change how we think. You have the power to educate yourself and to hold others accountable for the damage they have caused to people suffering from the disorder —if you so choose. 

Works Cited

Biskin, Robert S. "The Lifetime Course of Borderline Personality Disorder." National Library of Medicine, July 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4500179/. Accessed 28 Apr. 2024.

Fox, Daniel J. The Borderline Personality Disorder Workbook: An Integrative Program to Understand and Manage Your BPD. 2019.

Hancock, Cameron. "The Stigma Associated with Borderline Personality Disorder." National Alliance of Mental Illness, 28 June 2017, www.nami.org/Blogs/NAMI-Blog/June-2017/The-Stigma-Associated-with-Borderline-Personality. Accessed 18 Apr. 2024.

Klein, Pauline, et al. International Journal of Mental Health Systems. BioMed Central, 29 Sept. 2022. Gale Academic OneFile, doi.org/10.1186/s13033-022-00558-3. Accessed 12 Dec. 2023.

Krauss Whitbourne, Susan. "Why People with Borderline Personality Are Treated so Poorly." Psychology Today, Jan. 2022, www.psychologytoday.com/intl/blog/fulfillment-any-age/202201/why-people-borderline-personality-are-treated-so-poorly. Accessed 7 Feb. 2024.

National Institutes of Health. Borderline Personality Disorder. Report no. No. 22-MH-4928, National Institute of Mental Health, 2022.

Netherton, Elisabeth, and Jessica Rohr. "Mothers with Borderline Personality Disorder Often Experience Trauma." Psychiatric Times, vol. 39, no. 6, June 2022. Gale Academic OneFile Select, link.gale.com/apps/doc/A705920632/EAIM?u=mlin_c_bancsch&sid=bookmark-EAIM&xid=299c9e62. Accessed 5 Jan. 2024.

Rosenhaft, Andrea. "We Are Still Fighting the Stigma of Borderline Personality Disorder." Psychology Today, Sussex Publishers, Jan. 2022, www.psychologytoday.com/us/blog/both-sides-the-couch/202201/we-are-still-fighting-the-stigma-borderline-personality-disorder. Accessed 5 Jan. 2024.

Saks, Elyn R. The Center Cannot Hold: My Journey through Madness. 2008.