Shari Roan of the LA Times says borderline personality disorder has long been seen as one of the most difficult mental illnesses to treat. But advances in therapy are improving that prognosis for sufferers — and busting some stereotypes.
Roan says people with borderline personality disorder (BPD) "make a mess of their relationships — and no wonder, given the hallmark symptoms: mood instability, fear of abandonment, impulsive behavior, anger and suicidal or self-injurious acts. People with the disorder may misperceive the actions — even the facial expressions — of others." Borderline patients frequently also struggle with other mental illnesses or substance abuse. Psychologist Marsha Linehan, an expert on the disorder, describes it thus: "You can't regulate your emotions despite your best efforts."
Roan writes, "the composite of an angry, unstable, clingy, substance abuser is not a pretty one, and people with the disorder suffer greatly because they drive away even the people who love them most." They may also suffer stigma from the very people who are supposed to help them. One writer says some therapists use a diagnosis of BPD "to express hatred of patients," and psychiatrist Richard G. Hersh tells Roan, "borderline personality disorder is considered a pejorative term." A test for BPD, the Diagnostic Interview for Borderlines, describes the disorder as being characterized by "sexual deviance," "manipulativeness," "demandingness," and "entitlement." Therapists who are looking for these qualities in their patients may well develop a negative attitude toward them — especially if patients prove difficult to treat.
Dr. Josepha A. Cheong of the American Psychiatric Association says media portrayals of borderline personality disorder — like Glenn Close's bunny-boiler in Fatal Attraction — are often inaccurate. She says a better example is Jenny from Forrest Gump, "a somewhat sympathetic but self-destructive, dysfunctional woman who wanted a normal life but couldn't achieve it." But maybe an even better example would have been a man.
Although Roan says men and women suffer borderline personality disorder in equal numbers, many still consider it to be a woman's disease. This may be in part due to media influence — the main character in Girl, Interrupted is also diagnosed with BPD — or because men are more likely to be diagnosed with other problems. Whatever the cause, the image of the "clingy" patient who can't regulate emotions tends to be the image of a woman.
But clinicians may now be focusing less on stereotypes, and more on what patients can do. BPD was front-and-center at this year's meeting of the American Psychiatric Association, and today's therapies offer hope, not judgment. Roan mentions Linehan's dialectical behavior therapy, which encourages therapists "to balance acceptance and change." In addition to teaching strategies for forming healthier relationships, therapists also "highlight for clients when their thoughts, feelings, and behaviors were 'perfectly normal,' helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves." Dialectical behavior encourages doctors to see borderline patients as people in pain who also have the capability to lead normal lives. This image may not be as sensational as a bunny-boiler, but it's a lot more helpful.
Borderline Personality Disorder Grows As Healthcare Concern [LA Times]
Reducing Severe Episodes Of BPD [LA Times]
What Is Borderline Personality Disorder? [LA Times]