Borderline personality disorder stigma undermines care

People with a diagnosis of borderline personality disorder and their carers report experiencing discrimination and stigma when presenting to health services following self-harm or a suicide attempt, leading to inadequate treatment and care for suicide prevention, according to the authors of a new large-scale review published in the International Journal of Mental Health Systems.

Researchers at Flinders University are calling for better use of existing resources to improve health and community-based services and staff training.

Led by Pauline Klein, a Casual Academic and PhD candidate in Flinders’ College of Medicine and Public Health, the research team undertook a review of the international literature to investigate people with a diagnosis of borderline personality disorder, their carers’ and their health practitioners’ experiences of health services.

Borderline personality disorder affects 1–2% of the global population and has high rates of self-harm and suicide, the review found.

“Unlike schizophrenia, borderline personality disorder is much less likely to respond to medications, with previous research finding longer-term solutions, such as face-to-face therapy and ongoing support, better suited to manage the underlying trauma that is thought to have led to the disorder for many of the people who experience it,” said co-author Dr Kate Fairweather, a mental health epidemiologist and public health/health equity lecturer at Flinders University.

“We found that the available public health services and programs have long waitlists, and specialist services are not an affordable option for many people,” added Klein.

“Similarly, health practitioners reported experiencing challenges navigating health services and referral pathways due to the limited services and supports available.”

The research further suggests that there is a dominant stigmatising culture, particularly in emergency and acute mental health services, that perpetuates misconceptions regarding the legitimacy of the diagnosis of borderline personality disorder as well as its treatability and recovery prospects — leading to reluctance among some health practitioners to diagnose or treat people with this mental health condition.

“Alarmingly, there are consistent reports in the literature indicating that when experiencing a suicidal crisis, people with a borderline personality disorder diagnosis and their carers are treated disrespectfully and denied treatment when presenting to some health services, leading to a lack of support being offered to these patients at a pivotal time when crisis intervention is needed,” said Klein.

“The Clinical Practice Guidelines for the Management of Borderline Personality Disorder, developed in 2012, state that treatment for this disorder is a legitimate use of healthcare resources and that having a diagnosis of borderline personality disorder is never a reason for withholding health care to a person.

“These stigmatising experiences lead to patients and their carers facing discrimination and high levels of anxiety when seeking treatment because the presenting condition is not taken seriously, undermining patient care and potentially re-traumatising and exacerbating patients’ self-harming behaviour.

“We need a system-wide approach including providing health practitioners who work with people with borderline personality disorder ongoing access to education, training and supervision to better support them in their role.”

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