Written by Luiza Ghazaryan 

Borderline personality disorder (BPD) is a mental illness that affects one’s ability to control emotions and comprehend self-image. The symptoms include fear of abandonment, unstable relationships, impulsive anger, feelings of emptiness, self-harm behavior, feelings of dissociation, etc. Living with BPD can feel scary, dark, lonely, however, many of the struggling people do not even know their true diagnosis. Only 1.4 percent of the adult U.S. population is diagnosed with BPD. Meanwhile, researchers at the University of North Texas and Brown University found that at least 40 percent of the people in their research who had BPD were previously misdiagnosed as having bipolar disorder. Misdiagnosis impacts a patient’s rights to receive necessary and sufficient care, as well as the chances of remission. National Institute of Mental Health (NIMH) indicates that individuals with borderline personality disorder who don’t receive adequate treatment are more likely to develop other chronic medical or mental illnesses. 

So, why are BPD patients misdiagnosed? The reasons target a few aspects: funding, research, specialists’ licenses, the symptoms of the disorder. Due to lack of funding for BPD research, mental health professionals have insufficient knowledge on how to treat the disorder. An observation done on funding for mental health research concluded that bipolar disorder studies, for contrast, received more support than BPD research ($622 million vs. $55 million). Mark Zimmerman and Doug Gazarian mentioned in their research, “These findings suggest that the level of NIH research funding for borderline personality disorder is not commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder.” It becomes difficult to understand people whose struggles are not emphasized enough; and this, in its turn, leads to stigma. The misunderstanding impacts affected people’s quality of life because socially, their rights are unrepresented. Because it is so hard to distinguish between disorders, people with BPD get labels that are offensive for everyone who is struggling with their mental health. For example, they get called “unstable,” “dangerous,” or “borderline.” The person doesn’t equate with the diagnosis or struggles. It is upsetting to find out that even healthcare specialists label their patients. The authors of Psychology Today note, “it is common to hear patients referred to as ‘borderlines,’ and mental health providers may go so far as to use language such as ‘oh no, she’s a borderline,’ ‘that’s very borderline,’ … or ‘bad borderline.’’’ They add, “The problem with this type of language is that such ‘noun labels’ imply permanence of the condition as well as a loss of personhood.” Knowing that it is a personality disorder, these “specialists” do more harm than help since it is complex for the patient to distinguish their diagnosis from their persona. These people need support to be able to see that they are not their disorder and they can overcome the struggles. In an interview, another case with wrong language usage was found. When a patient talked about a strong fear of abandonment (one of the symptoms of BPD), the psychologist referred to the fear as “fantasy.” It is crucial to understand that the feelings of their patients are valid and not just trivial thoughts. Such derogatory language creates a negative image and representation for people with mental illnesses.

Continuing the topic of mental health professionals, there has been an observed trend among them, avoiding BPD patients. Cognitive-behavioral therapy is known to be used as a BPD treatment, a subset of which is called Dialectical Behavior Therapy, which requires special training and education to be able to practice appropriately. Nevertheless, many healthcare practitioners decide not to spend the time learning this psychotherapy technique due to “risks” associated with patients with BPD.

The National Institutes of Health found that psychiatrists mentioned the diagnosis of Borderline Personality Disorder up to four times more often than any other diagnosis when asked about the characteristics of difficult patients. Several more have indicated that almost all difficult patients have “borderline personality organization.” The psychiatrists refer to patients as “difficult” when describing borderline personality symptoms. A question arises, what do they mean by “difficult?” Two possible answers exist: the way symptoms function and some legal factors such as their licenses or the funding for this illness. Because emotional attachment is an observed symptom among these people at the same time as uncertainty, the therapists fear to find themselves caught in their BPD patients’ conflicting desires.

Another obstacle BPD patients face is the lack of financial aid for the treatment of personality disorders (USA). Due to this, many therapists avoid diagnosing BPD, knowing that their patients will not get the necessary support. Instead, they misdiagnose them with depression, anxiety, and other mental illnesses that have common symptoms with BPD. There are also specialists who refuse to engage in such activities and therefore, the patient is left all alone, with no treatment.

Mental health as a field continues to battle stigma, however, certain disorders are more severely disadvantaged. Inequities in the quantity of research regarding borderline personality disorder is impacting people’s rights to receive the essential and proper treatment. The absence of knowledge is leading many people to misunderstand humans struggling with BPD. Moreover, it results in a shortage of healthcare professionals who truly wish to support people with personality disorders. What we need is awareness of the issue, more advocates who can bring attention to the research of BPD, and officials who will enhance the chances of getting specialized mental health treatment equal and possible for everyone. An outcome of this would be more people educated about borderline personality disorder, making such individuals feel more accepted in society.

People with borderline personality deserve the same time, care, and empathy as the rest of the population. Will we be able to set aside personal bias to designate resources toward the few who need it?

Edited by Anna Boyarinova