Borderline Personality Disorder Management: A Lapse in Healthcare?

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Internationally, stigma surrounding mental illness and people with mental illness has reduced due to greater understanding, education and advocacy in the community, and more focus on recovery‐oriented care within practice guidelines. With all this being said, it is clear that we still have progress to make in the domain of mental illness. One such example of this is with borderline personality disorder (BPD).

BPD is now accepted as a valid psychiatric diagnosis with specific and effective psychotherapeutic treatments available, however this was not always the case. Worldwide, many individuals with a diagnosis of BPD continue to experience stigma, barriers to treatment, and difficulty accessing appropriate health services. These individuals are more likely to be viewed as manipulative, and deal with more frequent negative responses from health professionals in comparison to those with other mental health diagnoses.

Image 1: BPD Symptoms.

The researchers of the paper in question conducted an investigation in which surveys were developed to gather information from people with a diagnosis of BPD regarding their perceptions of care and experiences seeking support in health services, both public and private

Effective evidence‐based treatments are available to help people with a BPD diagnosis on their road to recovery, so they can succeed in their personal relationships, careers, and other aspects of their life. However, this Australian study showed that – in spite of national guidelines being in place –  individuals with a diagnosis of BPD continue to experience frustration and stress when navigating healthcare systems for seeking treatment and help in understanding their experiences and feelings. They frequently reported distress when trying to seek help in crisis – such as self‐harming and suicidality. Inappropriately slow responses to physical injuries and psychological distress, lack of empathy and poor listening skills seemed to be increased in the emergency department and acute inpatient setting.

It’s clear from the data that a lot of people, when seeking help by presenting to an acute health service in crisis, felt that they did not receive the help they required, or were actively ignored and/or mistreated by health staff at the time.

The findings clearly show that those with BPD diagnosis want to receive comprehensive, holistic, and evidence‐based support, including psychotherapy. The data also highlights a shift in consumer preference from psychiatrists to psychologists, as their main treating health professional. It’s impossible to define the exact reason for this from the data, but one possible explanation mentioned from a participant in the survey is a view amongst patients that psychiatrists’ role is to diagnose and prescribe medications, whereas the role of psychologists is to assist with understanding emotions and behaviours.

Going Forward.

There is a clear gap in training for health professionals outside of specialised BPD services, and what does exist varies in their success. More research is needed into education programmes and ways to implement training on appropriate conduct and skills for health professionals when working with individuals with a BPD diagnosis. Ongoing work by advocacy groups and government campaigns is required to eradicate stigma towards those diagnosed with BPD, and adequate funding and services is an essential focus.

A state-wide initiative, called BPD Collaborative, is a service developed in Australia that has a training and education programme, which aims to upskill health professionals and staff involved in service delivery, carers and families, and eventually the wider general community. BPD is a complex and often debilitating health condition for individuals and their families, but with awareness, education and accessible, evidence‐based, effective treatments, better outcomes for those with this manageable condition can be accomplished.

Image 2: BPD Awareness Poster.

Original Source:

Proctor JM.Lawn S., and McMahon  J. (2020) “Consumer perspective from people with a diagnosis of Borderline Personality Disorder (BPD) on BPD management—How are the Australian NHMRC BPD guidelines faring in practice?” Journal of Psychiatric Mental Health Nursing. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpm.12714  

Image Sources:

Image 1: https://lizziesargent.com/2019/05/11/so-what-is-bpd/

Image 2: https://www.reddit.com/r/BPD/comments/6aslaj/what_is_borderline_personality_disorder/

Featured Image Source: Photo by Daria Sannikova from Pexels.com

Edited by Cyrus Rohani-Shukla

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