It’s a cruel irony that people who have borderline personality disorder (BPD) will often have the most difficulty finding and getting proper treatment from mental health professionals. Because, unlike virtually every other mental disorder in the book, borderline personality disorder is seen as one of the worst of all disorders to try and treat. People with BPD are the most stigmatized amongst a population already burdened with heavy stigma, people with mental health concerns.
Borderline personality disorder is characterized by a long-standing pattern of instability in interpersonal relationships, the person’s own self-image and their emotions. People with borderline personality disorder can also tend to be impulsive. Borderline personality disorder is a fairly rare concern in the general population.
It’s the ever-changing and very intense emotions that set someone with BPD apart from others. Their relationships are fast, furious and fleeting. Whether it be a friendship or a professional therapeutic relationship, people with BPD often find it difficult to hold on to it. Their thoughts are often characterized by what cognitive-behaviorists term “black-or-white” or “all-or-nothing” thinking. You are either 100% on their side, or you are actively against them. There is little in-between.
Given this manner of looking at the world, it’s no wonder people with borderline personality disorder can be challenging to work with. They will often “test” the therapist who works with them, by either engaging in impulsive, dangerous behavior (needing to be “rescued” by the therapist, such as committing an act of self-harm), or by pushing the professional boundaries of the therapeutic relationship into forbidden areas, such as offering a romantic or sexual encounter.
Most therapists throw up their hands when it comes to treating people with BPD. They take up a lot of the therapists’ time and energy (often much more than the typical patient), and very few of the traditional therapeutic techniques in a therapist’s arsenal are effective with someone who suffers from borderline personality disorder.
Dozens of people with borderline personality disorder have shared their stories with us over the years, expressing the pure frustration they experience in trying to find a therapist willing (and able) to work with them (see, for example). They often recount stories of having to go through therapists in their local geographic vicinity like others might go through a box of tissues at a funeral. It’s distressing to hear these stories time and time again.
But that’s not the way it should be.
Borderline personality disorder is a legitimate, recognized mental disorder that involves long-standing and negative patterns of behavior that cause a person great distress. People with BPD need help as much as the person with depression, bipolar disorder or anxiety. But they’re not getting it because they are being discriminated against by therapists who simply don’t want to deal with the time and hassle of someone with BPD.
Therapists can legitimately turn away someone seeking their help if they don’t have the skills, experience or education necessary to treat a specific concern. Borderline personality disorder is best treated with a specific type of cognitive-behavioral therapy called Dialectical Behavior Therapy (DBT). This specific type of psychotherapy requires specialized training and education in order to use it productively and ethically.
Few therapists bother to learn this technique, however, because of the trouble that is commonly associated with people with BPD. Plus, they think, they may not even get reimbursed for treatment of this concern because generally most insurance companies do not cover payment for treatment of personality disorders (no matter how much pain the person is in). This is a bit of a red herring argument, however, as professionals know many reasonable and ethical ways to obtain such payment by adding additional, reimbursable diagnoses on the patient’s chart.
The stigmatization and discrimination of people with borderline personality disorder needs to stop within the mental health profession. This bad behavior reflects poorly upon therapists who repeat the same inaccurate and unfair generalizations about people with BPD as others did about depression three decades ago. Professionals should know the local therapists within their community who are experienced and well-trained to treat borderline personality disorder. And if they find such numbers lacking, they should seriously consider it as a specialization of their own.
But if a therapist does nothing else, they should stop talking about people with borderline personality disorder as second class mental health citizens, and start treating them with the same respect and dignity all people deserve.