When a family member has recently been diagnosed with borderline personality
disorder, I think family members feel quite scared about what that means.
There's a lot of terrifying information on the internet about this, most of which
by the way is quite inaccurate, so what I tell families is this is actually a very
hopeful moment because to have an accurate assessment to classify
accurately as borderline personality disorder, is actually quite hopeful.
In 2015, for the first time we have multiple treatments that work and that
wasn't true even 30 years ago. So it's actually good news, as surprising as that
might sound,
new therapists working with people with borderline personality disorder need a
variety of skills to be effective, not least among them would be an open mind
to actually bring themselves to the interpersonal situation so that they can
enjoy the person, enjoy the human being that they're working with, in addition to
understanding and seeing the suffering and the pain that's involved. Actually to
be able to have both sides of that is very important.
Diagnosis for Borderline Personality Disorder is very confusing, it's
confusing to patients and their family members, and believe it or not, it's very
confusing for therapists. Part of the reason is that there's an ongoing debate
within the field of psychiatry and psychology about what borderline
personality disorder is, that's confusing, it's a heterogeneous disorder, that means
that one person with borderline personality disorder can look very
different and have a very different set of problems than somebody else with
borderline personality disorder, and probably most importantly the fact is
that borderline personality disorder rarely stands by itself.
People with borderline personality disorder typically have two, three, four
or more other diagnoses they carry around with them. This can be very
confusing for everybody.
Stigma has been following borderline personality disorder around like a dark
shadow for as long as there has been borderline personality disorder as a
diagnosis. It comes from a lot of different reasons, probably most among
them is the fact that for so many years the mental health community was so
ineffective at treating borderline personality disorder. Now that we have
effective treatments, stigma has started to go down and so stigma has actually
been reduced quite a bit in the last 25 years or so since the first randomized
trials of dialectical behavior therapy were published.
I think the priorities and treatment for BPD today are to expand the number of
treatments that actually work for people suffering with borderline personality
disorder. The number of treatments that we have with very good results that endure,
is still relatively small and and don't necessarily help everybody. Borderline
personality disorders a very heterogeneous disorder, so in order to
help people who meet the criteria for BPD we are going to need to have
multiple different approaches to treatment to be able to help them
broadly.
I remember when I first heard borderline personality disorder back in
the mid-1980s, and there was an enormous amount of stigma attached to it and the providers that I was working with a psychiatrist and psychologists
were often very stigmatizing, very judgmental about people with BPD, and I
wish I could have gone back and told myself, but also them, that you know we're
all human beings and the differences between people with BPD and people
without BPD are actually much smaller than the things that we have in common.
Everybody gets emotionally disregulated sometimes, everybody does, people with
borderline personality disorder get more intensively dysregulated more often and
so carry with them a lot more pain and suffering, but the nature of the
dysregulation is quite the same as it is for anybody.