A Stigmatising Diagnosis?
Last week, Australian Open player Destanee Aiava revealed she had struggled with borderline personality disorder. The tennis player said a formal diagnosis, after suicidal behaviour and severe panic attacks, “was a relief”. But “it also felt like a death sentence because it’s something that I have to live with my whole life”.
A diagnosis is often associated with therapeutic nihilism. This means it’s viewed as impossible to treat, and can leave clinicians and people with the condition in despair.
A Stigmatising Diagnosis
The name “borderline personality disorder” is confusing and adds greatly to the stigma around it. Doctors first used “borderline” to describe a condition they believed was in-between two others: neurosis and psychosis. But this implies the condition is not real in itself, and can invalidate the suffering and distress the person and their loved ones experience.
What is Borderline Personality Disorder?
People with the disorder can express a range of symptoms, but high levels of anxiety – including panic attacks – are usually constant. Symptoms cluster around four main areas:
- High impulsivity (leading to suicidal thoughts and behaviour, self-harm and other risky behaviours)
- Unstable or poor sense of self (including low self-esteem)
- Mood disturbances (including intense, inappropriate anger, episodic depression or mania)
- Problems in relationships
Who Does It Affect?
The disorder affects one in 100 Australians, although this is likely a conservative estimate, as diagnosis is based on the most severe symptoms. Women are much more likely to be diagnosed with it than men – but why this is so remains a major debate, with political and sociological factors playing a role in making psychiatric diagnoses. Symptoms usually begin in the mid to late teens.
What Causes It?
The main cause for borderline personality disorder appears to be trauma in early life compounded by repeated traumas later. Early life trauma can lead to biological changes in the brain that cause behavioural, emotional or cognitive shifts, leading to social and relationship issues. This is known as complex post-traumatic stress disorder.
Can It Be Treated?
There are many effective psychological therapies and other treatments for people with borderline personality disorder or complex post-traumatic stress disorder. For example, dialectical behavioural therapy is a type of cognitive therapy that helps people learn skills such as tolerating distress, managing relationships, regulating emotions and practising mindfulness.
Treating Trauma, Not Personality
Rethinking borderline personality disorder as a trauma disorder enables a more effective and understanding approach for those with it. Understanding what trauma does to the brain means newer, targeted medications can also be used. Educating partners and families about borderline personality disorder, providing them support and co-designing crisis strategies are also important parts of total care. Preventing early life trauma is also critical.
Conclusion
Borderline personality disorder is a complex and poorly understood mental illness. It is not a hopeless condition, and with the right treatment and support, people with the disorder can recover. By understanding the trauma that underlies the disorder, we can work towards a more effective and compassionate approach to treating it.
FAQs
* What is borderline personality disorder?
+ Borderline personality disorder is a mental illness characterized by a range of symptoms, including high levels of anxiety, mood disturbances, and problems in relationships.
* Is it a stigmatised condition?
+ Yes, the name “borderline personality disorder” can be stigmatising and adds to the negative perceptions and stereotypes surrounding the condition.
* Can it be treated?
+ Yes, there are many effective psychological therapies and other treatments available for people with borderline personality disorder or complex post-traumatic stress disorder.
* What is the main cause of borderline personality disorder?
+ The main cause of borderline personality disorder appears to be trauma in early life compounded by repeated traumas later.
* Is it a hopeless condition?
+ No, borderline personality disorder is not a hopeless condition, and with the right treatment and support, people with the disorder can recover.
