The dialectics of the borderline

Time magazine has an interesting piece on borderline personality disorder (BPD), a sometimes stigmatised diagnosis that implies the patient has unstable impulsive emotional reactions and tumultuous relationships.

In contrast to popular perception, the ‘borderline’ part doesn’t imply the condition is between ‘normal’ and ‘abnormal’ but that the patient is on the borderline between a psychotic and non-psychotic disorder, as low-level distortions of perception (fleeting hallucinated voices for example) and magical or paranoid thinking are not uncommon.

The stigma of the diagnosis comes from the fact that people with the label are widely considered by mental health professionals to be ‘difficult’ or ‘challenging’. The fact that self-harm is common in this group often leads to informal negative labels indicating that the patient is a ‘cutter’ or ‘manipulative’.

This has been borne out by various studies. Two studies have found that the label of personality disorder is associated with staff perceiving the person as less deserving of care, more difficult, manipulative, attention-seeking, annoying, and more in control of their suicidal urges and debts – even when everything else about them is the same.

A study specifically with psychiatric nurses found that they were more likely to offer belittling or contradicting responses to statements from patients with the diagnosis.

Borderline is, perhaps, one of the mythologised conditions in psychiatry.

The fact that many mental health professionals believe that the condition is ‘lifelong’ and ‘untreatable’ is contradicted by studies that have found that the majority of people who have the diagnosis improve drastically. The most comprehensive study has found that 75% of patients with BPD no longer qualify for the diagnosis after six years.

The article also discusses one of the most promising new treatments – a type of psychotherapy called dialectical behaviour therapy (DBT) – that has been found in early trials to improve the emotional tolerance, self-control and day-to-day functioning of patients with BPD.

It was invented by psychologist Marsha Linehan (who according to the article, used to be a nun), based in part on the Buddhist techniques of mindfulness and emotion regulation.

The Time piece is a little overly-dramatic in places, but is generally well-written and avoids the usual clichés associated with BPD and is well worth a look.

Link to Time on ‘The Mystery of Borderline Personality Disorder’.

5 thoughts on “The dialectics of the borderline”

  1. Thanks for the find: I hardly ever glance at the cover of TIME magazine any more. I’ve been dying for people to move away from the “Law & Order”-style cliches.

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