Psychiatria pre prax 1/2015

If you label me, go with your therapy to hell! Borderline personality disorder and stigma

Introduction:Borderline personality disorder is associated with numerous symptoms that interfere with interpersonal relationships. Both mental health professionals and the general population often think negatively about patients suffering from this disorder, which may worsen the creation and maintenance of the supporting therapeutic relationship. Method:Research and review articles were identified using the Web of Science, Medline and Scopus. Keywords were represented by terms “borderline”, “stigma”, “internalized stigma”, “therapy”, “treatment”, “psychotherapy” and “psychosocial treatment”. Results: Psychiatric staff´s opinions on the patients with personality disorders are strongly judgemental and stereotypic. Mental health professionals stigmatize the patients with borderline personality disorder even more frequently than the general population does. The rule is that there is a conviction about incurability of the disorder, manipulative nature of self-mutilation or other symptoms, and the strong traits of the patient are overlooked. The considerable percentage of medics tries to avoid the contact with these patients. These reactions partly arise from the patient’s real maladaptive behaviour; however they are partly the result of prejudice, negative stereotypes and unprocessed countertransference. Negative attitudes of medics lead to the marginalization of patients with borderline personality disorder within the health care system. Conclusion:The health professionals often negatively and stereotypically evaluate the patients with borderline personality disorder, which can lead to an increase of maladaptive symptoms and worsening of treatment effectiveness in these patients. It seems necessary to increase the understanding and empathy towards these patients, what can be supported by the consultation with the supervisor.

Keywords: stigma, internalized stigma, borderline personality disorder, psychotherapy, pharmacotherapy.