Psych Gumbo: Poor understanding of borderline personality disorder causes stigma

Holly Peak, Staff Columnist

The following is an opinion article, and does not reflect the views of The Tulane Hullabaloo

The diagnosis of “borderline personality disorder” unfortunately carries with it much stigma. A “personality disorder” may carry negative connotations and the term “borderline” can conjure an image of an unstable person precariously straddling an imaginary line of what would be considered a “normal,” stable personality. BPD is a mental health issue just like anxiety and depression, yet it does not receive the same level of recognition.

Though many have heard the term “borderline personality,” most do not know exactly what the diagnosis means. Personality disorders, in general, are characterized by long-term patterns of thoughts or behaviors that are unhealthy and often inflexible, which can cause significant problems in one’s emotional and interpersonal life.

To be diagnosed with BPD, one must exhibit an enduring pattern of several of the following symptoms: extreme reactions to real or perceived abandonment, including panic, depression, rage; stormy relationships with others, often alternating between extreme closeness to extreme dislike or anger; an unstable sense of self resulting in sudden changes in feelings, values or future plans; a pattern of impulsive and dangerous behaviors, such as reckless spending, unsafe sexual encounters or substance use; recurring suicidal behaviors, threats of suicide or self-harm, such as cutting; chronic feelings of emptiness or boredom; intense and highly changeable moods, including issues controlling intense anger; and having stress-related dissociative feelings, such as losing touch with reality or feeling cut off from oneself.

Many people also have co-occurring mental health issues, such as post-traumatic stress, bipolar disorder, depression, anxiety or eating disorders.

It is unclear exactly what causes BPD, but it is likely a combination of genetics or biological factors and environmental influences, such as childhood neglect, dysfunctional family dynamics and a history or trauma, including emotional, physical and/or sexual abuse. Having borderline personality disorder makes success in relationships, school and work difficult. The most concerning consequence is suicide. Eight to 10 percent of those with the disorder commit suicide, which is a rate 50 times higher than in the general population. More than 70 percent of individuals with BPD will attempt suicide at least once, with rates peaking in individuals in their 20s and 30s.

Seeking treatment is important, as many will learn new patterns of thinking and behavior over time. Though medications can help with some mood symptoms, psychotherapy is essential as it allows individuals to learn new coping skills and emotional regulation.

Though those with BPD face much stigma, partly because the nature of their chaotic and stormy relationships. It is important to recognize that BPD is a mental health issue that deserves as much recognition as depression and anxiety. The dysfunction and deadly consequences are significant in the young adult college population, making seeking help that much more important.

Holly Peek, MD/MPH, is a third year psychiatry resident at Tulane University School of Medicine. She can be contacted through her website at or[email protected].