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Stigma Undermines Care for Patients With Borderline Personality Disorder
People with borderline personality disorder and their carers/families face significant structural problems in the health care system, including stigma and limited public health services, according to a scoping review published in the International Journal of Mental Health Systems.
“Alarmingly, there are consistent reports in the literature indicating that when experiencing a suicidal crisis, people with a borderline personality disorder diagnosis and their carers are treated disrespectfully and denied treatment when presenting to some health services, leading to a lack of support being offered to these patients at a pivotal time when crisis intervention is needed,” said lead author Pauline Klein, a PhD candidate at Flinders University College of Medicine and Public Health, Adelaide, Australia.
The review included 55 peer-reviewed articles and 2 reports. Researchers investigated challenges, gaps, and barriers in accessing health care and support for patients diagnosed with borderline personality disorder, their carers/families, and their health practitioners.
The findings illuminated a dominant stigmatizing culture, particularly in emergency and acute mental health services, that perpetuates misconceptions about the legitimacy of the borderline personality disorder diagnosis and its treatability. Multiple studies included reports of health practitioners avoiding or denying care to patients with borderline personality disorder.
“These stigmatizing experiences lead to patients and their carers facing discrimination and high levels of anxiety when seeking treatment because the presenting condition is not taken seriously,” Klein said, “undermining patient care and potentially retraumatizing and exacerbating patients’ self-harming behavior.”
The review also identified limited public health services and community group programs to support and educate patients with borderline personality disorder. Those that do exists have long wait lists. Meanwhile, specialist services are not affordable for many patients and families. Health care providers, too, report challenges navigating health services and referral pathways for patients with borderline personality disorder because of limited options.
“This should serve as a call to action for governments to prioritize and address these important public health concerns,” Klein advised. “We need a system-wide approach including providing health practitioners who work with people with borderline personality disorder ongoing access to education, training, and supervision to better support them in their role.”
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