5 Myths that Undermine Treatment of Borderline Personality

Misconceptions regarding borderline personality (BPD) are widespread. General fallacies and longstanding myths have been reinforced by often overdramatic media portrayals, misguided literature, and people’s limited understanding of the condition.

This kind of misinformation might discourage an individual from seeking treatment or from believing treatment for borderline personality is even a possibility. For example, if a man believes the common misunderstanding that BPD is exclusive to women, he might reject the diagnosis for himself. When those less inclined to seek a pharmaceutical solution hear a personality condition like BPD can only be treated with pills, it can undermine their path to treatment.

Psychologist Traci Stein, PhD, MPH, said negative health outcomes can result from inaccurate beliefs.

“Pessimistic or inaccurate beliefs regarding a condition can set up a type of negative expectancy with regard to treatment outcomes, and also generate feelings of shame, hopelessness, and unworthiness,” Stein said. “These can make it more difficult to accept support and take a self-compassionate stance, which has been shown to be important for healing and growth.”

According to the National Institute of Mental Health (NIMH), borderline personality is characterized by unstable moods, relationships, and behavior. People with BPD may experience issues with regulating emotions, impulsive behavior, or co-occurring mental health issues such as depression or anxiety. Research suggests the prevalence of personality disorders, of which there are several specific diagnoses, varies from 5-13% in the general population.

Unhinging the common public misperceptions surrounding BPD and many other personality conditions can result in real changes and can impact how those diagnosed are treated—especially outside the clinical environment.

Here are five common myths and misconceptions about borderline personality:

1. Myth: BPD Is Gender-Specific

Despite repeated studies that indicated men made up a sizable portion of those diagnosed with borderline personality, a common belief took hold that only women were susceptible to the condition. While some early research had estimated women made up roughly 75% of the diagnoses, newer findings suggest there may have been some gender bias in survey sampling to come up with that estimate and there may actually be little or no difference in gender prevalence.

A 2008 report in The Journal of Clinical Psychiatry did not find any gender differences in the rates of BPD, instead indicating prevalence is more common among distinct types of people. These include younger people, individuals with lower income or education, and those divorced, separated, or widowed.

Both men and women can exhibit the symptoms and match the diagnosis—though they may cope in different ways. Men with BPD, for instance, are more likely to experience substance abuse or volatile outbursts, according to a 2011 report, while women are more likely to experience disordered eating behaviors or anxiety symptoms.

2. Myth: Borderline Personality Is Incurable

Even among counselors and psychologists, personality conditions such as BPD have been frequently viewed as incurable, often discouraging people with lingering symptoms from actively seeking help.

“Our personalities are shaped by early experiences, and so, often by the time someone seeks treatment, their patterns of thinking and conceptions of themselves and the world can feel fairly entrenched,” Stein said. “Ways of coping have usually been reinforced again and again by this time, making it challenging to switch to coping tools that are newer to the person, even if these would be more adaptive. Thus, it takes time and often considerable effort, at least initially, to feel comfortable and confident using them.”

While media depictions often suggest people experiencing BPD are constantly suffering and plagued by misdiagnoses, the realities of treatment and response are not quite so bleak.

In 2003, a six-year study tracked 290 people experiencing borderline personality—with most receiving multiple treatment sessions. More than a third of the people receiving treatment met the criteria for remission within two years, while 68% matched it by year six.

“With practice and support, many people can learn to reframe outdated cognitions, develop greater mastery with regard to managing difficult emotions, and become more comfortable using effective interpersonal skills,” Stein said.

Those encountering symptoms should not allow the incurable myth to dissuade them from seeking help, and consulting a qualified mental health care provider may be a good next step.

3. Myth: Diagnosing Borderline Personality Is Easy

According to therapist Kimber Shelton, PhD, despite the widely held belief that people can easily diagnose a personality condition in themselves or others, it is not always simple.

Unhinging the common public misperceptions surrounding BPD and many other personality conditions can result in real changes and can impact how those diagnosed are treated—especially outside the clinical environment.“The fact is, diagnosing personality disorders is very challenging,” Shelton said. “There are a number of mental health diagnoses that share symptoms with personality disorders, which makes it difficult to discern.”

Borderline personality, and other personality conditions, are frequently masked amid other symptoms, sometimes resulting in a misdiagnosis. This can prolong the effects, exacerbate symptoms, and extend uncertainty.

“An inaccurate diagnosis can result in a person feeling misunderstood and unhelped, and can also increase the likelihood that they will believe treatment in general won’t be helpful,” Stein said. “An accurate diagnosis, however, can help a person to feel understood, sometimes for what feels like the first time ever. Accurate diagnoses point people in the direction of treatments that are more likely to be effective for the person and feel like a good fit.”

4. Myth: People with Borderline Personality Are Dangerous

Challenging the myth that people with personality conditions present an increased risk to others, a 2007 report in the Journal of Psychiatric and Mental Health Nursing examined the frequency of violence during actual treatment. Only one instance of violence was found in more than 40,000 hours of group therapy reports, when acute personality conditions were treated alongside other mental health conditions.

It is more likely for people with personality conditions to be a danger to themselves. People with conditions such as BPD generally have high rates of self-harming behavior, including substance abuse, eating disorders, and suicidal ideation, according to the NIMH.

The authors of the 2007 report suggested a group-based and social therapy treatment program might be the most effective for people with borderline personality or other personality conditions, as those kinds of approaches establish a safe and solid base from which to build.

5. Myth: Only Medication Can Treat Borderline Personality

Researchers suggest BPD, in addition to several other personality conditions defined in the DSM, are best treated with psychotherapy, but medication may also be helpful in some cases. Despite usually being a second option for personality conditions, many falsely assume antipsychotic prescriptions are the hallmark of treatment.

Dialectical behavior therapy (DBT) is just one method of treatment that has been successful aside from prescribed medication. Combining cognitive behavioral methodology with concepts like greater mindfulness, community contribution, and increased distress tolerance, DBT offered moderate results, according to a 2010 report in the Journal of Consulting and Clinical Psychology.

The Importance of Accurate Information

Greater awareness and understanding can be crucial in helping those with BPD, and Stein highlighted the importance of making sure accurate information is widely available.

“Making accurate information available educates clients and their loved ones—friends, family, and partners—about the most appropriate treatments available for a particular condition, and helps to destigmatize mental health issues,” Stein said.

Myths and misconceptions can further delay individuals from finding a suitable form of treatment—leaving them to not only battle their internal challenges within, but also widespread presumptions and half-truths about the realities they face.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2. American Psychological Association. (n.d.). Dialectical behavior therapy for borderline personality disorder. Retrieved from http://psycnet.apa.org/
3. Borderline Personality Disorder. (n.d.). Retrieved from http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
4. Grant, B. F. (2008). Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder. Retrieved from http://www.psychiatrist.com/JCP/article/Pages/2008/v69n04/v69n0404.aspx
5. Kim, Y.-R., & Tyrer, P. (2010). Controversies Surrounding Classification of Personality Disorder. Psychiatry Investigation, 7(1), 1–8. http://doi.org/10.4306/pi.2010.7.1.1
6. Mayo Clinic. (n.d.). Borderline personality disorder. Retrieved from http://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/basics/treatment/con-20023204
7. Sansone, R. A., & Sansone, L. A. (2011, May). Gender Patterns in Borderline Personality Disorder. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115767/
8. Skodol, A. E. (2003). Why are women diagnosed borderline more than men? Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14686459
9. Winship, G. (2007, March 7). Perspectives on the prevalence and treatment of personality disorder. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2007.01057.x/abstract;jsessionid=78B565A67F721596E8B880A92698ECCD.f04t03?userIsAuthenticated=false
10. Zanarini, M. C. (2003, February). The longitudinal course of borderline psychopathology. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12562573

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