Understanding Borderline Personality Disorder

6- 10 million Americans are afflicted with BPD

By Ethan Elgin

I don’t know how many times I’ve heard a psych nurse say, “Oh man, we're getting another borderline.” To the layperson, this would make absolutely no sense, but to me, I knew what it meant. It meant a war within the hospital staff. A war of treatment and an uncertain outcome for the patient.

Let’s face it; one of the most controversial and potentially stigmatizing psychiatric disorders is Borderline Personality Disorder (BPD). First introduced in 1994 in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, (DSM IV) mental health workers have strived for common ground on how to treat patients with this diagnosis.

More info on BPD criteria can be found here.

Often times, the divide, even among particular staff in hospitals, is so great that they debate the validity and even the existence of such a disorder. This can ultimately lead to doing greater harm than good in such a patient who exists in this grey area of stigma.

In an inpatient setting, what makes this most difficult for staff and doctors to get around is the fact that many times these patients engage in self destructive behavior as a direct result of staff interaction (however self-interpreted by the patient). Meaning, to test how much one cares about their current given situation. This is displayed usually by such acts as cutting, head-banging, staff splitting (pitting one staff member against another), or destruction of property.

All of this culminates in looking past the fact that these patients are typically terrified of being in a locked unit, probably waited more than eleven hours in the ER to be seen, have a significant history of emotional, physical and/or sexual abuse, and many times can, in fact, be truly suicidal.

As a society, we tend to overlook the histrionics of an individual as “attention seeking” and especially in an emergency room setting where decisions are, in fact, life or death, these actions usually displayed by a person with BPD are often overlooked; and, in my experience, sometimes to the detriment of the patient.

What I would hope to see happen, in this day and age where personality disorders are increasingly becoming a deep staple of mental illness, is that doctors and intake personnel at hospitals read the literature more carefully; that they begin to hold in-services and take charge of a greater understanding of that which cannot be physically seen, but only heard by an often times cynical ear.

In recent years, steps have begun to be taken to recognize and take more seriously Axis II disorders, but speaking from one who has worked in that setting, it takes far more than simply going through the motions of setting up a care program at the responsibility of people afflicted with this disorder. It takes putting aside the cynicism and stepping up the compassion; in time you’ll notice that even the smallest bit of validation can go a long way towards saving a life.