Borderline Personality Disorder: Why We Need to Start Talking
An illness which strikes fear into the heart of clinicians, mislabelled and misunderstood, in the silence of stigma, we need to speak out.
Borderline Personality Disorder is, after all, an illness that is fortified by loneliness and isolation, which makes it that much harder to overcome. Despite affecting roughly 1% of the general population, no one wants to admit to it. Perhaps because of the alarming symptoms which evoke terror and revulsion in the most compassionate of hearts: 10% of those with the BPD will commit suicide. A further 70% will have attempted suicide at least three times in their life, and 90% of sufferers will engage in self-damaging behaviour, including cutting, burning, drug and alcohol abuse, and overdosing.
the suicide risk is 800% higher than the general population.
the annual cost to the NHS from Borderline Personality Disorder is estimated at £61.2 million. Each person with the diagnosis of BPD is estimated to cost £3000 per annum, but this can rise to £14 000 if the patient requires inpatient treatment and a bed at a hospital. BPD sufferers account for 50% of all mental health service users. 42,000 inpatient beds at psychiatric facilities are given to people with BPD. hospital admissions to A & E are over 1000 per year. And 20% of prisoners on remand will have symptoms which warrant a diagnosis. Despite these statistics, only 17% of mental healthcare trusts across the country have a personality disorder service. This figure today, is likely to be declining due to significant cutbacks in government funding. A staggering 28% of local councils provide no service at all. The social and economic costs of BPD are astronomical! But, before complaining about the taxpayers’ burden and hard-earned wages being spent, there are some important things to consider.
people with borderline personality disorder have almost always experienced some form of extreme childhood trauma, including violent abuse (71%), sexual abuse/rape (68%), and witnessing serious domestic violence (62%.)
Many experts see BPD as a form of PTSD. Emotional dysregulation and behavioural instability, are a reflection of a lifetime’s worth of suffering, but it hits young people the hardest because they have not lived enough to counterbalance bad experiences, with positive ones. Yet, sufferers of BPD are not attention-seekers despite often being cast in a pejorative light by psychiatrists and laypeople alike. Problematic behaviours and intense use of medical services are often the result of extreme emotional distress. Self-destructive acts like overdosing, cutting, burning, or suicide attempts, seem so contrary to our life-drive, and the label ‘Borderline’ itself, stokes the fear and stigma. And yet this evocation of savage gods of death and despair serves a purpose: They help regulate emotions and provide a desperate means of communication to the outside world.
As well as this psychological explanation, Borderline Personality Disorder, has a neurological basis. Brain scans reveal structural abnormalities in the prefrontal cortex, amygdala and hippocampus, primary areas that regulate emotion, impulsivity and cognition.
However, revolting or scary BPD patients appear, they are often doing their best with the impoverished skills they have. Renowned Psychologist Marsha Linehan likens those suffering from BPD as psychological ‘burn victims,’ that left untreated, experience such a great deal of pain that their life is unlivable. However, sufferers can be treated, and can recover, yet in order for this to happen, compassion is a prerequisite. we still have the outdated view of pulling your socks up, and it is time we change our views and recognise the illnesses that remain hidden because we closet them.
We wouldn’t complain about the economic implications of autism, yet when it comes to BPD patients are often vilified.
While medication is shown to have little effect on Borderline Personality Disorder, psychotherapy has gained positive results. Both Dialectical Behaviour Therapy and Transference Focused Psychotherapy, have empirically validated benefits, with most clients reporting a significant improvement in their everyday lives. The conclusion is this: BPD destroys lives and families. The personal cost is unfathomable, but the economic cost can be quantified. Seen together, it is clear the mental health service needs to get their act together and treat this disorder as a legitimate medical problem, and one that can be treated and even prevented. The cost of ignoring it is a too a greater price to pay; for individuals, families, and society. It is in the public interest to treat this disorder, but it is in all our interests to be compassionate towards it. And the good news is this:
80% of BPD patients will experience a remission in their lifetime. In other words, 8 out of 10 people recover completely.
Somewhere an adolescent girl is lying in a hospital bed with cuts to their arms, an adolescent boy is hooked up to a saline drip after taking an overdose, a prisoner is screaming in his cell, and a tramp lies inebriated in drink. At the moment, they too are just another statistic. And I for one don’t want to be another statistic!
