Many therapists share the general stigma that surrounds patients with borderline personality disorder (BPD). Some even avoid working with such patients because of the perception that they are difficult to treat.

As reported in Social Science & Medicine last year, interviews with 22 mental health clinicians in the United States1 suggest that the BPD diagnosis “can sometimes operate as a cue to healthcare providers that they should anticipate this patient will be hard to work with,” and “some providers will avoid working with this patient group,” author Sandra H Sulzer, PhD, an assistant professor of sociology Xavier University in New Orleans, told Psychiatry Advisor. “This creates a series of cracks for patients to fall through–these patients have a medically recognized condition, and yet, they get treated as if they don’t entirely belong in our medical system.”

Clinicians may be apprehensive about the level of risk associated with symptoms of BPD, such as non-suicidal self-harm,and suicidal behavior, Shannon Sauer-Zavala, PhD, a research assistant professor at Boston University and director of the Unified Protocol Institute, told Psychiatry Advisor.

Additionally, relationship instability is a feature of BPD, and clinicians may be wary of patients with whom establishing a therapeutic bond could be difficult. They may also hold the mistaken belief that treatment is ineffective for BPD patients. Some providers who do see patients with BPD are not approaching diagnosis and treatment appropriately, recent data suggests.

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Research that appeared last year in European Psychiatry investigated how psychiatrists differentiate between bipolar disorder and BPD.2 The results show that in “only a minority of assessments were symptoms of mania or BPD sufficiently assessed to establish the presence or absence of each diagnosis,” the authors wrote. “The absence of reliable diagnostic practice has widespread implications for patient care, service provision and the reliability of clinical case registries.”