The BPD Perspective

During his Grand rounds presentation on March 4, Dr. John Maher, a Psychiatrist at Ontario Shores Centre for Mental Health Sciences (Ontario Shores), challenged the audience to look both sides of a situation.

“We need to think about perspective and how the world would be different looking at it from the other side,” said Dr. Maher, who discussed the topic ‘Crisis Junkies: Stereotypes Affecting Treatment of Patients with Borderline Personality Disorder’ to a standing room only crowd.

Patients with Borderline Personality Disorder (BPD) have a way of thinking in their personality disorder that is either too much or too little. It is an affective/emotional information system that has been shaped and integrated with extremes and deficiencies” necessary for human interaction and development, explained Dr. Maher.

We all learn to have emotional responses with a rationality of emotions in understanding ‘right vs wrong’ and what is an over or under reaction to an appropriate situation.  Unfortunately, patients with BPD struggle with their emotional affect and have a tougher time comprehending why kicking a dog may elicit a response different from their own for example.

In the healthcare field BPD patients have been impacted by the judgment of their behaviour rather than the understanding of their illness.  A BPD patient may have good intentions within a behaviour perceived as negative. Unfortunately, the judging of the behaviour is what they receive during treatment and unfortunately for them, they know when they lose the benefit of the doubt, even when their intentions were good.

The challenge for healthcare professionals is to differentiate the behaviour of these patients separate from intentions, but as part and parcel of the BPD condition. 

Treatment of people with BPD is challenging and considered untreatable by some clinicians. However, what seems to hold back the therapeutic benefits of treatment for BPD patients is the negative perception and stereotype clinicians can hold.  Beneficial therapeutic treatment and healing for BPD patients is very dependent on their clinician’s willingness to empathetically understand and realize that treatment can benefit their patient. 

“Patients are not likely to get better without experiencing an empathetic response from their clinician,” explained Dr. Maher.

BPD patients are not junkies of any sort; they are simply trying to reduce emotional pain in the best way their affective and emotional information system has taught them.