By Nicole Roder, LCSW-C
Did you know that clients with borderline personality disorder are over-represented in all levels of mental health care?
Nicole Roder, LCSW-C
Research shows that about 20 percent of all patients admitted to psychiatric hospitals meet criteria for BPD, as well as 10 percent of people seeking outpatient mental health treatment.
As a DBT therapist, I specialize in treating these folks, who come to me desperate for help with changing their suicidal behaviors and dysregulated emotions. For clinical social workers, this means that we will almost definitely encounter a client with BPD at some point in our careers.
Unfortunately, despite the high prevalence of individuals with BPD in our client populations, many social workers misunderstand the diagnosis. Most of my clients have told me that their past providers seemed to dislike them, blamed them for their painful emotions, or even unilaterally discharged them without warning.
Myths and Facts About BPD
It’s true that BPD is difficult to treat, especially without specialized training and an accurate understanding of the disorder. My hope is that, by dispelling certain myths about BPD, this article can help social workers combat the structural stigma that surrounds this diagnosis and advocate for better treatment of clients with BPD.
Myth: BPD is untreatable.
Fact: Many people with BPD recover.
There are several treatments that have been shown to be effective in treating BPD. The most well-researched is Dialectical Behavior Therapy (DBT), which is what I practice. I work for a DBT-Linehan Board of Certification, Certified Program that includes individual therapy, a weekly skills group, and between-session phone coaching. I have personally treated many people with BPD who have fully recovered. I’ve seen people go from frequent suicide attempts and having raging fights with loved ones to living full and satisfying lives.
Myth: BPD can’t be diagnosed in children or teens.
Fact: BPD can be diagnosed at any age.
I’ve treated quite a few adolescents with BPD. There is nothing in the DSM that requires clinicians to wait until a client is an adult to give the diagnosis, as long as the symptoms have been present for at least a year and are not better explained by normal development or another disorder. In fact, BPD symptoms (which you can find below) often first appear during the teen years, and diagnosing a client early can help them get access to treatment.
Myth: People with BPD are manipulative and impossible to work with.
Fact: People with BPD are doing the best they can.
I have gained so much from my clients. When someone has untreated BPD, it is true that they often experience uncontrollable emotions and behaviors. They might feel intense sadness, fear, shame, or anger and engage in disruptive behaviors like self harm or isolation. When they behave this way, their therapists and loved ones might feel manipulated, but feelings aren’t facts. The truth is that they are using these behaviors to relieve their painful emotions. Figuring out and changing the causes of behaviors works better than judging and blaming.
Hopefully, learning about these myths and facts will help social workers show empathy to their clients with BPD and refer to effective treatment when necessary.
Nicole Roder, LCSW-C, DBT-LBC, is a bilingual, DBT-Linehan Board of Certification certified therapist in Columbia, MD. Find her online at https://www.gladstonepsych.com
