Dear Editor,
This letter is in response to the article written by Meshkinyazd, Bordbar and Heydari.[1] Through qualitative research with caregivers of people diagnosed with borderline personality disorder, the authors demonstrate the distressing experiences of stigma and discrimination both clients and caregivers endure in relation to a diagnosis of borderline personality disorder. Within their discussion, the authors pose that nursing education should include training about social stigma to support caregivers of those with mental illness. This proposed approach is a critical first step: yet potentially not fully adequate to address stigma in borderline personality disorder.
Meshkinyazd et al.[1] provide evidence regarding stigma experienced by clients from healthcare professionals; experiences that are, unfortunately, commonplace for clients across the world.[2] While social stigma from the general population can be related to any psychiatric label, stigma from healthcare professionals is more specific to borderline personality disorder as a diagnosis itself.[3] Indeed, there are higher rates of stigma and discrimination from health professionals than from the general public in relation to borderline personality disorder, likely due to the interpersonal elements of the disorder and inadequate support for staff.[3]
Despite extensive research demonstrating the positive effects of staff training programs and support when caring for clients diagnosed with borderline personality disorder, access to such resources remains limited internationally due to funding and other constraints.[4] These deficiencies impede health professionals’ empathetic development and clients’ access to adequate support, thereby compounding social and institutional stigma and discrimination of those with the disorder.[5] While providing specific education regarding borderline personality disorder, treatment options and stigma should be a focus of educational and health institutes, this approach requires reinforcement with ongoing follow-up support through clinical supervision to reduce the likelihood of staff reverting to their previous practices and attitudes.[5] Only through this ongoing support will we see a shift in staff attitudes and ability to support caregivers and clients with borderline personality disorder, including their experiences of social stigma.
Financial support and sponsorship
Applied Research Training Scheme through Nelson Marlborough Institute of Technology, funded by Unitec Institute of Technology, Auckland, New Zealand 2021
Conflicts of interest
Nothing to declare.
References
- 1.Meshkinyazd A, Bordbar MF, Heydari A. Experiences of family caregivers of patients with borderline personality disorder of social stigma. Iran J Nurs Midwifery Res. 2021;26:18–24. doi: 10.4103/ijnmr.IJNMR_267_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Day NJ, Hunt A, Cortis-Jones L, Grenyer BF. Clinician attitudes towards borderline personality disorder: A 15-year comparison. Personal Ment Health. 2018;12:309–20. doi: 10.1002/pmh.1429. [DOI] [PubMed] [Google Scholar]
- 3.Aviram RB, Brodsky BS, Stanley B. Borderline personality disorder, stigma, and treatment implications. Harv Rev Psychiatry. 2006;14:249–56. doi: 10.1080/10673220600975121. [DOI] [PubMed] [Google Scholar]
- 4.Dickens GL, Lamont E, Gray S. Mental health nurses’ attitudes, behaviour, experience and knowledge regarding adults with a diagnosis of borderline personality disorder: Systematic, integrative literature review. J Clin Nurs. 2016;25:1848–75. doi: 10.1111/jocn.13202. [DOI] [PubMed] [Google Scholar]
- 5.Gray SM. New Zealand: University of Auckland; 2021. Factors influencing care of clients diagnosed with borderline personality disorder: A mixed methods study in a New Zealand mental health service [thesis] [Google Scholar]