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Borderline Personality Disorder Label Creates Stigma
Finding A New Name
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What's in a name? In the disability community this question is a hot topic. In fact, the use of negative language has proven time after time to be a major influence on individual and public attitudes towards people with disabilities and as Dahl asserts often constitutes "a major barrier for people with disabilities".³ However, despite progress being made to use less stigmatizing disability terms, psychiatry has not kept up with these changes. Borderline Personality Disorder, listed in the Axis II section of Diagnostic and Statistical Manual (DSM IV), is an example of one such term and the focus of this paper.⁴

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The DSM IV defines BPD as "a pervasive pattern of instability of interpersonal relationships, self-image, and effects, and marked impulsivity beginning by early adulthood ...".⁴ The mental health disability causes extreme emotional vulnerability, an unstable sense of self, impulsiveness in potentially self-damaging behaviors (e.g., spending, sex, substance abuse, driving, eating, etc.), suicidal or self-mutilating behavior, chronic feelings of emptiness, intense anger or difficulty controlling anger, and periods of feeling removed from reality (dissociation).

This paper will discuss the negative connotations of the term "BPD", examine the origin of the term, the effects it has on treatment and ways the term shapes both individual and public perception of people diagnosed with the disorder. In addition, the paper will explore whether or not the term is an acceptable use of language based on current terminology standards outlined in the government publication "Worthless or Wonderful".¹⁵ Finally, it will propose recommendations for changing the name and identify recent progress towards this goal.

Origin

The origin of the term "BPD" dates back to the early 1900's. At this time people with mental health disabilities were either categorized as neurotic or psychotic. ¹³ As it became increasingly clear to Dr. Stern (an early psychiatrist) that a growing patient body did not quite fit into these oversimplified diagnostic categories of the day, the term "borderline" was born. According to Dr. Stern's theory, such patient's teetered on the "borderline" between neuroses and psychoses. Although this theory went out of favor shortly after it was proposed, the "borderline" label stuck. ²

Inaccuracy

Dr. Leland Heller (M.D), an expert in BPD treatment, believes the BPD term is inaccurate and that the 'BPD' label "in and of itself is as if the whole person (and the personality) is flawed ...".⁷ He strongly objects to this implication because the most recent research on BPD indicates that the cause of the disorder is not a "flawed personality" but rather a biologically based brain disorder. He believes there is a dysfunction of the limbic system of the brain.⁷ Heller backs up his objection to the term with recent research on the biological components of BPD.

Evidence linking BPD to a limbic system dysfunction is based on current knowledge regarding the function of the limbic circuit and studies examining the biological causes of the disorder. The limbic system, itself, is often thought of as the "emotional centre" of the brain. ¹ The amygdala and hippocampus are important components of the limbic system that regulate emotional expression, especially fear, rage and automatic reactions (such as impulsive behaviors) and emotional memory. Although not formally part of the limbic system itself, the pre-frontal cortex (located near the forehead) is another important structure thought to play a key role in emotional regulation. Both areas of the brain have been the subject of a number of studies examining the neurological origin of BPD. For example, studies examining the connection between BPD and neuroanotomical differences in limbic system found that the volume of the hippocampus and amygdala were respectively, 16 percent and 7.5 percent smaller in the BPD group than those in the control group (people without any form of mental illness). ⁵ It is hypothesized that these differences may be related to prior abuse experiences, a common issue for people diagnosed with BPD. However, more research is required to prove this theory.

Another study by Paul Soloff, M.D. and his associates found a connection between BPD and low level brain activity in the pre-frontal cortex. Using Positron Emission Tomography (PET) scans, researchers can measure glucose levels to detect brain activity Low glucose levels have been connected to deficiencies in serotonin, a naturally occurring chemical in the brain that helps regulate emotion. In this study, Soloff established two groups. The first group comprised of BPD patients, while the second group, served as the control group made up of participants with no history of mental illness. Subjects from both the BPD group and the control group were either given the serotonin-enhancing drug, Fenfluramine or a placebo. Under both conditions, researchers consistently observed higher level glucose activity in the frontal lobes of control participants than those in the BPD group. ¹²

These biological explanations for BPD substantiate Heller's belief that BPD is in fact a biological disorder, and not just a personality flaw.

Disorders - Borderline Personality Disorder