Borderline personality disorder (BPD) is a major social problem about which little
empirical research has been done. Individuals with this diagnosis, who are approximately 75% female, are highly stigmatized in society, do not readily respond to treatment, and are at very high risk for completed suicide. Between 8% and 10% of individuals, who
currently have a diagnosis of BPD, will eventually commit suicide (APA, 2000;
Gunderson, 2006; Oldham, 2006). This suicide rate is 50 times higher than the rate in the general population (Skodol, 2005; McKeown, Cuffe & Schultz, 2006).
There is a near-consensus among treatment providers and researchers that BPD is still not well understood and that further research is needed.
The aim of this qualitative study was to examine the subjective experience of
women in treatment for BPD. Results indicated that the research participants identified with many of the diagnostic criteria for BPD described in the DSM-IV-TR (APA, 2000), as well as
in other professional literature. Part of their narrated experience that has been less emphasized by the BPD treatment literature, however, was their subjective experience of shame.
Shame has been defined in professional literature as “a global, negative evaluation of the entire self” (Tangney et al., 1996); “a self-conscious emotion, similar to self-hate, involving a belief . . . that one’s own person is immoral or disgusting”
(Tangney & Dearing, 2002).
Many participants in this study made statements such as “people think I’m crazy” and “the hospital staff made me feel like I was real dirty”, indicating the stigma they felt from other people. They also evidenced self-stigma, with statements such as “I feel like a
failure”, “I feel worthless”, or even, “I hate myself”, indicating that they had internalized an extremely negative view of themselves.
The experience of shame often has destructive consequences including: a sense of isolation; impulsivity; refusal to seek or follow through with treatment; self-mutilating behavior; and, most importantly, suicidal behavior (Crowe, 2004). Indeed, at least three studies have shown that a significant proportion of deliberate overdoses have occurred while the individual was experiencing shame-related thoughts and emotions.
The findings have implications for treatment of women with BPD, particularly in order to lower their risk for suicide. Although these research participants voiced many
feelings related to shame, the analysis was cross-sectional and the sample size was small; thus one must be cautious about its generalizability.