Stigma perpetuation at the interface of mental health care: a review to compare patient and clinician perspectives of stigma and borderline personality disorder

Background: People with borderline personality disorder (BPD) experience significant stigma, particularly at the interface of care delivery. Aims: To compare and contrast what stigma looks like within mental health care contexts, from the perspective of patients and mental health professionals (MHPs) and how it is perpetuated at the interface of care. Method: A review of the literature was undertaken to compare the experiences of stigma towards BPD from the patient and MHP perspective by thematically analysing the results from empirical studies exploring their experiences. Results: Thirty studies were found; 12 on patients perspectives and 18 on clinicians perspectives. Six themes arose from the thematic synthesis: (1) stigma related to diagnosis and disclosure; (2) perceived un-treatability; (3) stigma as a response to feeling powerless; (4) stigma due to preconceptions of patients; (5) low BPD health literacy and (6) overcoming stigma through enhanced empathy. A conceptual framework for explaining the perpetuation of stigma and BPD is proposed. Conclusion: Stigma towards people with BPD is perpetuated through poor BPD health literacy by patients and MHPs that stalls effective treatment and engagement, and disempowers all concerned, deferring responsibility to others. Addressing this stigma requires multiple strategies that include more targeted education, advocacy and leadership.