Aviram Ron B, Brodsky Beth S, Stanley Barbara
New York State Psychiatric Institute, New York, NY 10023, USA.
Harv Rev Psychiatry. 2006 Sep-Oct;14(5):249-56. doi: 10.1080/10673220600975121.
Borderline personality disorder (BPD) is often viewed in negative terms by mental health practitioners and the public. The disorder may have a stigma associated with it that goes beyond those associated with other mental illnesses. The stigma associated with BPD may affect how practitioners tolerate the actions, thoughts, and emotional reactions of these individuals. It may also lead to minimizing symptoms and overlooking strengths. In society, people tend to distance themselves from stigmatized populations, and there is evidence that some clinicians may emotionally distance themselves from individuals with BPD. This distancing may be especially problematic in treating patients with BPD; in addition to being unusually sensitive to rejection and abandonment, they may react negatively (e.g., by harming themselves or withdrawing from treatment) if they perceive such distancing and rejection. Clinicians' reactivity may be self-protective in response to actual behavior associated with the pathology. As a consequence, however, the very behaviors that make it difficult to work with these individuals contribute to the stigma of BPD. In a dialectical relationship, that stigma can influence the clinician's reactivity, thereby exacerbating those same negative behaviors. The result is a self-fulfilling prophecy and a cycle of stigmatization to which both patient and therapist contribute. The extent to which therapist distancing is influenced by stigma is an important question that highlights the possibility that the stigma associated with BPD can have an independent contribution to poor outcome with this population. A final issue concerns the available means for identifying and limiting the impact of stigmatization on the treatment of individuals with BPD.
边缘性人格障碍（BPD）在心理健康从业者和公众眼中往往被视为负面形象。这种障碍可能带有一种污名，其程度超过了与其他精神疾病相关的污名。与BPD相关的污名可能会影响从业者对这些个体的行为、思想和情绪反应的容忍度。它还可能导致对症状的轻视和对优势的忽视。在社会中，人们往往会与有污名的群体保持距离，并且有证据表明，一些临床医生可能会在情感上与患有BPD的个体保持距离。这种距离在治疗BPD患者时可能尤其成问题；除了对拒绝和抛弃异常敏感外，如果他们察觉到这种距离和拒绝，他们可能会做出消极反应（例如，伤害自己或退出治疗）。临床医生的反应可能是对与该病理相关的实际行为的自我保护。然而，结果是，正是这些使与这些个体合作变得困难的行为导致了BPD的污名。在一种辩证关系中，这种污名会影响临床医生的反应，从而加剧那些相同的消极行为。结果是一个自我实现的预言和一个污名化的循环，患者和治疗师都对此有所促成。治疗师的距离感受污名影响的程度是一个重要问题，它凸显了与BPD相关的污名可能对这一群体的不良治疗结果有独立影响的可能性。最后一个问题涉及识别和限制污名化对BPD个体治疗影响的可用方法。
