Every year, millions of individuals are diagnosed with mental illness. As they endure the ongoing challenge of coping with their disorder, several are plagued by the additional challenge of navigating a world that continues to stigmatize mental illness. There has certainly been a meteoric rise in mental health awareness over the last few years, but mental illness is still often misunderstood. This is especially true for disorders that are considered to be severe and/or rare, such as Borderline Personality Disorder (BPD), and Schizophrenia.
Even for the most widely-known disorders like anxiety and depression, most individuals overestimate how much they understand about mental illness. Depression is not just being sad; anxiety is not just feeling nervous; OCD is not just wanting things to be clean; schizophrenia is not just hearing or seeing things. Researchers, psychologists, educators, medical doctors, and other professionals have spent several years delving into the nuances of mental illnesses, and still, several questions remain unclear. So, while it is a positive thing that the general public is becoming more aware of mental health, the importance of tending to it, and the prevalence of mental illness all around us, it is important to remain curious about all mental illness to avoid enabling damaging myths and half-truths.
In the spirit of Mental Illness Awareness Week, we will discuss two of the most misunderstood mental illnesses: schizophrenia and borderline personality disorder. This blog will provide introductory information about each disorder and debunk some of the most common myths associated with each disorder.
What is it?
Schizophrenia is a mental disorder characterized by a loss of contact with reality. Those with schizophrenia may experience several combinations of positive and negative symptoms. “Positive” refers to the presence of something – examples include hallucinations, delusions, and disorder thoughts and/or actions. In contrast, “negative” symptoms refer to the absence of something – examples include anhedonia (lack of pleasure), social withdrawal, and lack of concentration.
- Schizophrenia is a split personality disorder.
Perhaps most telling of how misunderstood schizophrenia is, is the myth that it is synonymous with Dissociative Identity Disorder (DID) – previously known as multiple personality disorder. This, of course, is not the case as they are separate disorders altogether. Schizophrenia is characterized by the abnormal interpretation of reality, whereas DID is characterized by the presence of two or more distinct personalities within one individual. While someone with schizophrenia may hear voices in their head, it does not mean that they identify with them.
- Schizophrenia is caused by bad parenting and/or childhood abuse.
While the exact cause of schizophrenia is still unknown, there is no evidence to suggest it is caused by poor parenting. Mental health professionals have several theories that largely involve the interaction of genetic and environmental factors. One theory suggests schizophrenic behavior is influenced by a chemical imbalance in the brain, specifically involving dopamine. Twin studies also suggest genetics play a role in developing schizophrenia, as blood-related family members are more likely to develop schizophrenia than non-blood related.
- People with schizophrenia are violent and dangerous.
The goal of movies and TV shows is to engage their audiences with exaggerated, compelling stories, and this extends to their portrayal of mental illness. The assumption that people with schizophrenia – or any mental illness for that matter – are violent and dangerous is harmful and largely contributes to the stigma that continues to surround mental illness. In reality, schizophrenia does not present the same in every person who has it and there is a wide spectrum of symptom severity. The extreme is not the norm and the majority of people with schizophrenia are not violent. In fact, they are more likely to be victims of violence than perpetrators because of their nonadherence to many social norms.
- There is no treatment for schizophrenia.
Though there is no definitive cure for schizophrenia, there are certainly methods of treating the disorder. The most common form of treatment for those with schizophrenia is antipsychotic medication like aripiprazole and clozapine. These work to improve the chemical imbalance of dopamine in the brain and help to alleviate some of the more severe symptoms, such as hallucinations and delusions. In addition to medication, many people with schizophrenia also benefit from psychotherapy (talk therapy), such as cognitive behavioral therapy (CBT), which can help them to cope with their symptoms and work on restructuring their life.
- Those with schizophrenia cannot function normally in society and require long-term hospitalization.
Though schizophrenia may be harder to treat in some individuals who aren’t even aware they’re displaying schizophrenic symptoms, the disorder is still ultimately treatable. Some individuals with persistent schizophrenia may benefit from temporary hospitalization, but the model for treating schizophrenia has largely moved toward focusing on outpatient treatment. In fact, studies suggest that empowerment and psychosocial support from a schizophrenic individual’s environment outside of hospitalization are important components of the recovery process. The National Alliance on Mental Illness estimates as many as half of the 2 million Americans with schizophrenia can improve significantly or even recover fully if they receive treatment.
Borderline Personality Disorder
What is it?
Borderline personality disorder (BPD) is a mental disorder that impacts the way an individual feels about themselves and others. It severely impacts a person’s ability to regulate their emotions and is characterized by impulsivity, mood swings, and an extreme fear of abandonment or instability. People with BPD often perceive things in extremes – all good or all bad. Other signs and symptoms of BPD include engaging in impulsive and reckless behavior (spending sprees, substance abuse, unsafe sex, etc.), self-harming behavior, feelings of dissociation, chronic feelings of emptiness, and an unstable self-image or sense of self.
- Borderline personality disorder is synonymous with bipolar disorder.
BPD and bipolar disorder are two distinct mental disorders. While both mental disorders involve wide mood swings, they differ in a few key ways. There are actually three main variations of bipolar disorder – bipolar 1, bipolar 2, and cyclothymic disorder – and each involve a different combination of manic, hypomanic, and depressive episodes. In contrast, borderline personality disorder does not have any variations based on mood states. Also, while the wide mood swings those with BPD display typically last a few hours, mood episodes of those with bipolar disorder can last a few days, weeks, or months.
- Borderline personality disorder is rare and only females develop the disorder.
Contrary to popular belief, BPD is actually one of the more common severe mental disorders. Nationwide epidemiologic studies estimate the point prevalence of BPD in the United States is about 1.6% in the general population with a lifetime prevalence of 5.9%. Furthermore, patients with BPD compose approximately 11% of the psychiatric outpatient population and as much as 20% of the psychiatric inpatient population. Though the ratio of BPD prevalence in females to males is 3:1 in the clinical setting, challenging studies have found no significant difference in rates of BPD between males and females in the general population. Some mental health professionals contend that BPD may be overdiagnosed in the female population and underdiagnosed in the male population as a result of lasting gender bias.
- People with borderline personality disorder are manipulative attention-seekers.
As previously mentioned, BPD is characterized by a hypersensitivity to abandonment or rejection. This typically results in desperate attempts to prevent abandonment, which may be misunderstood and perceived by others as intentional manipulation. People with BPD may not necessarily be looking for attention, but rather a way to avoid being alone.
- Individuals with borderline personality disorder are not treatable.
Those with BPD may get labeled as egocentric, help-rejecting complainers who don’t actually want help as a result of the impulsive, potentially self-damaging behavior they may display. However, data suggest there is a good prognosis for individuals with BPD. A longitudinal study of 290 inpatients diagnosed with BPD found remission rates to be 35% after 2 years, 91% after 10 years, and 99% after 16 years. Furthermore, once remission was achieved, it was sustained for over eight years in 75% of patients.
- Those with borderline personality disorder can’t maintain healthy relationships.
It’s not that people with BPD can’t maintain healthy relationships, but rather that the fear of abandonment is so strong that it may present extra challenges in the development and maintenance of long-term relationships. When someone with BPD perceives even the slightest hint of rejection, they may react in an extreme or disproportionate manner in order to avoid being abandoned. This, in turn, often pushes people away. With treatment, however, many people with BPD are able to develop and maintain long-lasting, healthy relationships.
Mental illness is still largely stigmatized and misunderstood – especially severe disorders like schizophrenia and borderline personality disorder. Each mental illness is complex and nuanced, and there is still much we are learning about them every day. We hope debunking some of the most common myths about schizophrenia and borderline personality disorder has helped you better understand some of the most misunderstood disorders. We will continue to work to break down the stigma surrounding mental illness and provide support for those affected by these conditions.