Stigma, Compassion, and Recovery in Borderline Personality Disorder

Stigma plays a significant role in shaping how people with Borderline Personality Disorder (BPD) relate to both themselves and others. While much has been written about the damaging effects of stigma, its impact on compassionate acts, whether showing compassion to oneself, to others, or accepting it, remains underexplored. Yet compassion is critical for recovery, helping to foster social connection, emotional resilience, and well-being. If stigma prevents people with BPD from accessing these benefits, we need to take notice.

In a recent paper, I explore how stigma, public, institutional, and internalised, creates barriers that discourage people with BPD from engaging in compassion. These barriers are not simply personal struggles; they are embedded in societal structures and reinforced by harmful misconceptions. Addressing them is not just about promoting kindness; it is about removing a major obstacle to recovery.

How does stigma limit compassion?

Public stigma, rooted in societal attitudes, portrays people with BPD as manipulative, unstable, or even dangerous. These stereotypes do not just shape opinions, they affect how individuals with BPD are treated. Media portrayals and casual conversations reinforce the idea that they are difficult or untrustworthy, leading to social exclusion. Given that interpersonal struggles are already a core challenge for people with BPD, this exclusion only deepens their difficulties in forming meaningful, compassionate connections.

Institutional stigma is equally harmful. Many mental health professionals view BPD as a "difficult" diagnosis, leading to frustration or reluctance to treat individuals with the disorder. Service users often report their distress being dismissed as attention-seeking; having care withheld; or even being told they are beyond help. If mental health services themselves communicate that individuals with BPD are not worthy of compassion, it is not surprising that many disengage from seeking help altogether.

Then there is self-stigma: the internalisation of these negative messages. People with BPD frequently struggle with low self-worth and intense self-criticism. When the world reinforces the idea that they are undeserving of kindness, self-compassion becomes even more difficult. If you believe you are broken or unworthy, how likely are you to be kind to yourself? How likely are you to believe others’ kindness is sincere? For many, the answer is: not very.

Compassion and recovery

Yet research consistently shows that engaging in compassionate acts, towards oneself, towards others, or accepting compassion from others, can improve mental health, reduce distress, and promote recovery. So how do we dismantle the barriers preventing people with BPD from accessing these benefits?

Challenging public stigma requires changing how we talk about BPD. The harmful stereotypes surrounding the diagnosis must be replaced with a more accurate understanding. People with BPD are not manipulative or untreatable; they are individuals navigating profound emotional distress, often shaped by trauma.

Tackling institutional stigma means changing attitudes in mental health services. Clinicians need training to approach BPD with the same empathy and evidence-based care as other conditions. No one should be denied appropriate treatment because of their diagnosis.

Addressing self-stigma is perhaps the most complex but crucial step. Interventions such as compassion-focused therapy can help individuals with BPD develop self-kindness and challenge the belief that they are undeserving of care. Encouraging social connection in spaces where they feel accepted can also counteract the isolating effects of stigma.

The bigger picture

The barriers to compassion that people with BPD face are not just individual struggles; they reflect a deeper societal issue. When certain individuals are treated as less deserving of care and kindness, their path to recovery becomes exponentially harder. If we are serious about supporting people with BPD, we must take stigma seriously. More than that, we must recognise that fostering compassion, both towards and from individuals with BPD, is not just ethically important, but a necessary step in dismantling the obstacles that stand in the way of recovery.

Catrin Street-Mattox is a PhD researcher in psychology at the University of Birmingham, exploring the relationship between challenging social experiences and compassionate engagement for individuals with borderline personality disorder (BPD). Before beginning her doctoral studies, she was a specialist further education lecturer, supporting students with mental health conditions and special educational needs. Her academic interests lie at the intersection of psychology, philosophy, and mental health reform, particularly in addressing stigma and improving care systems. More about her research can be found here, and those interested in participating in her BPD study can visit bpd.cesmresearch.com.

Affective injustice and borderline personality disorder

Borderline personality disorder (BPD) is a contentious and heavily stigmatized diagnosis. This is something one cannot help but become acutely aware of when navigating the healthcare system with a BPD diagnosis. We are stereotyped as attention-seeking, manipulative and intentionally antagonistic. Such stereotypes and beliefs about people with this diagnostic label inevitably influence clinical encounters. Moments after being diagnosed, a well-meaning nurse encouraged me not to disclose my diagnosis if I were ever to seek private psychotherapy. Some therapists, he noted, simply refuse to work with people diagnosed with BPD.

I am particularly concerned with how diagnostic criteria for BPD may interact with negative stereotyping in particularly harmful ways. One of the nine diagnostic criteria (of which five are required) for BPD listed in the DSM-5-TR is display of ‘Inappropriate, intense anger or difficulty controlling anger’. This criterion is notably wide and stated examples range from extreme sarcasm to recurrent physical fights. The openness of the criterion is not in itself a bad thing, it may even be necessary for clinicians to apply it to individual persons with unique and complex ways of being in the world. The danger is that such openness can increase use of stereotyping that can lead to situations wherein our anger is dismissed – from the outset – as inappropriate and pathological.

Initially, this may seem like a case of testimonial injustice – roughly, a form of epistemic injustice wherein someone’s standing as a knower and credible testifier is undermined due to negative prejudices about their identity. For example, the idea that people diagnosed with BPD are purposefully hostile could lead clinicians to make biased assessments of the legitimacy and proportionality of our anger.

The ‘problem’ with anger, however, is that it is not clear that what we are dealing with are claims to knowledge and, consequently, that prejudice-driven dismissals of anger as inappropriate or pathological always involve an epistemic wrong. Imagine a case where negative stereotypes lead clinicians to assume that (nearly) all anger experienced and expressed by someone with a BPD diagnosis is inappropriate and pathological. Even in instances where the anger may indeed be inappropriate because it involves or is based on an incorrect belief, the fact that such anger is met with an assumption of (a pathological kind of) inappropriateness seems wrong. It is not clear to me that this wrong is epistemic.

Mit liv (My life in Danish) by Leif Hakon Olesen, from a collection (Livsbilleder, 1995) of painting and poetry made by service users at the social institution Basen that operated in the Danish town of Aarhus in the 1990s.

Instead, it may be a distinctly affective wrong, a form of affective injustice. Affective injustice has been defined as the phenomenon whereby people are wronged as feeling or affective beings. It may, for example, occur when racialised people’s anti-racist anger is dismissed as counterproductive to constructive debate, in turn, putting them in a normative conflict between their apt emotional responses to racial injustice and desire to better their situation.

It may also occur, I would argue, when the affective experiences of people diagnosed with BPD are viewed through a lens of pathology and negative stereotypes to a degree that makes it incredibly hard (if not impossible) to have our anger be seen as genuine and sometimes appropriate reactions to past trauma, neglect, discrimination and apathy.

Astrid Fly Oredsson is a self-described PhD drop-out with formal training in philosophy and lived experience of navigating various healthcare systems with a BPD diagnosis. 

Her research interests lie in topics such as psychiatric diagnoses, emotional experience and epistemic and affective injustice.