Is Borderline Personality Disorder a Serious Mental Illness?

Le, Hai MD
Hashmi, Ali MD
Czelusta, Kim-Lan MD
Matin, Asna MD
Moukaddam, Nidal MD
Shah, Asim A. MD

Hai Le, MD, is an Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Ali Hashmi, MD, is an Associate Professor, King Edward Medical University. Kim-Lan Czelusta, MD, is an Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Asna Matin, MD, is an Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Nidal Moukaddam, MD, is an Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Asim A. Shah, MD, is a Professor and the Executive Vice Chair, Menninger Department of Psychiatry and Behavioral Sciences; and a Professor, Department of Community and Family Medicine, Baylor College of Medicine.

Address correspondence to Hai Le, MD, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM350, Houston, TX 77030; email: [email protected].

Disclosure: The authors have no relevant financial relationships to disclose.

Psychiatric Annals 50(1):p 8-13, January 01, 2020. | DOI: 10.3928/00485713-20191203-02

Historically, the term serious mental illness (SMI) has referred to bipolar, schizophrenia, and severe depression, which are conditions that are well studied and discussed. Although there have been inconsistent definitions of SMI in the United States, the one with the broadest consensus is that of the National Institutes of Mental Health (NIMH), which includes personality disorders. Borderline personality disorder (BPD), one of the most common problems encountered in psychiatry practice, has distinctive characteristics and associated severe functional impairment that fits the NIMH definition of SMI. BPD can also lead to poor general health and lower life expectancy from causes such as suicide, substance abuse, and poor physical health. In this article, we explore the background of various definitions of SMI and why BPD should be classified as an SMI based on the definition set out by the National Institute of Mental Health. We also explore how BPD can develop into an SMI that makes early diagnosis and treatment imperative. Furthermore, we identify the issues of stigma and counter-transference that are routinely encountered by mental health providers and that can be barriers to appropriate treatment and optimal outcome. [Psychiatr Ann. 2020;50(1):8–13.]