There are some problems and difficulties when treating BPD that hopefully can be reduced or eliminated with further research and government funding.
- Until recently, doctors were taught that BPD is unchangeable and largely un-treatable. Working with BPD patients was seen as challenging, frustrating and futile, so doctors would not diagnose patients with BPD properly or they might refuse to treat them.
- There are not enough specially-trained clinicians, therapists, and medical professionals to treat all the people, so waiting lists can be long. This is compounded by therapist burnout leading to abandoning therapy with the patient, which DBT tries to avoid by having a team of clinicians treating each patient.
- The waiting list for the STAT DBT program in Winnipeg is 3-6 months long and the CAMH Borderline Personality Disorder Clinic in Toronto (as of January 16, 2024) is closed to new referrals. A documentary called “The Diagnosed” said the waiting list for DBT is up to 2 years long in the United Kingdom.
- The treatment process is slow and episodic. The main treatments for BPD must be long term (generally more than 1 year), which is hard for patients to maintain. The therapy involves a lot of time and effort from the person with BPD. After the intensive psychotherapy is completed, the patient should continue less-intensive therapy indefinitely.
- There are many comorbid mental illnesses that may need to be treated first or at the same time.
- Self-medication by abusing non-prescription drugs and alcohol can exacerbate the symptoms of BPD, lead to more self-harming behaviour, and interfere with treatment programs.
- Research into treatments for BPD is under-funded. More research is needed on BPD treatments, including long-term recovery effectiveness.
- BPD treatments such as DBT & CBT are often not covered by private insurance and are not covered by Canadian Medicare.
- BPD patients are very sensitive to rejection and invalidation. It’s hard to hear and admit that they are a big part of the problem and need to change. They want validation that they have suffered as victims, but also want someone to help them change.
- Recovery is a scary and painful process. Patients must let go of the harmful coping mechanisms used to numb the emotional turmoil & pain (like drugs, alcohol, & cutting), and instead feel & accept the intense emotions (often from discussing past trauma) while learning skills to manage their emotions. The need for multiple behavioural interventions and learning coping and cognitive skills can be overwhelming and can cause confusion.