Is Borderline Personality Disorder a Serious Mental Illness?

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.