Should "personality Disorder" Diagnosis Be Scrapped?

[pain-dance]

Does anyone out there agree with me that the term Personality Disorder should be replaced with the term Adjustment Disorder, eg Borderline/Paranoid/Schiziod, etc-Adjustment Disorder. I feel that it sounds more humane and truthful, in that people with Personality Disorders have unusual difficulty in adjusting to the stresses and strains of the world as it constantly changes around us, rather than simply having attention-seeking or malicious character traits.

I also feel that the term Personality Disorder has now become a millstone to hang around the necks of "awkward" and "threatening" patients, but who nonetheless have genuine psychological problems, simply in order to justify giving such patients a lower (and therefore cheaper) standard of care.

COLIN.

[drew]

i prefer it the way it is i can only see if they change it they will confuse people

[Rook98]

I have to agree. The term Personality Disorder is a label used for many years to categorize an illness. Seems like a sloppy attempt at naming a disorder. Colin's suggestion is a step in the right direction. After all, most agree that Borderline Personality Disorder is an old & inaccurate title.

[Joshua]

was talk of it being renamed complex ptsd

also it being an axis one illness rather than axis two

[Doug]

was talk of it being renamed complex ptsd

also it being an axis one illness rather than axis two

That makes sense!

d

[bish31]

was talk of it being renamed complex ptsd

also it being an axis one illness rather than axis two

That makes sense!

d

What is an axis one..never heard of this.

I thought that there as been talk about it being renamed 'emotional deregulation disorder' which I believe has been used in some parts of the country?

[Lily-Bee]

In Holland the term emotional regulation disorder is sometimes used instead of borderline personality disorder. But not all therapists-psychiatrists use the new term so that makes it I think a little more confusing.

Lilly

[gingernut]

Whatever happens the stigma and waryness of others will follow so I dont see it matters. Maybe difficult behaviour created the stigma in the first place.

Ginger

[sundries]

I think complex PTSD would significantly minimise stigma.

People UNDERSTAND PTSD its what veterans get, its what 'victims' get. People can see why, they understand that it arises in response to being exposed to situations most people dont have to deal with - its because of having harder circumstances to deal with reather than being a weaker person who deal with the same stressors as everyone else worse. Perhaps if it was renamed that people would be better able to link it with thier attitude to child abuse - theyd feel the same sympathy and understanding that they do when the NSPCC does its full stop adverts.

[gingernut]

Is that excluding the people who have not suffered "trauma" and diagnosed with borderline personality disorder? Some of the borderline behaviours are hard to cope with and I think they have created the stigma. Treatment is difficult because the behaviours are difficult.

All mental illness has stigma from schizophrenics to depressives. I dont think anything will change with the name.

Could be because I dont like the diagnosis at all and have probably not accepted it but " sticks and stones will break my bones and names will never hurt me ".

Please ignore just needed to say it thats all and doesnt count much from a person in so much denial of everything.

Ginger

[Rook98]

I also have a problem with the use of "emotional disorder" since in the eye of the general public anyone who gets emotional is showing a sign of weakness. Clinically it may be an accepted term but in everyday life it has a negative stigma. Emotional Problems suggests something outside genuine mental illness. The public has not evolved enough to see the difference.

[gingernut]

Do you think we will ever be happy with the name chosen?

Ginger

[Silkworm]

I'm all for changing the name...the stigma attached to a personality disorder dx is at it's worst within the health care professions. The general public isn't nearly as aware of what a PD is, when compared to mental illness like schizophrenia/bipolar/depression. The stigma is still a problem in general, with mental illness, but in health care it's entrenched when it comes to personality problems.

I worked in health care for 15 years (before burning out), and witnessed the casual cruelty quite often ~ throwaway comments like " oh, there's a 'PD' in bed 15" (accompanied by much eye-rolling). Many nurses provided the basic nursing care appropriate, but were determined not to do more. When I worked in mental health, I often 'specialled' (1:1 nursing care) patients with mental illness who were in a hospital after a suicide attempt. Patients who may or may not have a personality disorder. The relief from the ward nurses was palpable when they knew a special nurse would be responsible for the mentally ill patient. Nurses who choose to do this kind of work are often viewed as a bit odd themselves (which admittedly, I am).

I could think of a bunch of reasons why it is this way...the main one is I think that general nurses (not in mental health) are trained to heal wounds, treat physical illness, make people well and send them home fully recovered ( with hopefully no need to return). It's very hard, in this kind of culture, for nurses to conceptualize someone causing harm to themselves. And doing it repeatedly. So basically it's ignorance.

Nurses are also chronically overworked, exposed to constant pain/suffering/trauma/death/loss. After a while, it hardens people...I know I began growing hard, which is why I got out. Some have little patience for self-inflicted suffering, because they see it as adding to their already significant workload.

So anyway, there needs to be changes..not sure they will happen overnight. Josh mentioned the talk about changing bpd to an Axis 1 dx...which I think would be a really positive step. The way things are now is (to me) inhumane. Tagging someone with such a loaded label; not nearly enough appropriate treatments;stigma and prejudice rampant in the very profession charged with helping the mentally ill; lack of recognition of the brain/biological/behavioural changes associated with exposure to prolonged trauma.

The last thing I wanted to say was something I wonder about, but really haven't looked at research to back it up. I wonder if this is also about a cultural cringe ~ the subject of child abuse and it's effects is still hush-hush. It's coming out of the closet more than it once was, but I wonder if there is some kind of societal denial happening. Maybe this just adds to the problem? If the cause isn't acknowledged, how can the victims be?

Sw

[Marchmadness]

It really doesn't matter what you call it- it is what it is. We all suffer from the same issues -

the public has a certain image when it come to MH - that is what needs to be changed.

Not what label you give it.

Marchmadness

PS

When I am with friends and family we joke around and I always say

"emotionally challenged"

[Rook98]

Do you think we will ever be happy with the name chosen?

Ginger

You can't please all the people all the time but there's always room for improvement.

[sundries]

silkworm

yes i agree with you re the child abuse

I often think that the NSPCC adverts should have the kid being abused, and hten cut to a scene of a suicide attempt survivor and the nurses acting in hte same callous ways as the parents did.

[nobodyzdream]

I don't think it would make much of a difference honestly-no matter the condition someone has. Whether it be BPD, depression, autism, bipolar, skitzophrenic, etc., the symptoms will still be listed under it, and the same people will still have it. Just instead of someone rolling their eyes and saying "here comes another one of (insert illness name here)", they'll say "here comes another one of (instert NEW illness name here)", because they will just adjust to the name change since the symptoms and people are still the same.

If Jane goes in with BPD one day, and feels really crappy about having it, once they change the name, Jane will still have the same problems no matter the name, and it still won't be fun carrying a label that has bad ideas associated with it, as so many of them often do. It'll just be another name for it that no one will like after a while, because people will learn to associate that name with the same situations-the same as they did the original name.

[therealme]

I have just finished reading the book "Sometimes I Act Crazy" by Kreisman and Straus, and they say that ...

the future DSM-V (will) include cosideration of redefining personality (AxisII) disorders utilizing dimentional models.

, as opposed the categorical definitions now used.

This is good news as the criteria now states that say if a person fits 4 or less of the criteria for BPD, then that person does not have it. SO, in theory, and unfortunately, in practice, if one is in therapy and receiving meds and 'looses' one of the criteria, then one is said to be cured. While a cure is the goal, without taking into consideration the levels or degrees of the condition, or the remaining symptoms the person has, this leaves alot of people uncovered by the medical plan, or 'abandoned' because they are cured, when that is plainly not the case.

It may be that with this new criteria, that the powers that be could be open to redefining the termonology they use.

I think the name change, as previous posters have indicated, will do little to change attitudes. That would take a shift in people's perceptions.

Baboo

[nobodyzdream]

I have just finished reading the book "Sometimes I Act Crazy" by Kreisman and Straus, and they say that ...

the future DSM-V (will) include cosideration of redefining personality (AxisII) disorders utilizing dimentional models.

, as opposed the categorical definitions now used.

This is good news as the criteria now states that say if a person fits 4 or less of the criteria for BPD, then that person does not have it. SO, in theory, and unfortunately, in practice, if one is in therapy and receiving meds and 'looses' one of the criteria, then one is said to be cured. While a cure is the goal, without taking into consideration the levels or degrees of the condition, or the remaining symptoms the person has, this leaves alot of people uncovered by the medical plan, or 'abandoned' because they are cured, when that is plainly not the case.

It may be that with this new criteria, that the powers that be could be open to redefining the termonology they use.

I think the name change, as previous posters have indicated, will do little to change attitudes. That would take a shift in people's perceptions.

Baboo

The sad thing, is that when the criteria changes, people who are found to have it probably will INITIALLY get treated differently, with a more open mind... until the same names start coming up and it "clicks" that it is the same thing

Every time I hear about BPD, I hear all of the negatives to it, as those are what is stated in the criteria, and the criteria is available for everyone to read if they just look it up. So people get set on these things. Also noting, it's really crappy that being manipulative and things in that nature are considered part of the criteria when you look at it in depth. It's sad that this is included, because if someone knows very little, or is learning about the disorder, and they are presented with someone who has BPD... what is the first thing they are going to think if the person says something nice to them? The world is pretty screwed up due to these things. Sure, it's great to know what you are talking about and how to go about treatment and such, but it's pathetic that such negative things on the list seem to get highlighted even by professionals at times.

Just like with autism... lack of empathy is often on the list... but what am I doing right now? I'm feeling it all from another perspective, but a very similar experience, therefore I can empathize... but it goes unnoticed by therapists and such often, because it doesn't show on the outside in a "typical" fashion. If the name for it were to change, it would change absolutely nothing when it clicked with people that it isn't a new diagnosis, just the same old one-new name.

This is probably the 3rd time I've talked about my issues with criteria only talking about negative aspects, lol, and I apologize as I'm not sure whether or not it is bothering anyone to keep referring to it and bringing it up.

[Silkworm]

I think the point is that changing the label is a step in the right direction. It's pretty well documented how this diagnosis is viewed by (some) health professionals. There will always be ignorant Dr's/nurses...what this is about is empowerment for patients/consumers and the shedding of old and no-longer-useful labels. The other thing is that as a label, it's quite inaccurate. People with BPD were initially thought to be on the borderline between psychosis and neurosis, hence the name. This has since proven to be way off base...even if some people with bpd have transient psychotic symptoms, the predominant feature of bpd is emotional/affective instability.

Some health professionals see it being on the Affective spectrum(mood disorders)...others see it as sitting on the Dissociative spectrum. Whichever way you look at it, BPD is a disabling condition that creates misery for those of us afflicted with it. Given the prevalence of BPD (equal to and eclipsing mental illnesses like schizophrenia/bipolar) the suicide rate...changing the label is a crucial first step in getting people humane and effective treatment. If it became an Axis I diagnosis in the next DSM, this would change a lot of things. Not the least of which is better treatment; more research; better insurance coverage; greater empathy; less stigma ; more govt funded health care.

It matters a great deal what it's called.

Sw

[PanickyPolly]

Yes...bump, bump...change the lable please!!!

For what it's worth!

[nobodyzdream]

I think the point is that changing the label is a step in the right direction. It's pretty well documented how this diagnosis is viewed by (some) health professionals. There will always be ignorant Dr's/nurses...what this is about is empowerment for patients/consumers and the shedding of old and no-longer-useful labels. The other thing is that as a label, it's quite inaccurate. People with BPD were initially thought to be on the borderline between psychosis and neurosis, hence the name. This has since proven to be way off base...even if some people with bpd have transient psychotic symptoms, the predominant feature of bpd is emotional/affective instability.

Some health professionals see it being on the Affective spectrum(mood disorders)...others see it as sitting on the Dissociative spectrum. Whichever way you look at it, BPD is a disabling condition that creates misery for those of us afflicted with it. Given the prevalence of BPD (equal to and eclipsing mental illnesses like schizophrenia/bipolar) the suicide rate...changing the label is a crucial first step in getting people humane and effective treatment. If it became an Axis I diagnosis in the next DSM, this would change a lot of things. Not the least of which is better treatment; more research; better insurance coverage; greater empathy; less stigma ; more govt funded health care.

It matters a great deal what it's called.

Sw

Please excuse my ignorance in advance But I'm just curious as to how it will change it if the symptoms and situations are still the same. Not quite comprehending or maybe I'm just looking at it too closely.

I can only see this one really from my POV overall. I'm autistic-people see that and automatically associate it with "Rainman", but I am hardly Rainman. I have a lower than average IQ, but not due to my intelligence, it's due to not fully understanding the questions asked in most cases, or seeing the questions, comprehending, but not knowing exactly what to do with them in order to answer it. So I get thrown into a group based on the fact that I can't answer the questions on an IQ test, and I have all of the common symptoms (along with some of the more complicated). Individuality matters very little. So now if someone refers to it as "classic autism" when talking about me, they are also grouping me with much more severe cases or they start talking reeeeaaalllllyyyyy slooooooow to me, as if I can't comprehend basic language. They also use simple words when speaking with me, and it's very frustrating to be treated like I'm an idiot just because I can't comprehend basic social cues.

I just don't see where it would matter if they changed the name in my case specifically, because people would realize after a while that it is the same thing, therefore the same approaches would still have to be taken, etc. People say the name of the diagnosis as it's a negative thing, and their attitudes change greatly-they usually don't listen to a whole lot of what I say just knowing what it is about... because they know the criteria, and they know of past situations with people with autism and I'm treated accordingly. I'm not really treated as an individual who just learns things differently.

I'm really not trying to sound ignorant, rude, or disrespectful-I just want to know what actually would change vs. what would be nice to see change as far as attitudes about dealing with people in certain conditions. Did that make sense? Mainly because I think every label, no matter where it falls on the charts and all, stigma is always going to go hand in hand. They could call it "the super happy fun disease" and if people associate that with the symptoms that seem to accompany it, then it will, too, eventually have the same negative responses from people over time.

Unless you are talking about the name change for specific reasons rather than good things that might come out of it... such as BPD symptoms don't really fit into the category of a "personality disorder" and such.

Sorry again, I got interested and just want to learn more about the views of it changing.

[sundries]

Because

1) bipolar has pretty much the sdame symptoms but cos it is viewed as a mental illness rather than the bad behaviour of a bad personlity, people treat it much better, and almost see the 'personality' as heroic in dealling with the affliction

2) because in giving it another name which more fairly represents what it is about people will treat the individual differently - people with PTSD might behave in similar ways but cos it is understood that they are afflicted rather than just 'bad' which is what persoality disorder implies to people, they are treated better

basically, its not so much the behvaiours that cause hte bad treatment of BPD - more the fact that the lable personlaity diosrder implies more of a moral judgment than other lables

[nobodyzdream]

Because

1) bipolar has pretty much the sdame symptoms but cos it is viewed as a mental illness rather than the bad behaviour of a bad personlity, people treat it much better, and almost see the 'personality' as heroic in dealling with the affliction

2) because in giving it another name which more fairly represents what it is about people will treat the individual differently - people with PTSD might behave in similar ways but cos it is understood that they are afflicted rather than just 'bad' which is what persoality disorder implies to people, they are treated better

basically, its not so much the behvaiours that cause hte bad treatment of BPD - more the fact that the lable personlaity diosrder implies more of a moral judgment than other lables

Okay, that makes more sense tyvm! I see where you are getting at now, and I do think it could help a lot for those reasons for sure. I guess it would be true for the most part that if someone hears "personality disorder", most tend acknowledge that you don't have much control over it, but they tend to get this "it doesn't matter how I treat them anyway, they'll react regardless" type of attitude? (as far as nurses/docs, etc.) Because they don't even give it a chance to actually get to know the person and find out more based on the actual wording of the label.

[Jadey]

Whatever happens the stigma and waryness of others will follow so I dont see it matters. Maybe difficult behaviour created the stigma in the first place.

Ginger

Yeah, I agree. I really don't think that changing the name of personality disorders would make much difference. The stigma will still be there. I would get more into it, but this pretty much just says it all, IMO.