Should "personality Disorder" Diagnosis Be Scrapped?

[Silkworm]

Nobodyzdream,

I'm sorry if my post wasn't clear..wasn't my intention to sound patronizing. It's a topic I'm more than a bit passionate about! Sundries post really captured what I was trying to say..it bothers me a lot that bpd is seen as a 'character' defect. It devalues people and denies the biological aspects of the illness. It also doesn't do much for giving people hope of stability in the long-term and some kind of normal life. Bipolar isn't curable, but it's very treatable and people often live stable and productive lives ~ why not people with BPD? I would think that BPD would have an even better hope of stability because the chemical mood instability may not be as extreme ~ if the research continues and treatments keep improving.

Changing the label would also change how seriously BPD is taken as the disabling illness it is. As Sundries wrote, PTSD and Bipolar are taken seriously...BPD can have very similar symptoms.

Sw

[nobodyzdream]

Nobodyzdream,

I'm sorry if my post wasn't clear..wasn't my intention to sound patronizing. It's a topic I'm more than a bit passionate about! Sundries post really captured what I was trying to say..it bothers me a lot that bpd is seen as a 'character' defect. It devalues people and denies the biological aspects of the illness. It also doesn't do much for giving people hope of stability in the long-term and some kind of normal life. Bipolar isn't curable, but it's very treatable and people often live stable and productive lives ~ why not people with BPD? I would think that BPD would have an even better hope of stability because the chemical mood instability may not be as extreme ~ if the research continues and treatments keep improving.

Changing the label would also change how seriously BPD is taken as the disabling illness it is. As Sundries wrote, PTSD and Bipolar are taken seriously...BPD can have very similar symptoms.

Sw

oh, no you weren't patronizing at all, don't worry about that I was just very curious and wanted to see the other view of it Thank you both for explaining it better to me, as I think I was trying to get too much out of it and was confusing myself, lol, so I was missing the actual point trying to analyze the rest of it.

[gingernut]

Just realised this comment was a complete contradiction in terms and does not warrant being read.

hey ho and all that malarky guess this is a subject that gets me too heated.

Ginger

[Doug]

Just realised this comment was a complete contradiction in terms and does not warrant being read.

hey ho and all that malarky guess this is a subject that gets me too heated.

Ginger

I was going to reply to that n'all...

d

[gingernut]

Sorry Doug I was hoping I had caught it in time, and you were too quick for me and read it.

Ginger

[gingernut]

Sorry Doug I was hoping I had caught it in time, and you were too quick for me and read it.

Ginger

[Doug]

Sorry Doug I was hoping I had caught it in time, and you were too quick for me and read it.

Ginger

Never mind, Ginge, I'll catch you later!!

d

[name]

I despise the name borderline personality disorder, because no one I've mentioned it to has a clue what it really is. Everyone I've talked to ASSUMES it's split or multiple personality, which it is NOT, or they think it means that you hallucinate. I'd rather have a more accurate description of the disorder itself as the title.

Emotional Deregulation Disorder and Complex PTSD are good suggestions.

[Warrior Princess]

Multiple Personality Disorder was changed to Dissasociative Identiy Disorder and the stigma did not really change... just the name. it's still doubted by many health care professionals and labeled "false memory syndrome" and other things! I, personally, hated the name change because I felt that the first label was more accurate. It's what I live with.

However, It's well known that borderline personality disorder is a bad label for the symptoms. If BPD was changed to complex PTSD that may change some Psychiatrists opinion of the diagnosis becuase it would associate the symptoms with trauma rather than just a disorder in someones personality... or a difficult personality. However, what about those who have these symptoms with out serious traumatic stress? Not every one with BPD is diagnosed with PTSD as well. yes, we have all had some kind of trauma but the symptoms of PTSD are specific and not everyone with BPD has them.

I don't really care if they change the name or not... I'd rather see the stigma changed than the name.

Paine.

[Effervescence]

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

Silkworm, I agree with every single word--you expressed my feelings beautifully!!

I also wholeheartedly agree with sundries about the moralistic attitude so many people (including doctors, nurses, etc) take towards BPD. To a lot of them, BPD seems pretty much to mean "spoiled brat"!

I can't think of many other disorders offhand that have such a negative and morally judgmental connotation.

As someone else said (sorry--forgot who! )--even if you behave pleasantly, the nurses are likely to figure you're up to something--no BPD could ever just be a nice person, surely?!

If you watch someone, expecting their every move to be motivated by narcissism, manipulation, etc, well--generally you see whatever you expect to see.

I think it's called a vicious circle, and the so-called mental health "professionals", with their own profound biases, aren't helping any!!!

[sundries]

I wonder if there has been any research looking at how BPD in people who havent been abused differes from BPD in those that have - is the prognosis any different for instance. There are over 256 different combinations that could get the BPD dx. Id just like to know if some of those combinations are more common in BPD abused and some more common in BPD alone.

Maybe a name change is required and the two types of BPD should be seperated. One into Complex PTSD and one into Emotional Disregulations (yes maybe it all looks the same and treatment is the same but doesnt mean aetiology is and hta could be reflected in the dx)

For instance,

If someone showed all hte signs of PTSD but htere had been no significent event then they might get dx with schizophrenia + anxiety or something. Or, BPD can sometimes be diagnosed as bipolar - symptoms very similar - so why not divide the BPD into two seperate dx! one for those abused and one for those not abused. At least then there might be some acknowledgement of 'BPD' as a normal human reaction to prolonged abuse - and that might actually help reserachers focus on why some people exhibit this 'normal' reaction, without the abuse - akin to why do some people feel anixety all the time (GAD) and the rest of people havea normal response of only feeling anxiety in threatening situations.

[gingernut]

<_< I really should stop reading this post.

Ginger

[name]

However, It's well known that borderline personality disorder is a bad label for the symptoms. If BPD was changed to complex PTSD that may change some Psychiatrists opinion of the diagnosis becuase it would associate the symptoms with trauma rather than just a disorder in someones personality... or a difficult personality. However, what about those who have these symptoms with out serious traumatic stress? Not every one with BPD is diagnosed with PTSD as well. yes, we have all had some kind of trauma but the symptoms of PTSD are specific and not everyone with BPD has them.

I have BPD but have never been dx with PTSD

[lostsoul]

does it need a name?

everyone has different combinations of symptoms anyway, and it is the person that should be treated, not the 'disorder'. working to progress with the particular symptoms that each individual presents with, and recognising that they ARE individuals, as opposed to 'sufferers', makes much more sense to me

in one fell swoop that eliminates any stigmas, and ensures that appropriate, not stereotypical and generalised treatment, is offered as required

i think more progress would be made this way

x

[rebeccaborderline]

slightly off-topic, but does anyone know if they have a date yet for the next DSM?

thanks

rebeccaborderline

[name]

How often do they re-do the DSM's? I was only aware of 2, but maybe I'm thinking of something else.

[rebeccaborderline]

we're up to DSM IV (4th Edition) at the mo

rebeccaborderline

[loulou1330]

not sure changing name would achieve anything great other than more confusion. thought i heard a serious rumour awhile back about them now referring to it as 'emotional' rather than personality (emotional regulation disorder)

for me took me a long time to accept the borderline part more than personality disorder and for me again if it was substitued with emotional would again struggle with it.

In my humble opinion i think they should just leave it as bpd now i mean look how long its taken to get it into the publics edge of awareness and then people wanna go change it, doesnt do it for me - sorry

[KavanIce]

I agree with this:

"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."

But changing the term does not change the stigma nor the reaction from those who find us awkward and threatening. The only adjustment that can and should be made is by mental health practitioners understanding what they are dealing with. The fault is with the practitioners and not with us. It is not our fault that they do not know how to sympathize nor treat. It is only through knowledge will they be able to change their notions of the condition and who we are.

Personally I accept the diagnoses. I went through a period of suffering, going in and out of emergency rooms and ever-changing therapists where the diagnoses had been identified but they didnt want to tell, they just allowed me to flounder in the darkness wondering what was wrong with me. Now I say 'I am borderline' but I keep it within an existentialist framework by telling myself it is in 'bad-faith' to deny what I am but its also in 'bad-faith' to believe it cannot be altered, changed, transcended so that I can willingly become something else. BPd does not define all of who I am. I have not yet found a way of transcending this condition but I find the existentialist notion of the 'self' as being non-existent useful as it means the diagnoses isn't carved in stone and therefore inalterable. In existentialism existence proceeds essence. We become who we are through action within an environmental framework, actions can sometimes change even if the environment doesn't.

[pain-dance]

KavanIce:

I am also a fan of existentialism, although I only have a working, rather than detailed, knowledge of it. I am not advocating that we should all "play the victim" and sit around feeling sorry for ourselves. I am simply arguing that we should have the same entitlement to treatment as anyone with a more conventional mental illness when we are in a period of crisis.

I would also argue that we have a personal responsibility to take measures that should minimise the risk of escalating our illness, such as not binge-drinking and staying away from street drugs: sometimes you have to make do and mend with the personal resources you've got, rather than wishing away your problems.

In terms of the self, perhaps it would be useful to go through a period of stream-lining your life: I don't mean live as a pauper, but take a long, hard look at yourself and get rid of things in your life that are doing you more harm than good. You're right, you can't change the world, but you can change your relationship with it: that is the attitude that is working for me at the moment.

COLIN.

[rebeccaborderline]

Anybody read Irvin D Yalom, the existentialist psychotherapist and psychiatrist?

Thoroughly recommend "Loves Executioner-tales of psychotherapy"

Also "The Gift of Therapy-Reflections on being a psychotherapist"-this one was like giving myself several private therapy sessions!

Available on Amazon

rebeccaborderline

[sundries]

Yes it is fantastic

[KavanIce]

Colin I never thought you were advocating us playing the victim. Yes we should be entitled to proper treatment, unfortuantely the type of treatment and resources necessary to heal a bpd isn't always available because the therapuetic strategies have not been fine-tuned as yet or are relatively new, like DBT, and there are not enough therapists trained in the technique. Still yet there are those practitioners who believe we are simply 'difficult' and are not willing to deal with a BPD patient. Medication as far as I am concerned is only a band-aid for those who suffer so I am not generally concerned about new types of medication. Its difficult to find a truly caring and committed therapist who knows what they are doing, this isn't going to change anytime soon so I don't think changing the name will change any of these other considerations.

Thanks Rebecca for the book suggestions. Haven't heard of Yalom but will seek them out on the internet...lord knows i need all the help and inspiration I can get.

[KavanIce]

Colin I never thought you were advocating us playing the victim. Yes we should be entitled to proper treatment, unfortuantely the type of treatment and resources necessary to heal a bpd isn't always available because the therapuetic strategies have not been fine-tuned as yet or are relatively new, like DBT, and there are not enough therapists trained in the technique. Still yet there are those practitioners who believe we are simply 'difficult' and are not willing to deal with a BPD patient. Medication as far as I am concerned is only a band-aid for those who suffer so I am not generally concerned about new types of medication. Its difficult to find a truly caring and committed therapist who knows what they are doing, this isn't going to change anytime soon so I don't think changing the name will change any of these other considerations.

Thanks Rebecca for the book suggestions. Haven't heard of Yalom but will seek them out on the internet...lord knows i need all the help and inspiration I can get.

[becsnoamp]

Hi

In my opinion I think the whole entire disorder of bpd should be scrapped! Get it out the psychiatrist manual! Bin the whole disorder in a little bucket, close the lid on it, seal the lid shut with super glue, and stick it in the Outer Hebredies where no one can have the utter trauma of being labelled "bpd" ever again. That label has been nothing but a complete pain in the *beep!* to me ever since I got labelled with it 3 years ago. Since "bpd" came into my life I can no longer get any help for my depressions and I get support withdrawn when I become ill with depression, plus my physical problems are partly put down to "bpd" as well. Its just been one long nightmare for me. Hate the dratted label.