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Borderline Personality Disorder - Page 3

post #41 of 67
Just to return to an earlier point I made, I do not thing Axis II, or personality disorder, diagnoses are helpful to the patient. Labeling someone "Borderline" is, among many psychologists, the psych-talk equivalent of an eye roll. The reason it needs a label is so that people can bill insurances appropriately. I believe therapy should be affordable and accessible to people who need it, and so I can see why it is necessary. The problem is that once that label is applied, it is impossible to delete. A personality disorder diagnosis can have profoundly negative sequellae for a person's life. It is a clear example of psychologists adopting the medical model, which does not fit much of what human beings struggle with in their lives.

In fact, some individuals with "borderline" symptoms will overcome most of them them naturally sometime after the age of 30. There is a maturational process that manifests itself as what some developmental psychologists call "dialectical thinking" that emerges sometime in the 4th decade of life (i.e. in the 30's). But insurance records don't suddenly remove the "borderline" label when a woman turns 30. It goes with the person forever. And that's not helpful or fair.

My objection to the "borderline" label has nothing to do with whether a certain approach to symptom amelioration or trauma recovery is valid or helpful. Each individual will benefit from a different approach at a different time in their lives. My objection is to the borderline label itself, how it came to be, its immediate and deeper implications, and the detrimental impact such a label can have on someone's life. I object because every single one of the nine diagnostic features appears in another diagnosis somewhere in the DSM-IV. I object because the diagnosis asks that an individual meet 5 out of 9 diagnostic features. Well, 9 items can be rearranged in many different combinations of 5. It's not specific enough. And when the next revision of the DSM comes out, the Axis II personality disorders will reflect the change in thinking about these issues.

Just as a point of comparison, there was a time when the psychological profession labeled homosexuality as a disorder. During those years, gay men and women would go to therapists to try to "correct" their sexual orientation. Many individuals' lives have been damaged by those so-called "reparative" therapies. Homosexuality is no longer considered a disease by the psychological profession, and there is no longer a diagnostic category for it. Labels can have profound effects. My point is that the diagnostic tools and labels that psychologists and psychiatrists use should not be taken as "truth" because unlike medical diagnoses that can be linked to a particular etiology (an underlying cause such as an infection, genetic mutation, physical injury, etc.), many psychological diagnoses do not have such clear causes.

What is clear about "Personality Disorders", however, is that most develop in the aftermath of severe or sustained interpersonal trauma, and each symptom in a person's profile is most likely an enactment of what that trauma was like. The trauma-related diagnoses (PTSD, etc.) will also be much revised in the upcoming version of the DSM, probably to reflect what is being learned about trauma sequellae since 9/11.
post #42 of 67
As you said, "The reason it needs a label is so that people can bill insurances appropriately."

Are you saying that diagnosis should be withheld from clients? Or that the term "Borderline" should be changed?


It's great that we continue to evolve over time, isn't it? Just think how they used to treat alcoholics, Bipolar disorder and as you mentioned homosexuality! Pretty "crazy!" (Har har) We're lucky to live in "modern" time. I'm excited to see what the next 20 years will bring!
post #43 of 67
Thread Starter 
Quote:
Originally Posted by Vishapmama View Post
The problem is that once that label is applied, it is impossible to delete. A personality disorder diagnosis can have profoundly negative sequellae for a person's life. It is a clear example of psychologists adopting the medical model, which does not fit much of what human beings struggle with in their lives.
This is about the labeling, and I must say I want a label. Probably sounds stupid but I need something. I feel like I'm crazy, I feel like there is no one else like me, I feel alone, I feel like I've been grasping at straws my whole life. Like being told I was boderline bipolar when I was 14 and the dr. never told my mother about it, I felt like I was being purposely put in the dark. Like no one believed I was really hurting on the inside like I was just some hormonal teen out of her mind. If I had a name for whatever is wrong with me I would feel something positive in knowing it has a name and if there is a name there is a treatment and I can get better in some way. If someone told me yeah you're just nuts that would negatively impact my life.
post #44 of 67
I was diagnosed (and met all of the criteria) for borderline personality disorder 10 years ago. I never took meds and I'm mostly fine today. I no longer meet the criteria for a diagnosis. This does not mean I no longer have irrational emotions at time, but I am able to control it. It has taken a lot of time, and effort on my part to get to this. In the beginning, I was really totally crazy. I would feel rage and hate towards someone (DP) to the point of telling him (and really wishing) he would die to feeling overwhelming love for him 5 minutes later. Wanting to kill myself (and trying) to loving my life a few minutes later. My emotions were all over the place and I could not control them at all. It was like being possessed. I would explode with anger and hate.

Quote:
The moods of borderline can not be snapped out of.
In my case, I am able to control my actions (screaming, etc.). I may not be able to stop the emotion but I can control my actions (and even the emotions are not nearly as intense as they once were). This has taken years of practice though, and something happened (possibly the new hormones?) during my first pregnancy, which is when I really started feeling better and being able to do this.
post #45 of 67
Quote:
Originally Posted by Carley View Post
I'm Bipolar & was "borderline" since I was about 9. I've done some pretty outrageous things, and in retrospect most of them were pretty hillarious. I definitely would have laughed at myself behind my back in ADDITION to having empathy.

OMFG you guys!!! I was just cleaning my kitchen & this fabulous snap shot popped into my head:

When I was 15 (200+ pounds overweight due to a delicious cocktail of Risperadol/Haldol/Zyprexa etc etc my mother took a rare weekend to herself.

We left my dad a few months prior & were living on my mothers $5/hr wage (nice, huh? min wage used to be a joke). You can imagine how physically and mentally exhausted she must have been. Sooo deserving loved that break.

Yeah. So naturally I went bat sh** crazy and cut myself to shreds, complete with head shaving. I was very proud of myself at the time. I'm sure I looked fabulous

Eat your heart out Britney Spears!


My mom and I have a beautiful relationship now (after years of that awkward & tumultious "healing period") & we laugh about that a LOT. It's kind of a family joke now.

The Beautiful Path is awesome! I'm glad I took the detour from Batguano Avenue!
post #46 of 67
Quote:
Originally Posted by Carley View Post
As you said, "The reason it needs a label is so that people can bill insurances appropriately."

Are you saying that diagnosis should be withheld from clients? Or that the term "Borderline" should be changed?


It's great that we continue to evolve over time, isn't it? Just think how they used to treat alcoholics, Bipolar disorder and as you mentioned homosexuality! Pretty "crazy!" (Har har) We're lucky to live in "modern" time. I'm excited to see what the next 20 years will bring!
Oh no. A diagnosis should never be withheld from clients. That would be unethical. I do believe, however, that "BPD" and other "personality disorders" should be reconfigured and revamped, and until they are, clinicians should be very careful about applying Axis II diagnoses to patients, and patients should be careful about accepting such diagnoses without questions.

Sammie, you mentioned that the diagnostic label was helpful to you. I have found that patients can find a diagnosis comforting at times. It's a way of giving a name, putting into language, and feeling that someone actually understands what you are feeling. But as a therapist, I also know that it is possible to help patients feel comforted and understood, to help them contain what they are feeling in language, without applying labels. That is what recovery from trauma actually entails: putting feelings, urges, sensations, and impressions that are unspeakable into language. Sometimes giving a label can actually forclose the process of recovery. But that's a different matter.
post #47 of 67
I agree that it is a problem when professionals misuse a label like BPD and that professionals should act, well, professionally with a client regardless of their diagnosis.

The problem with the personality disorders is that the behaviours that qualify a person for these diagnostic labels are at times quite difficult for other people to be in relationship with. When in treatment, a professional is dealing with just the person before them - but often people with personality disorders, because of their traits which well could be because of their horrible life experiences - are not easy for others to relate with.

My mother has BPD and never had any use for psychological treatment and dismissed anyone who suggested that she had a problem. She didn't give anyone a chance to help her work through the issues that caused her to be diagnosed with BPD. Still, hearing her diagnosis helped me learn how to deal with our relationship better than I had previously. If no one had ever spoken the term borderline personality disorder to me I would have had no understanding of what she and we were dealing with. Reading some excellent books about BPD helped me deal with her illness, even if she wasn't interested. Ditching the label would not have served anyone in this case - things would have carried on in the same hurtful, destructive way they always had.

New labels might help, but the problems that come with personality disorders will still be the same even with new names. And since many people who have personality disorders tend to deny that they have a problem, the same dynamics are likely to continue with this group of people regardless of what we change terms like 'borderline personality disorder' or 'narcissistic personality disorder' to.
post #48 of 67
Quote:
Originally Posted by Vishapmama View Post
Here's a link to an excellent, albeit difficult-to-read (due to content, not writing style) article on the History of Child Abuse by Lloyd de Mause:

http://www.psychohistory.com/htm/05_history.html

In it, de Mause clearly states his belief that Borderline symptoms are sequellae of particular kinds of early psychological injury, and that throughout history, what are now labeled personality disorders have existed and have taken the particular guises of particular temporal and cultural contexts.
I read this article yesterday. What nightmares I had last night. :

At first I thought surely de Mause must have been lying, because the idea of these practices historically being widespread rather than the acts of a handful of broken people on the fringes of society seems too horrible to bear. So I read up on some of the things he references and lo and behold there's evidence aplenty to support what he claims. I have to wonder now why historical cultures tend to be so romanticized (the root of that word is terribly ironic) by educators?

Holding my sweet baby close ...
post #49 of 67
Quote:
Originally Posted by Shantimama View Post
I agree that it is a problem when professionals misuse a label like BPD and that professionals should act, well, professionally with a client regardless of their diagnosis.

The problem with the personality disorders is that the behaviours that qualify a person for these diagnostic labels are at times quite difficult for other people to be in relationship with. When in treatment, a professional is dealing with just the person before them - but often people with personality disorders, because of their traits which well could be because of their horrible life experiences - are not easy for others to relate with.

My mother has BPD and never had any use for psychological treatment and dismissed anyone who suggested that she had a problem. She didn't give anyone a chance to help her work through the issues that caused her to be diagnosed with BPD. Still, hearing her diagnosis helped me learn how to deal with our relationship better than I had previously. If no one had ever spoken the term borderline personality disorder to me I would have had no understanding of what she and we were dealing with. Reading some excellent books about BPD helped me deal with her illness, even if she wasn't interested. Ditching the label would not have served anyone in this case - things would have carried on in the same hurtful, destructive way they always had.

New labels might help, but the problems that come with personality disorders will still be the same even with new names. And since many people who have personality disorders tend to deny that they have a problem, the same dynamics are likely to continue with this group of people regardless of what we change terms like 'borderline personality disorder' or 'narcissistic personality disorder' to.

I totally agree!!
When Dh and I saw read what Borderline Personality Disorder was, we both felt so relieved that there was SOMETHING to describe MIL.
I wouldnt be surprised if her doctor got frustrated with her and found her difficult at times. It's human nature to be irritated at times with someone who is 24/7 needing your attention. I wish she would realize that.

So, a personality of any other name, would still be the same....it shouldn't be taken offensively, it just is what it is.
post #50 of 67
Yes, it may be difficult to work with someone who has "borderline" features. But I also feel that people should choose their professions wisely. If one is not prepared to serve the neediest, then what good is it? I actually feel that a psychologist earns his or her stripes by working with difficult cases. That's certainly where you learn the most about yourself as a clinician, about your strengths and weaknesses, about your blindspots, your prejudices. I also think there's another element that doesn't get talked about. It's pretty well accepted at this point that the "personality disorders" have roots in early and/or sustained abuse. People who go into the field of psychology often do so as a way of indirectly dealing with their own stuff. Believe it or not, therapy is no longer a requirement for clinician training, and so many psychologists come to the field without having adequately worked through their own abuse histories. So, who knows? The clinician who is reacting to a difficult patient with an Axis II diagnosis may very well be reacting to something unresolved that is internal, that somehow gets triggered by the patient. It's just not as clear-cut as a diagnosis of Major Depression. And hence I really feel that the debate has to continue, and that clinicians have to be challenged on giving labels.

Shasharna, de Mause's article is certainly sobering. I think everyone needs to be aware of what he says, that the abuse of those who are most vulnerable has been the norm rather than the exception for most of human history and has had a tremendous impact on human culture.
post #51 of 67
Quote:
Originally Posted by Vishapmama View Post
Yes, it may be difficult to work with someone who has "borderline" features. But I also feel that people should choose their professions wisely. If one is not prepared to serve the neediest, then what good is it? I actually feel that a psychologist earns his or her stripes by working with difficult cases.

I understand what you're saying, but not everyone who becomes a psychologist desires to serve the neediest mentally ill population. If they did we'd have a saturated market and noone to fill the gaps. There's so many fields of psychology, and even within clinical psychology (which I assume you're talking about) there are people with different interests.


Here's an analogy. Two Engineers that specialize in Astronautical Engineering, received the same education, both clearly work with spacecrafts knowing the ins & outs and probably even work in the same building.

One Astronautical Engineer specializes in building spacecrafts, the other in the navigation of spacecrafts. Their knoweldge and specialties overlap to create a strong feild.

Should the navigator be required to build the most complicated spacecraft to earn their stripes? Or the builder to navigate the most challenging of environments?


Again, I see your point but this isn't communism. People specialize in what they're interested in and what they're good at. I believe that psychologists are people too, just like everyone else. They, like everyone else, deserve and have the right to choice, preference and limits.

ETA My psychiatrist has interest in Bipolar disorder and postpartum psychiatric issues. He contributes in this area in his field and takes on the most difficult of cases. Right up my ally.

I didn't choose a psychiatrist who has specific interest in Schizophrenia or Autism for a reason. Someone who takes on the most difficult schizophrenic cases probably wouldn't be as effective for a severely impaired person with autism. They might even refer that patient to someone else (hopefully).
post #52 of 67
Quote:
Originally Posted by Vishapmama View Post
Shasharna, de Mause's article is certainly sobering. I think everyone needs to be aware of what he says, that the abuse of those who are most vulnerable has been the norm rather than the exception for most of human history and has had a tremendous impact on human culture.


I'd be interested to see who disagrees with this. It doesn't just apply to psychology. People have done (& continue to do) some f*** things. The more "modern" we become, hopefully, the less f*** we'll be.

I do wonder what the scenery of our century will look like to the next. What will they find abusive? My list possibilities is endless...
post #53 of 67
Thread Starter 
So yesterday was my visit, just the history stuff. She said it sounds like I've suffered from chronic depression. I also talked to her about my "dx" at 14 being borderline bipolar and she went over the symptoms of bipolar and BPD and she agreed that BPD fits me. She also explained how people can identify with a lot of the symptoms to a degree but with BPD it's like extremes of everything and that makes sense, and how basically we're going to work on finding a less extreme ways of reacting as well other goals I'm excited to work on. She also said the same thing that was said her some dr's are afraid of it in that it's a lot to take on but she's comfortable and happy to treat anyone who fits the criteria, she also told me that she doesn't like labeling patients either but understands that it can be helpful. I can only afford once a month visits for now but I've taken a step and I'm going to improve! Other problems may arise and that's fine, I think she's a good fit for me and I think she's got a good perspective on everything. Thanks for all the wonderful dialogue and support it's been wonderful to read!
post #54 of 67
Have you had your thyroid checked?

Mood swings are a symptom of hypothyroid. Just another avenue to explore.

And read this about hypothyroid testing:

http://thyroid.about.com/cs/testsfor...a/labs2003.htm
post #55 of 67
That's awesome news. I'm so happy for you...!!
post #56 of 67
Wow, it sounds like this therapist is a very good fit! Yay!!! Lots of potential good to come of this.... :
post #57 of 67
I know it may be frequently misdiagnosed, but BPD is a real disorder. As someone who's been on the other side of it, I really appreciate the fact that many of you are seeking out therapy and treatment to help.
From the other side, the most notable trait about BPD is the raging. Being raged at for hours by a borderline is a pretty traumatic experience, whether it's a parent, step-parent or partner. Severe BPD must be horrible to live with, but it can also have a pretty huge impact on the lives of your loved ones.
post #58 of 67
Quote:
Originally Posted by *MamaJen* View Post
From the other side, the most notable trait about BPD is the raging. Being raged at for hours by a borderline is a pretty traumatic experience, whether it's a parent, step-parent or partner.
OMG this sounds like my father at times.

Any reading recommendations as one from the other side?
post #59 of 67
post #60 of 67
Thank you. You know, my dad and gma show some of the traits of BPD and bipolar but not quite all of them... perhaps not quite enough to make a diagnosis? ... : Hmm anyway, just reading and learning here...
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