Tuesday, March 22, 2011

Does Borderline Personality Disorder exist? - Controversy in Borderline Personality Disorder

 
There is a lot of myth and controversy surrounding Borderline Personality Disorder. This is due to the fact  that the nature of BPD is very complicated.
Controversy ranges from Diagnostic criteria, usefulness of medication, effectiveness of therapeutic techniques, gender discrepancy, possibility of recovery, Axis location, terminology, and whether it even exists as an actual disorder at all. There are many, many more. I can’t say I’m surprised though, we’re a pretty controversial group of people.
This will be the beginning of a series of entries surrounding the controversies with BPD.
So to start; I think it’s appropriate to begin with:

Does Borderline Personality Disorder even exist?
One of the myths I’ve found is that there is no such thing as BPD. However more than three hundred research studies and three thousand clinical papers provide ample evidence that BPD is a valid, diagnosable psychiatric illness.
The question about the existence of BPD comes from several claims.
1.)     The first being shear ignorance of current psychological research. Definitions and diagnosis of BPD have changed drastically in the decades that it has been recognized as a disorder and some clinicians may be overwhelmed, or choose, to focus on many other areas of specialization and just not know how this subject has developed.

2.)    Some clinicians believe that it is not a separate disorder. They believe it is a collection of symptoms that are better encompassed by Bipolar Disorder or Post Traumatic Stress Disorder.  I’ve talked about PTSD before {here} and why I believe these are different disorders.  Bipolar II is a bipolar spectrum disorder characterized by at least one hypomanic episode and at least one major depressive episode; with this disorder, depressive episodes are more frequent and more intense than manic episodes. As far as Bipolar is concerned; I can see how Borderline Personality Disorder could be confused with Bipolar II (Bipolar depression) from a mood disorder standpoint. People with BPD tend towards a chronic depressive state with instance of hypomania (this certainly fits me). However BP II doesn’t the address the "instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts,” markers that define BPD. (More on Bipolar II)


3.)    Some simply reject labeling because of the stigmas associated with BPD and find all psychiatric diagnosis limiting and misleading. This one in particular I find to be ignorant. Yes, BPD does have a lot of associated stigmas (which I will also discuss in a later post), and avoiding stigmas is beneficial to the personal interactions of a patient in the outside world. However, by refusing to provide a diagnosis it can be very difficult to provide a clear course of action in therapy. By extension, it makes it more difficult to find a path to recovery. Not to mention, someone with BPD doesn’t have to tell anyone that they have been given this diagnosis, which will also allow them to avoid the general stigmas. If the psychiatrist/ologist/therapist holds onto these stigmas, it’s best for the patient to find a professional that is better equipped to handle the challenges associated with the present symptoms.

4.)    Another reason stems from the fact that the categorical diagnosis and causes for BPD are often disputed among professionals.  While the DSM does provide a list of criteria, there isn’t a single dimensional model that clearly maps how to identify traits and how, or if, they correlate to one another. This means there is dispute over the importance of various criteria, whether they are related to one another at all or just coincidentally present in the patient, existing as distinct problems or pieces of various other disorders. So the root causes that are traditionally used to classify BPD are called into question.  
"There continues to be some debate as to which personality variables should be assessed to make a diagnosis of personality disorder in the normal/abnormal personality continuum. It would seem to be appropriate in this approach to choose those personality variables more likely to be personal and concerned with functioning, in order to assist in understanding the patient's disabilities and obtain strong clues about them. The difficulties encountered in the diagnosis and study of personality disorder include inconsistencies in assessment across both instruments and raters. "

Most professionals agree that the symptoms that compose Borderline Personality Disorder are part of one clinical diagnosis. The symptoms themselves are not deniable. No doctor or therapist would look at a patient talking about their problems and tell them these issues do not exist. That is not the question. The question is mostly one of definition and categorization. Regardless of what anyone thinks, the problems are real and having the ability to recognize the distinction of various symptoms is an important tool in order to deal and work to recover.

19 comments:

  1. I agree very much with 3. In fact i had this discussion with Medusa on SW yesterday.

    When it comes to bipolar, i think that people with bipolar have difficulties in relationships too. Apparently 80% of those marriages end in divorce. I still find it difficult to distinguish, and i'd argue that Borderline PD involves some kind of bipolar 2. But then, i'm only talking from my own experience, and maybe it's not the same across the board.

    I think any mood disorder will effect someone's self-esteem, affect a stable sense of self, and produce crazy-making relationships.
    I dunno, without a therapist and psych right now, i'm a bit in the dark about it all, and i find it hard to get the distinction.
    Anyway, i look forward to you elaborating a bit on that. :)

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  2. Oh I definitely agree. People with Bipolar, or any mood disorder, absolutely have difficulty with relationships (btw my sister is strongly Bipolar). All I know about BPII is the little I've read about it so far but the main markers are the prevalent depression and at least one hypomanic occurence. By this definition I'm likely to qualify for BPII. Bipolar is more chemical in nature. It's an identified fluxuation in chemical regulation that is treatable with medication.

    Borderline isn't characterized by this. BPD has a mix of Nature/Nurture (Environment and Biology)... whereas BP is primarily Nature (biology). So I think while BPII definitely do have turbulent relationship problems, it's more a matter of how their chemistry functions and how they react to the fluxuations therein. That's not to say that those of us with BPD don't react to our chemistry, that's def a part of itm but BPII doesn't diagnose based on personality traits, just medically quantifiable ones.

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  3. right, ok. It's easy to see where the lines can become blurred. Bipolar 2 dx here we come!...
    meh, i wouldn't doubt that i qualify for both too. I've been suspecting it for a while. Some borderlines say they'd prefer to have the label Bipolar over BPD. I disagree. Bipolar seems so much more set in stone. Ugh. lovely.

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  4. I mean, I fit the technical criteria, but i also fit the technical criteria for cyclothemia, PTSD, and probably some other things I don't know about. I think it's more about finding the best fit, the most encompassing diagnosis. I'm no psych though. I'm positive that both do exist in people. Maybe it is all wrapped up together.

    Why no psych/therapist now?

    I'm torn as to whether it would be better to have Bipolar over BPD. Bipolar does seem more set in stone - you can point to it and say, there, there's the thing. But you can also medicate it, stabilize it. BPD, there's no miracle drug combination to fix personality disorders. Even just diagnosing it is harder. But there's also a chance to recover from it and hopefully live a normal life. Bipolar is forever. Bleh.

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  5. No therapist cos i left mine last year to move out of town. I'll be moving back soon and then i'll get it all sorted. Truth is, when I started i went for only about four weeks and stopped. My depression was so bad that I didn't want to continue, i was missing sessions and she told me i need to want to get better otherwise the sessions are pointless. I agreed. But it was my first foray into it, and i think i was processing it all, but nevertheless i've learnt a great deal just by surfing the net in the last few months too. So when I start up again, i'll have a lot more know how when communicating to her, in theory. LOL. :) We'll see.

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  6. ::laughs:: I see. Knowledge is power and all that. {insert G.I. Joe theme song}. Hah,but yeah, def need to /want/ to be there. I def didn't want it most of my life. I didn't start in on it until like 3 years ago? And I took a year off in between then and last Oct/Nov. It can be really helpful though.

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  7. As a recovering narcissist, I can only say that the BEST Bipolah Eva to have is #1. I am number 1 ! I am number 1 !

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  8. So what do they say about a person who has BPD, and BP I, mild PTSD, and also hallucinations when off meds?

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  9. They are the devil's spawn. They only seek perfection in an imperfect, godless world. If I had a fetus knowing it was fucked like that, I would kill it. No doubt.

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  10. @Anon... I imagine they would say stick with the meds and continue therapy.

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  11. Thanks, Haven. They do say that. I love your blog. I hope it reaches far and wide.

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  12. I think there's a 4th dispute to consider when it comes to this classification, namely, that BPD is largely cultural. Take a Non-PD woman and put her in Saudi Arabia, and there would be a high chance of her exhibiting the symptoms suitable for classification. Either the person doesn't fit in, or the rules of society don't fit around them. Which is it?

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  13. im bpd saw my mental health doctor yesterday not sure if i want to see him anymore. dont think he believed me felt silly then he asked who diagnoised me with a smug smile on his face. i know something is wrong with me because i keep overdosing and ruin all my relationships.elizabeth jan 6 2012 8.32

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    1. Hm, that doesn't sound like a very open and receptive mental health doctor. I would find a new one that is less judgmental and more receptive to what you have to say. ::hugs:: Trust me there are good doctors out there.

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  14. Many psychologists arrogantly think they can deal with anything thrown at them. They believe they can fix a person truly disordered. You deserve a therapist who does not condescend to you. Even if no "professional" gives you a definitive diagnosis, you deserve to be taken seriously and explore any type of therapy you wish.

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    1. I agree Bella. It's sad that someone's ego can get in the way of what is actually important. Therapists teach us that we need to know our limits, but then some ignore their own. Fail.

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  15. I think the water with BP and BPD is even cloudier. With BPD being replaced with Emotionally Unstable PD and a whole new set of criteria it's pretty clear that there's no clear understanding of what "BPD" really is. Now the DSM 5 is changing things too. When I was diagnosed BPD I felt a connection to all the qualifying criteria to a greater or lesser extent and my understanding is that BPD is an "Umbrella" term gathering like behaviours.One person with BPD can be completely different to another! BTW, I've had a hypermanic episode and AFAIK I don't have bipolar. Someone talked about stabilizing BPs. It's not so easy to get that stability even with meds I understand. Definitely there is some difference. BPs tend to be treated medically with some therapy, BPDs tend to be treated Psychologically through therapy with some meds so if that is nature vs nuture...

    BPD has been so misused as a label in the past I'd be interested to understand the position from a psych with those specialities...

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    1. Yeah well that's the thing. Bipolar and BPD are actually very different things. They have some similar symptoms but the big difference is actually the physical neurological differences. However without an fMRI it's difficult to figure this out, which does lead to a lot of misdiagnosis.

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  16. I believe that BPD is the new "Hysteria" which was a place to send "angry" women or woman who fought against female oppression. If you look at the criteria, it's abnormal for a female but men all the time have fits of anger and do not get labelled "a personality disorder." It dances around the "Abuse" factor and places it on biology. I don't believe any of us were born defective, but I do believe that if you grow up with depression and anger, you develop a well adapted response system. We are extra sensitive to stress because we were made that way through repeated exposure and when your brain is young it become permanent. The other problem with the criteria is "who doesn't have periods" of high and low self-esteem. Who doesn't go emotionally crazy after a romantic break-up. Why are normal emotional cycles call "abnormal" except that men don't like emotions.

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Leave me a comment! It makes me feel good and less paranoid about talking to myself =)

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