Tuesday, November 4, 2008

BPD Discussion (MSN Groups Excerpt)

There is debate even within the BPD community regarding the validity of the BPD label.

From: MSN Nickname LawfulPossu, (Original Message) Sent: 5/29/2003 1:28 AM
Hi i am new here to this group. This bpd stuff gets to me. I am a self harmer and it seems like i am given this label. Cause the shrinks don't know how to handle self harmers. does anyone else have this problem.

Message 2 of 59 in Discussion
From: g-man Sent: 5/29/2003 4:48 AM
I think you are absolutely right! I firmly believe that the BPD label is one sued by psychiatirsts to define behaviour they can't understand. Psychiatirsts are entrenched in that very western discourse which states that medicine's goal, it's raison d'etre, is to 'fix' things by making them better (very much pro hoc ergo propter hoc). Easily done perhaps when it's a broken bone or other such complaints where the results are tangible but the same approach is too often applied to mental health problems, where the goal is to return the individual to some state, or norm of spurious mental health. It doens't work that way and anyone who has experienced a mental health problem could tell the professionals this - if only they would listen. Those who suffer from mental health issues very often can't be 'fixed' in the sense of a broken bone and more often live in a 'process' - you know the one, one step forwards, two steps back. That's why I get the impression that the BPD label, like a few others, is a form of psychiatric rubbish dump where, because the pateint won't/can't conform to to the model of recovery posited by western medicine, they are dismissed and denied treatment which really addresses their problems.

Of course, underlying this, the handing out of labels like BPD, is a form of judgement on the individual. The individual won't get better because they don't want to, rather,'...like a pet we feed our tame remorse/ as beggars take to nourishing their lice'! The individual won't enter into the rationalist discourse of western medicine, therefore they are irrational (who wouldn't doubt the reasonableness of this world?). They have basically failed and are thrown into the psychiatric rubbish dump!

Message 3 of 59 in Discussion
From: nettle Sent: 5/29/2003 6:57 AM
My current one seemed unbothered about it when I told him in my introductory session, so I havn't mentioned it since. My previous one just said it was a rather silly thing to do and that was the end of that topic. I agree it doesn't seem to be in their remit.

Message 4 of 59 in Discussion
From: MSN NicknameEndlessVictor Sent: 5/29/2003 6:28 PM
When it comes to self harm (and yes, I go there myself), I can see why docs don't go there. First off, its only a symptom. Do you talk about the harm or do you cure the problems that lead to the self harm? And there is the fear of negative attention. That is, someone cuts as a cry for help...if they get the recognition for it, then they are likely to turn back to the behavior repeatedly. Instead of getting better, they get worse.

I am not comfortable with the borderline personality disorder 'label' either. Perhaps, if members of the psychiatric profession truly understood the disease it would be different, but, I find that psychiatric nurses I have worked with generally don't understand the disorder. They tend to 'roll their eyes' when they hear 'another pd' is coming to the ward.
Perhaps if they had a better understanding they wouldn't look down so much on people who are diagnosed as such. As a psychiatric nurse in Canada, I find most of the nurses I work with are sorely undereducated in mental health areas. The RPN's get a psychiatric component that barely scratches the surface and they are suddenly deemed to be specialists.

Some patients have been lucky to find caring, empathetic caregivers and a great support network. Bravo! Please teach us...you are the true professionals.

Message 5 of 59 in Discussion
From: Lexy Sent: 5/30/2003 2:17 AM

Cheers to that!!

Lawfulpossum, I’m sorry to hear that you keep getting lumped with a ‘label’ because you self-harm. I think psychiatrists, psychologist and other mental health professionals too readily apply the BPD diagnosis to individuals without actually;

a.) sometimes getting to know the patient and seeing whether they can form a therapeutic relationship (apparently quite important in the diagnosis).

b.) seeing if there are other possible reasons for their behaviors (ie. a lot of the criteria can be related to other things in life other than a personality disorder – just because you are ‘abused’ doesn’t mean you have a personality disorder, maybe an adjustment disorder, developmental disorder, maybe a combination of things),

and c.) without considering whether ‘criteria’ are present at a pathological level. It’s fine and dandy to have traits associated with BPD, but it doesn’t necessarily mean that an individual has BPD – doesn’t stop the labeling though does it?!

I can understand your anxieties. I think it is a dangerous label to subscribe to people. If you look at the history of people with a ‘true’ personality disorder, then it is easy to see how negative and detrimental the disorder is for an individual. Subscribing the diagnosis in itself can quite easily fuel futile thoughts, which shouldn’t have been fueled in the first place because it’s a ‘cop out’/ ‘misdiagnosis’.

In some literature professionals argue it is one of the hardest things to treat – someone with a true form of BPD –not only for the patient but the clinician –that in some cases it’s untreatable. Furthermore the stigmas associated with it aren’t that pleasant. It’s almost as though people don’t even try to help because it’s the too hard basket, or they think their efforts will be futile, or they can’t be bothered with the highs and lows etc. The BPD diagnosis I think can quite easily mask situations that are ‘treatable’ with work, persistence, ‘retraining’ etc.

I recently rang my old shrink and psychologist and asked them about their ‘labels’ - they both said BPD - but notably the psychologist was probationary and the shrink idiotic. Idiotic – asked the same questions every week and never ever questioned things further. She didn’t actively try to help. But I was subscribed the diagnosis on the basis that I was abused, SI’ed frequently and to a decent extent and because I was depressed. I actually have/would feel quite ashamed of myself if I was diagnosed with BPD.

I now have a wonderful psychologist who has been in the field for many years and apparently a ‘leader’ in his chosen area of psych – clinical. Furthermore a new psychiatrist who doesn’t want to ‘label’ me. I asked both of them their views on BPD and they said it was a bit of a ‘cop’ out diagnosis. That it’s easy to label someone because of their past and behaviors that have resulted (SI as a coping mechanism?), but in fact they don’t ‘really’ fit the diagnosis. Thus, it is possible to have traits but not a personality disorder per se.

I don’t know if I’ve made any sense.

What I do want to say is if you want to challenge their diagnosis then challenge it. I think ‘professionals’ are too ready to say an individual has a personality disorder if they are SI’ing and are older in age. But, you can prove them wrong :-) As hard as it may be, I wouldn’t ‘label’ yourself. Very few people (less than 1% of the pop.) have a personality disorder (although it seems to be subscribed to a huge %).

I sincerely hope that what is triggering the SI, and associated feelings becomes more manageable for you with time. PTSD isn’t an easy thing to learn to deal and cope with. My thoughts and wishes are with you.

Treat yourself to something good this weekend :-) and promise it

Kind regards,


Message 6 of 59 in Discussion
From: Lexy Sent: 5/30/2003 2:29 AM
sorry if my post comes through with HTML script .... generally type offline over a period of time - forgot to 'retype' back here ....

will delete and try again if it's the case


Message 7 of 59 in Discussion
From: MSN Nicknameplaytto Sent: 5/30/2003 3:59 AM
I agree, I mean they can give us recogniasable signs and symptoms, for
But not really any for borderline, or its a foggy one at best.
And then there's post tramatic too, all very similiar.
Tho I reckon the bpd covers all in between, eh?
They gotta call it something.

Message 8 of 59 in Discussion
From: nettle Sent: 5/30/2003 7:05 AM
et al
I agree it is only a symptom, but so is not eating, excessive drinking and drug taking and they get talked about/treated to at least some degree.

Message 9 of 59 in Discussion
From: MSN NicknameEndlessVictor Sent: 5/30/2003 7:39 AM
I really have to question the way we look at borderline personality disorder.
We have lumped all people with bpd into one pot and have said all people
with bpd have to be treated with formula A, B, or C. Somewhere we forgot thatthese people are human and don't respond to formula. Some therapists trash the label because it doesn't mean anything. You may or may not be an abuse survivor and have the diagnosis bpd. You can come from
any walk of life. I've met some patients diagnosed with bpd who have had the proverbial perfect upbringing.

The typical therapies may or may not work. Most of the time, if you believe
the number of readmissions, the therapies don't work. For a select few, I am
greatful the therapies do work. But, I have to wonder why psychiatry tends to stick to labels and treatments that tend not to mean anything or work for the vast majority of sufferers of bpd when inroads into treatment of many of these symptoms have already been made in the form of DBT or through special inidividual programs such as the ones Dusty Miller proposes?
The hospital I work at has shunned DBT despite the higher return rate in
favor of more 'traditional' treatment.

Right now I'm thankful that I'm a psychiatric nurse. The level of care
offered to patients is so poor, and I'm a believer that if you need to make changes to the system you have to be on the inside.

Message 10 of 59 in Discussion
From: nettle Sent: 5/30/2003 10:26 AM
definitly glad there are people like you working from within et al. I wish you fortitude in the face of idiot authority and respect from your colleagues for wanting to make a difference.

Message 11 of 59 in Discussion
Sent: 5/31/2003 2:12 PM
This message has been deleted by the author.

Message 12 of 59 in Discussion
From: Lexy Sent: 5/31/2003 10:52 PM
Hi ya Lawfullpossum, Playtoo, Nettle, Et.al, Katy and those reading this thread!

How are you all? How are you all? I thought I might add two bob to some of the posts. Personally I find the topic of labeling controversial to say the least. Sometimes it would be nice to have just one label and receive treatment that would ‘solve’ things, but that’s rarely the case. Most people I think (whether or not active in knowing if they have a mental illness) cross several criteria in several disorders.

Playtto, honestly I don’t know what BPD covers - Difficult patients? Maybe it’s a label that professionals use to not to be frowned upon by their colleagues if their patient doesn’t get noticeably better? Too harsh?!

Personally I think the problem in diagnosing personality disorders lies in whether or not the disorder is at a pathological level. Most people show symptoms/traits of some if not multiple personality disorders. However only a small percentage actually suffer because of personality disorder problems themselves.

Et.al, I really appreciate the honesty and ideas you raise in your posts. People don’t follow a formula – who knows it might be easier if we did?! Sometimes I think we can all strive on identifying a label so then we know what treatment might be best, or the course of our illness. Ie. schizophrenia – often if diagnosed a patient will be prescribed anti-psychotics, and in most cases they stabilize, but it’s not true in all. But one can have a label and not respond to treatment, one can have treatment for a different ‘label’ then the one they’ve been diagnosed with but respond better … etc.

It's a great shame that DBT, which seems to have some degree of success in treating BPD, is shunned because of the higher return rate. It’s tragic that in the end the mental health system, much like every other system in society, seems to focus more on fiscal matters. But where and how to you change a system that has such ridged boundaries? And, what do you change in it so that ultimately it survives in boundaries which are still present or slightly different?

At least there are advocators that see the need for change within the system, those using the system and maybe to an extent those outside of it. Hopefully in time things will change so that patient care, not economics, are a priority.


Message 18 of 59 in Discussion
From: l_Bellamy_l Sent: 6/8/2003 6:40 PM
here are a few thoughts on the misdiagnosis of bpd

In the DSM-IV, the only diagnoses that mention self-injury as a symptom or criterion for diagnosis are borderline personality disorder, stereotypic movement disorder (associated with autism and mental retardation), and factitious (faked) disorders in which an attempt to fake physical illness is present (APA, 1995; Fauman, 1994). It also seems to be generally accepted that extreme forms of self-mutilation (amputations, castrations, etc) are possible in psychotic or delusional patients. Reading the DSM, one can easily get the impression that people who self-injure are doing it willfully, in order to fake illness or be dramatic.

Unfortunately, the most popular diagnosis assigned to anyone who self-injures is bpd. Patients with this diagnosis are frequently treated as outcasts by psychiatrists; Herman (1992) tells of a psychiatric resident who asked his supervising therapist how to treat borderlines was told, "You refer them." Miller (1994) notes that those diagnosed as borderline are often seen as being responsible for their own pain, more so than patients in any other diagnostic category. BPD diagnoses are sometimes used as a way to "flag" certain patients, to indicate to future care givers that someone is difficult or a troublemaker.

This is not to say that BPD is a fictional illness; many people meet the DSM criteria for BPD. They tend to be people in great pain who are struggling to survive however they can, and they often unintentionally cause great pain for those who love them. But many more people don't meet the criteria but have been given the label because of their self-injury.


Message 21 of 59 in Discussion
From: Scout Sent: 6/9/2003 5:00 AM
In order for you to have BPD, you need to fulfill 5 of the 9 criteria in the DSM IV. I have also been diagnosed with BPD, but you might as well write "troublemaker" in big letters on my chart .....cause that is what mental health workers usually see when they see the dx BPD. There are doctors though that specialize in BPD and understand totally it is not your fault and know how to effectively deal with these pts. If on other hand you don't fulfill the criteria for BPD and are being said you have it because of the cutting, then it could be factitious disorder. This means you are intentionally cutting yourself because you have a psychological need to be a patient (unlike malingering where you are doing it to fullfill some kind of end like winning a monetary suit or something). Factitious Disorder, although the doing of it it is on a concious level, the motive is completely on a subconscience level and beyond your control. You are fullfilling a psychological need. The hallmark of BPD is stormy (ie unstable) relationships (does that describe your experience?) and is why we have the banner of 'troublemaker' in people's mind. (confrontational, etc)

Message 22 of 59 in Discussion
From: MSN NicknameDisgracedNutria Sent: 6/25/2003 8:55 AM
I am also a self harmer, as they say. I have been diagnosed with BPD in the past. It is just a label and as such deserves not one bit of energy or consideration. People with a diagnosis of BPD have a "bad" reputation among those in the MH field because they are seen as manipulative. People become manipulative when they have been unable to have their needs met in any other way. We are all manipulative to some degree, every single human being. We all try to get what we need however we can get it. It is just human nature.

The self harming comes into the picture, for me, when the bad feelings are so bad that I can no longer tolerate them. When I injure myself I experience a brief interlude of peace. It is a signal to me that I've hit the skids again and it is time to take some kind of action, talk to my therapist about what is going on.

I believe that the key to recovery lies with a therapist who understands the various diagnoses but also understands that everyone is different and does not rely on the lable to direct the treatment.

Good luck to you in the future. I hope you find the assistance you need.

Message 23 of 59 in Discussion
From: MSN Nicknamenicnac12001 Sent: 6/27/2003 10:29 AM
Hi DisgracedNutria,

I wanted to thank you for encouraging others to look more indepth at manipulation. Manipulation is automatically seen as selfish and negative, therefore painting a picture of the manipulative person being selfish and 'bad'. This may be the case in some instances, but in many cases it is important to look behind the manipulative behaviour at what is going on in that person's mind and their life. It is important to look at what function the manipulation plays and why a person feels that they have to be manipulative. Chances are that others will discover that some people who manipulate are actually in a lot of pain themselves and are desparate for love and acceptance. Just as you pointed out, some people manipulate because that is the only way they have ever been able to get anything. Labelling such people as 'bad' will only perpetuate the problem as it will prevent them learning more effective ways of interacting. In this sense, I felt it necessary to highlight the point you made and to see what everyone else thinks about manipulative behaviour? Is manipulative behaviour really the sign of a 'bad' person?

Welcome to PsychHelp DisgracedNutria

Best Wishes,


Message 24 of 59 in Discussion
From: nettle Sent: 6/28/2003 6:43 AM

Intersting, yes. Some people do use manipulative behaviour purely for their own gain e.g. to get a promotion at the expence of someone else or to garner support for a cause. But yes in some respects most behaviour is manipulative in as much as it the has some effect on someone else's behaviour.

Nutria, it is one of the worst characteristics of physchiatry to lable BPD and self harmers as manipulative. Even if some individuals do self harm to get a reaction why can't phycs understand that the tecnique is being used because nothing else that person has tried has worked? Do they honestly think that saying to them 'oh you're a maipulative difficult person' is going to help?

Message 25 of 59 in Discussion
From: Purrpussful Sent: 6/28/2003 1:59 PM
Dear Nicola, and Group:

My favorite description of "manipulation" re: BPD is that it is an intelligent adaptation, indicitive of maturity, created as a logical reacion to a toxic environment. Note that this description is totally non-judgemental, and contradicts two popular beliefs: that engaging in manipulative behavior is immature, and that people who develop this ability do it because they lack the intelligence to adapt in a more construtive way. This doesn't say that it's a good thing, only that it ISN'T a BAD thing! I have one suicide attempt in my distant past, and don't have any complusion (is that the right word?) to engage in self-harming, but someone I once met at a Day Treatment Center who cut herself on the inner lower arms a lot explained, "Feeling pain is better than feeling nothing at all." She had adapted by shutting down emotionally, and causing herself pain was all she felt she had left.

I don't meet some of the criteria for BPD, with which I was diagnosed over 15 years ago (I am now 40), and have begun to wonder if I have some form of autism related to Asperger's syndrome, but because I haven't yet found a mental health professional with whom to work, my diagnosis can't be reconsidered (yet). Once I do, and it is, I have decided to explore the possibility of getting a Psychiatric Service Dog (PSD). Does anyone else here know about this type of treatment adjunct?

Message 26 of 59 in Discussion
From: nettle Sent: 6/29/2003 9:23 AM
That sounds interesting. I'm familiar with the work of epileptic seizure dogs, dogs for the diabled , blind and death, but not phtchiatric service dogs. What are they trained to do? I certainly find one of my dogs in particular is very sensitive to how I'm feeling and will try to be extra kind if I'm in the house feeling very low and they do insure that I get out of the house at least once a day to walk them, even if I feel rotton whilst doing so.
I had a couple of students with aspergers syndrome, I do know that it's more common in men then women, one of our aspergers guys was obsessed with the washing machine. What traits make you think you may have it?

Recommend Message 27 of 59 in Discussion
From: nettle Sent: 6/29/2003 9:25 AM
Incidently that is a great definition of manipulation in BPD. So nice to get away from the critical - these people are problematic - type attitude.