The Stigma of Borderline Personality Disorder

I recently read an article on the The Mighty website called “The Stigma of Borderline Personality disorder” by Autumn Aurelia. It covers the authors experience of being diagnosed with BPD and how the stigma attached to that label changed the way people treated her. It got me thinking about my own previous diagnosis of BPD (I no longer have this diagnosis) and how people treated me because of that.

I was never really convinced this was the right diagnosis for me (see story here) but none the less this is the diagnosis I was given. Going back about ten years now, I had been admitted to hospital primarily for depression and was in a meeting with the psychiatrist. She asked me if I knew what I was in hospital for, to quote her “…it starts with a D.” Ok, depression, but what I was trying to get out of her through the conversation was do I really have BPD? She simply said “people with borderline personality disorder can get depression too.”

I was desperately trying to get a more solid answer or explanation for my diagnosis but she offered none. She was treating me like a child and not really answering any of the questions I had. Was she doing this because of the stigma attached to the BPD diagnosis? (Yes, even health professionals get sucked into the stigma, sometimes even more so than others.) Did she think I was being attention seeking? Manipulative? Who knows. But I didn’t get any answers from her and I was quickly rushed out the room feeling more confused than before I went in.

The current case manager at CMH (which if you’ve been following along you’ll know by now I don’t like her) seems to be under the impression the diagnosis of BPD still applies to be even though I’ve been told that is not the case. I’m wondering if this is the reason she’s so harsh with me. Is she treating me this way, again, because of the attached stigma? Does she think she has to be ‘firm’ so I can’t manipulate the situation? You see people with BPD are often labeled as being manipulative and although that is sometimes true it is not always like that. Sometimes people just want answers and to be heard.

Jumping back to the past again to the time I was denied work due to my mental illness (see story here) Was this because they were scared of my mental illness in general of because they saw the words ‘borderline personality disorder’ and thought I’d be unstable and difficult to work with? Another broad generalisation that comes with the diagnosis.

I had a friend mention to me that I should be glad that I don’t have to carry this diagnosis with me anymore because the people she’s met in the past with BPD were not nice people and I am nice. This is her experience of the condition and I acknowledge that, I know she meant no harm by her comments, but this is also where stigma comes from. People see certain traits and think it applies across the board.

These are just some of the situations I have encountered and perhaps they don’t mean anything and I’m making something out of nothing. I don’t know. But I do know that the author of the above mentioned article is right. People with BPD do get treated different and it isn’t right. It isn’t fair.

There are nine different diagnostic criteria for BPD and to be diagnosed you need to meet five of those. Some people will only have five of the nine criteria, some will have all nine. That means there are a total of 256 combinations, all of which will lead to a diagnosis of BPD. Each borderline will present different to the next. To apply sweeping generalisations is not right and it’s hurtful. It needs to stop.

 

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Borderline Personality Disorder

*Please excuse the formatting in this post. WordPress is being less than co-operative.

I was first “diagnosed” with borderline personality disorder when I was about twenty years old. I use inverted commas for diagnosed because I don’t believe there was any real assessment done and I was just given a label because it was convenient for the psychiatrist at the time.

I had spent ten minutes in this man’s office and this is what he came up with. I don’t know how he came to this conclusion so quick with limited information. I can only assume he saw my self-harm and picked the diagnosis because it is a common feature of patients with borderline personality disorder.

When I went to see the psychologist who had access to my medical file I asked him more about it. He looked in my file to see the first thing written was “borderline personality disorder”. There was no evidence of diagnosis. No reasons written about how he came to this conclusion. No nothing. Just borderline personality disorder.

Now let’s give this guy the benefit of the doubt. He was an older gentleman so I’m sure he’s made this diagnosis many times before. Let’s have a look at what it take to qualify as a borderline.

In order for a diagnosis of Borderline Personality Disorder to be given, at least five of the following nine traits must be present

  1. Fear of abandonment
  2. Difficult interpersonal relationships
  3. Uncertainty about self-image or identity
  4. Impulsive behaviour
  5. Self-injurious behaviour
  6. Emotional changeability or hyperactivity
  7. Feelings of emptiness
  8. Difficulty controlling intense anger
  9. Transient suspiciousness or “disconnectedness”

Let’s go through this one point at a time.

  1. Fear of abandonment

This is defined as “frantic efforts to avoid being abandoned by friends and family.” An “intense fear of being left alone, which causes you to act in ways that, on reflection, seem out of the ordinary or extreme, such as constantly phoning somebody.”

While I didn’t always like being alone (who does?) I wouldn’t define it as an intense fear. I did not constantly phone people or act in any other strange ways. I do not believe this point counts.

  1. Difficult interpersonal relationships

This is defined as “intense and unstable relationships with other people that switch between thinking you love that person and they are wonderful to hating that person and thinking they are terrible.”

While I did have my moments with co-workers, disagreements and such. I don’t believe my feelings about these people switched as extremely as this. They were regular arguments that anyone could have. I still liked the person despite our disagreements and things usually sorted themselves out. I do not believe this point counts either.

  1. Uncertainty about self-image or identity

    This is defined as “distorted and unstable self-image, which affects moods, values, opinions, goals and relationships.”This point is possibly valid, but let’s face it, I was a young adult still trying to work out what I wanted from life. I’m in two minds about this one but I’ll let the psychiatrist have it. One point to him.
  2. Impulsive behaviour

    For this point to be valid, you have to “engage in at least TWO activities that are impulsive and potentially damaging. Examples include excessive spending, unsafe sex, substance abuse or reckless driving.”Now let’s define impulsive. According to the dictionary impulsive means “acting or done without forethought.”

    impulsive
    The only (ONE) activity I participated in according the examples given was substance abuse. I use to smoke marijuana. However, according to the definition, I would not say it was impulsive.

    Every time I smoked it was thought out. I treated getting high the same as I would if I was drinking alcohol. I never drove under the influence. I never went to work under the influence. I only smoked when I didn’t have to go anywhere, or was at a friend’s house when I knew I would be there long enough for the effects to wear off before I drove home, or had alternative transport.

    To me this is not impulsive. Plus it was only ONE activity I was engaging in. Not TWO. I did not, and still don’t drive recklessly. I actually believe I am a very safe driver. I was not having unsafe sex. I was not spending excessively. In fact at the time I had quite a good amount of savings in the bank. So does this point even count?

  3. Self-injurious behaviour

    I’ll give him this one. At the time I saw him I had made a single (and my only) suicide attempt and was self-harming fairly regularly.
  4. Emotional changeability or hyperactivity

    This is defined as “periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days.”Another point to the good doctor. I definitely had periods of depressed mood, irritability and anxiety that lasted from a few hours to a few days. Sometimes longer. In between that I could be in a regular mood like everyone else or be a little hyperactive.
  5. Feelings of emptiness

    This is defined as having “long-term feelings of emptiness and loneliness.”This could go either way for me. I did feel like this sometimes, but not all the time. Can we give half points? Half a point to the psychiatrist.
  6. Difficulty controlling intense anger

    This is defined as “inappropriate, intense or uncontrollable anger—often followed by shame and guilt.”First of all, does this not happen to everyone from time to time, especially when they are under stress? I had moments of anger the same as anyone but I don’t think it was anything that was out of control. Yes, sometimes I felt guilty after if I had taken it out on the wrong person but again, I’m sure this happens to most people from time to time. It’s not like it’s something that happened regularly and I believe the moments I was angry there was a valid reason to be feeling that way. I’m not counting this point.
  7. Transient suspiciousness or “disconnectedness”

    This one is defined as “dissociative feelings—disconnecting from your thoughts or sense of identity, or “out of body” type of feelings—and stress-related paranoid thoughts.”I did have moments of ‘zoning out’, I still do. The feeling like you’re there but you’re not there. Kind of like your floating over yourself. I believe this is more anxiety related though.

    I had the odd paranoid thought but that only happened when I had been smoking marijuana and it mostly revolved around me thinking I was being too loud and the neighbours were going to complain. I use to have the volume on the television set so quiet I basically had to sit on top of it in order to hear it myself. Does that type of paranoia count?

    I’ll be generous and give this one to the psychiatrist even though I don’t recall him ever asking me any questions about this type of thing.

 

Now let’s tally it all up

Point 1 – No
Point 2 – No
Point 3 – Yes
Point 4 – Maybe
Point 5 – Yes
Point 6 – Yes
Point 7 – Half point
Point 8 – No
Point 9 – Yes

So that’s four and a half yes’s and one maybe. Based on all this I’d say it’s fairly borderline (pardon the pun) whether I was borderline or not. It’s all very subjective really, it depends on the individuals interpretation of the criteria’s meaning.

Whether or not I actually did have Borderline Personality back then not doesn’t really matter now anyway. The last psychiatrist I saw (who actually did take the time to read my file and ask appropriate questions) has said that this diagnosis does not apply to me now.

References:

  1. http://www.borderlinepersonalitydisorder.com/wp-content/uploads/2012/12/2012_December_16_v2.pdf
  2. http://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder.aspx
  3. http://www.nhs.uk/Conditions/Borderline-personality-disorder/Pages/Diagnosis.aspx