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What does a personality disorder dx mean to you??

amathus

amathus

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The Impact Of Diagnosis – Positive Help Or Loss Of Self?

The term personality disorder covers such a broad range of feelings, experiences and ways of behaving that some question whether these are meaningful diagnoses or unhelpful constructions. The way that people are diagnosed from a list of possible criteria means that within any one specific personality disorder category, there will be a huge range of different experiences. For example, there are 246 different ways to meet the criteria for a diagnosis of borderline personality disorder. In addition, people are likely to be given a diagnosis of two or more personality disorders, again increasing the diversity of experience captured under these labels. Bringing together such a large range of experiences into these few diagnostic categories contributes to the controversies surrounding PD.

Campaigners argue that one of the dangers of mental health diagnosis is the very real possibility of losing sight of individual needs and experiences. Mental health professionals and services often respond to people on the basis of diagnosis rather than individual needs and preferences. In relation to personality disorder, people often talk of assumptions being made about their personal history on the basis of their diagnosis (i.e. if a woman has a diagnosis of BPD, it is assumed that she must have a history of abuse). Similarly, people report that prescriptive decisions are made about what treatment is offered (e.g. someone with a diagnosis of BPD is automatically given DBT).

When a diagnosis determines how someone is understood and treated, rather than their individual needs and choices, then we can once again see the potential damage that diagnoses can do. It has been argued that the use of diagnosis to define experience and determine treatment reinforces a sense of powerlessness that many people experiencing distress already feel. Whilst some people have felt the positive benefits of being able to access services they want because they have been given a diagnosis, others will be frustrated and angered to find they are pushed towards certain treatments considered ‘good for PD’ and steered away from or refused the services they would prefer. This highlights the powerful role of diagnosis within the psychiatric system and the reasons that controversy exists around this subject.
Individual Or Society?

A further argument surrounding PD relates to the evidence that a very high proportion of people given a PD diagnosis have had traumatic childhood experiences and life events. It is suggested that the concept of personality disorder obscures the wider social issues of childhood abuse, neglect, poverty and inequality by focusing on the individual. Rather than being concerned with the impact and prevalence of these issues, public outrage is focussed on containing people perceived to be dangerous. We have government policy, initiatives and new laws which focus on individuals given this diagnosis, but very little that directly addresses these underlying social problems.

The emphasis on the individual being given a diagnosis, to the exclusion of social causes and the broader context, also returns us to the stigmatising effects of diagnosis. People given a diagnosis often report how damaging it feels to be told that the problem lies within them, that they are at fault somehow. For many people this mirrors earlier traumatic experiences where people have been told they are to blame or are made to feel responsible for the abuse or neglect they suffered.

Work has been done looking at the ways in which such diagnoses have arisen out of social and cultural contexts. For example, there is a long history of feminist work which is critical of psychiatry. Writers highlight a pattern of women being driven to behave in ways society considers unacceptable or ‘mad’ because of social pressures such as oppression and sexual abuse. Women are then punished for behaving in ‘unacceptable’ ways. The social causes of their behaviour are obscured and hidden as the focus becomes the individual’s ‘mad’ and unacceptable behaviour. Hysteria is the most widely known example: some women responded to the oppression of Victorian society by expressing emotions in ways that were not considered appropriate for a woman. These women were discredited, their experience dismissed, and the broader issue of women’s oppression obscured by describing them as mad. It is argued that Borderline Personality Disorder is a modern day version of this same pattern.

Diagnosis has a very powerful role in society at large and within the psychiatric system. The diagnosis given determines how our feelings and behaviours are understood, how we are treated, and what options are available to us. And yet, the basis for diagnosis is an individual judgement shaped by social, cultural and gendered understandings of what is acceptable, normal and rational.
References

Emmelkamp P.M.G. & Kamphuis, J.H. (2007) Personality Disorders Psychology Press

Geraghty, R. (2002) The Dialogue Guide to Personality Disorder Personality Disorder Network

Haigh, Rex (2006) ‘People’s Experience of Having a Diagnosis of Personality Disorder’ in Sampson, McCubbin and Tyrer, P. (Eds.) (2006) Personality Disorder and Community Mental Health Teams

Paris, J (1996) Social Factors in the Personality Disorders Cambridge University Press

Proctor.G. 'Disordered Boundaries? A Critique of Borderline Personality Disorder' published by psychminded.co.uk and available on 23.8.09 at http://www.psychminded.co.uk/news/news2007/June07/borderline001.htm

Shaw, Clare ‘Women at the Margins: me, Borderline Personality Disorder and Women at the Margins’ Annual Review of Critical Psychiatry

Discussion between Louise Pembroke and Fenella Lemonsky on comments board of psychminded available at: http://www.psychminded.co.uk/news/news2007/June07/borderline001
 
amathus

amathus

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Psychiatry Discriminates Against People with BPD: Article

Psychiatry Discriminates Against People with Borderline Personality Disorder
By Elise Stobbe | Share | 4 Comments

Anti_Stigmatization.jpgBorderline Personality Disorder (BPD) is characterized by a pattern of unstable relationships, a self-image that is always changing, and poor impulse control. The person suffering from BPD fears abandonment and will go to any lengths to prevent this, including threats of suicide. Self-harm is a characteristic.

There may be no other psychiatric diagnosis more laden with stereotypes and stigma than Borderline Personality Disorder. People who live with this label — the majority being female — often have problems accessing good mental health services. (1) Unlike the stigmatization that society puts on mental illness, the stigma associated with BPD often comes from mental health professionals and their patronizing attitudes.

Many psychiatrists will not treat BPD patients, or they may limit the number of BPD patients in their practice or drop them as ”treatment resistant.” Often attempts to treat borderlines fail, and some professionals blame the patient for not responding to treatment. (2) It is often undiagnosed, misdiagnosed, or treated inappropriately. According to Dr. Joel Dvoskin, former Commissioner of the New York State Office Of Mental Health,

“Why would psychiatry and psychology turn so viciously against people they call mentally disordered? Apparently the greatest sin a client can commit is poor response to treatment. What is apparently so wrong about these unfortunate souls is that they have yet to demonstrate the ability to get better in response to our treatment. Thus, they don’t make us feel very good. With a few notable exceptions, we have simply given up on helping people who desperately need us to do a better job of helping them.” (3)

Many mental health professionals discriminate against BPD patients because of what their co-workers have said about them. They watch other professional people “rolling their eyes” when someone mentions BPD. This is just evidence showing others that “everyone knows that people with BPD are horrible people and hard to manage”. (4)

Clients who come to services with a diagnosis of BPD “may already be disliked before they have even been seen. Clients in treatment are often embroiled in clinician attitudes which are derogatory or denying the legitimacy of their right to access resources. Studies have demonstrated clinicians having less empathy for people meeting diagnostic criteria for borderline personality disorder than other diagnostic groups and making more belittling comments.” (5)

Support services for consumers and families are woefully inadequate. The public is generally unaware of the disorder due to the lack of educational materials available from various mental health organizations. No celebrity has yet come forward to put a face on BPD, probably because BPD is the most stigmatized of all mental illnesses today. (6)

Recent research studies have demonstrated the effectiveness of individual cognitive behavioral therapy along with group psychoeducation and skills training that teach emotional regulation skills, distress tolerance, improved interpersonal relationship behaviors and awareness (mindfulness). This, combined with careful medication management, may allow the patient to achieve significant progress. (7)

Effective treatment can reduce symptoms and improve quality of life. There is also considerable short-term fluctuation in symptoms and distress, and the long-term outcome for many patients is often better than originally thought, even without treatment. (8) A fairly new psychosocial treatment termed dialectical behavior therapy (DBT) which was developed specifically to treat BPD is available. But without willing professionals, people with BPD are denied the help they need.

References

(1) Nehls, N. Issues Mental Health Nursing. “Border Personality Disorder: Gender Types, Stigma and Limited System of Care“. Abstract. Entrez PubMed.

(2) Bogod, Elizabeth. Mental Health Matters. “Borderline Personality Disorder Label Creates Stigma“.

(3) CAMI Journal on BPD, Vol 8 cited by TARA Association, “Understanding Borderline Personality Disorder“.

(4) Fleener, Patty, M.S.W. BPD Today. “Stigma and Borderline Personality Disorder“. (2002).

(5) Krawitz, Roy and Watson, Christine. Mental Health Commission Occasional Publications: No. 2. “Borderline Personality Disorder: Pathways to Effective Service Delivery and Clinical Treatment Options.” (October, 1999).

(6) Porr, Valerie. TARA Association. How Advocacy is Bringing Borderline Personality Disorder Into the Light“. (Nov. 2001).

(7) TARA Association, “Understanding Borderline Personality Disorder“.

(8) Livesley, W. John, M.D. The Canadian Journal of Psychiatry. Editorial: “Progress in the Treatment of Borderline Personality Disorder“. (July 2005).
Elise Stobbe
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dib4uk

dib4uk

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Thank you very much for taking the time out to put this up and citing the source of your postings- done very welll i might say :p

The only thing I would say about the reports was that according to one of the reports dbt? is being used to treat borderline personality disorders... As i have emotionally unstable personality disoder would that also mean that I should expect to recieve this form of treatment other than the one that im currently waiting for-which is psychodynamic psychotherapy.

The thing that has me wondering is that theres so many different types of treatments avaliable for a person who has a personality disorder- that there should be a standardised theraputical treatment avaliable.

Regarding being labelled as emotionally unstable, I'm not really to sure what that means to me, but i dont publically declare this diagnoses to many people at all. All they know ie friends is that i suffere from low moods and low self esteem. To me that is part of what it means to be suffering from a personality disoder the way in which i function on an individual level and on a social level.
 
amathus

amathus

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TBH I'm not sure about the DBT and it's availability, I know I've never been offered it in my area...
It was however, suggested that I have Psychodynamic therapy by my pdoc, but my CPN didn't think I was in the right frame of mind to pursue it so the pdoc didn't give it any further consideration.
Basically I have been without any form of therapy for the four years since dx was made. My cpn talks to me about how my week has been and may suggest different coping strategies if I've run into difficulty...and that's it!
I've had the problem for forty years, it was only four years ago that I was given a dx...a label if you like.
I suppose in reality I have a lot of 'learned' behaviours' to 'unlearn'! I wonder if I am going to run out of time??

Yes I spent a lot of time with the posts and doing them properly...reckon I deserve a gold star!!:flowers:
 
A

Apollon

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I have diagnosis of schizotypal personality disorder...
Actually it helped me, to have diagnosis.
Because, now I know the name of disorder which I have, and I don't have to break my mind with self diagnosis.
Now I know the name of my demon, which is destroying my life.
It is helpful to me.
 
starflower

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I have been put on a waiting list for DBT, but have been told that it may take quite a while to get to the top of the list, as there are a lot of others also waitng for this therapy. I have heard both good and bad reports on it, but am hoping that it will help.

I was only given the diagonis of BDP last year, although I have been having treatment for depression and anxiety for nearly twenty years.

I have tried to find out as much as I can, but I do think that there is not enough written about the subject that is clear and easily understood.

Sometimes wonder if I was given the label just so that I finally belong to some distinctive group of patients.

I'm still confused, but still trying and hoping the DBT will help.
 
amathus

amathus

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I have been put on a waiting list for DBT, but have been told that it may take quite a while to get to the top of the list, as there are a lot of others also waitng for this therapy. I have heard both good and bad reports on it, but am hoping that it will help.

I was only given the diagonis of BDP last year, although I have been having treatment for depression and anxiety for nearly twenty years.

I have tried to find out as much as I can, but I do think that there is not enough written about the subject that is clear and easily understood.

Sometimes wonder if I was given the label just so that I finally belong to some distinctive group of patients.

I'm still confused, but still trying and hoping the DBT will help.

Hi there,

When I was first dx with BPD four years ago, the pdoc recommeneded this site to help me maybe understand a bit and get some support,
Borderline UK, perhaps you could have a look , if you haven't already...


meteos.
 
A

Ainsworth

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hmm....!

I havent been dx with a PD (yet) they tended to label me as complex with lots of things wrong or not fitting in for one thing, the voices being one thing. Hence long term therapy which they arent giving me!!!!

think i would rather have the dx of adult AD then a PD if it gets me to therapy. once labelled PD your screwed really, i may get away with AAD because most doesnt know what it is and doesnt carry the same stigma even though its the same thing :p
 
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