This diagnosis belongs in the bin - it's much more likely to be applied to women (borderline personality disorder)

[Sly Saint]

There's a mental health diagnosis that's applied three times more often to women than men. That should give you pause for thought alone.

But then, add to that the fact it may be diagnosed after only a brief encounter (not a full assessment) by a clinician who has never met you before; at the point when treatment for some other diagnosis is deemed to have "failed" for example when you don't recover quickly from depression or an eating disorder; when you are told you are "not engaging" (even though the therapist has responsibility to engage you too).

Or maybe you are deemed "unsuitable for this service", or "too difficult to manage" because you are harming yourself. What is this diagnosis? It's Borderline Personality Disorder (BPD), sometimes known as Emotionally Unstable.

According to the DSM (the Diagnostic and Statistical Manual of the American Psychiatric Association) people with BPD have a pervasive pattern of instability in interpersonal relationships, self-image and affect (mood), in addition to marked impulsivity and "self-injurious behaviour".

You need five out of nine different symptoms to get the diagnosis of Borderline Personality Disorder but if you are female and self-harm the sad truth is that you may be lucky to get a different one. It's a sticky diagnosis too. It can stay with you for decades and colour the way that every other health professional in your life behaves towards you.

We do know from research that for people who have these kinds of psychological difficulties there are therapies that can help them recover but these may be painfully difficult to access on the NHS.

But most don't get any treatment. Some get discharged from care completely and just told to go away. Those who cause most concern because of self-harm get sent to rehabilitation units and are sometimes locked away for years, often at great expense and of doubtful benefit.

Of young women known to mental health services in England and Wales who take their lives before the age of 25, a quarter are believed to have "personality disorder". More than 50 percent of those given this diagnosis who take their lives are women too (that's a higher proportion of women than in the general population where three times as many men take their own lives as do women).

But what has happened to these people, and why are so many women being given the diagnosis of "borderline"?

This diagnosis belongs in the bin - it's much more likely to be applied to women

 

[Sean]

I have always had serious doubts about the whole concept of personality disorder, and even more so about its use in the clinic.

 

[Joan Crawford]

I have always had serious doubts about the whole concept of personality disorder, and even more so about its use in the clinic.

Ditto

Majority of patients I see with BPD labels have highly traumatic pasts. PTSD often makes more sense. A normal response to abnormal situation(s). And undiagnosed autism can also be in the mix.

I'm trying to recall if I have ever met a male patient diagnosed with BPD.

 

[Haveyoutriedyoga]

In the UK psychiatrists diagnose complex PTSD, and many in the mental health field believe that is 'just a more socially acceptable way of saying BPD'

 

[Haveyoutriedyoga]

Also see 'complex emotional needs' and a newish term 'childhood emotional neglect'

 

[Ash]

This diagnosis belongs in the bin - it's much more likely to be applied to women

Article refers to studies pointing to women with a BPD diagnosis as having a higher risk of suicide. Compared to what I couldn’t quite grasp.

If higher risk be so, if I recall rightly from elsewhere it is, seems like the best case for removing the possibility that a component of the extra risk is the diagnosis itself. One knows one isn’t so likely to acquire a new personality in this lifetime. Personalities aren’t amenable to treatment. Making it seem like the only way out of the pain and distress is out of this life.

This diagnosis is bin worthy. But a new less obviously derogatory term isn’t going to solve the issue. Medicine, psychiatry and psychology as whole disciplines need to learn to let go of their prejudices and suspect ‘treatments’ and improve themselves. Work on their own obnoxious behaviours over this issue.

 

[Haveyoutriedyoga]

There is tremendous stigma associated with the diagnosis, I overheard a GP call people with the diagnosis ‘sticky’, as in, they ‘sticky-up the system and it takes a lot of time to deal with them’. Luckily a mental health nurse jumped in and explained how GP communication could be improved in order to understand and effectively address concerns and meet the needs that people with the diagnosis often have. It was a satisfying moment.

 

[Ash]

There is tremendous stigma associated with the diagnosis, I overheard a GP call people with the diagnosis ‘sticky’, as in, they ‘sticky-up the system and it takes a lot of time to deal with them’. Luckily a mental health nurse jumped in and explained how GP communication could be improved in order to understand and effectively address concerns and meet the needs that people with the diagnosis often have. It was a satisfying moment.

How awful.

A gloopy one. I think of a ‘sticky’ label as one that can’t be shaken off, nor can the negative effects of having it be shaken off.

But of course, I would look at it from the other direction. Being a patient with a ‘contested’ illness, the disaster of ‘CFS’ and everything.

No one more of a ‘heart sink’ patient than a person with an ME diagnosis I am reliably informed.