Should BPD be removed from the DSM?

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TheHaywire
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23 Dec 2009, 11:59 pm

Here is my proposal. What do you guys think?

=============================

Borderline Personality Disorder is a label that has been given to people who have suffered from repetitive trauma and reacted in an aggressive manner. It is considered to be an incurable disease.

The reason that BPD is incurable is because it's impossible to kill all the people (whether they are rapists, abusers, neglectful parents, or combat soldiers) who gave the victims this "condition" in the first place.

It is harmful to diagnosis a victim of repetitive trauma with an incurable disease. Judith Lewis Herman is a Harvard psychiatrist who has suggested that BPD be replaced with C-PTSD. (Complex Post Traumatic Stress Disorder)

By replacing the diagnosis of BPD with C-PTSD we are giving victims of repetitive trauma a chance to look in the mirror without having a negative stigma attached to their entire existence.



lotusblossom
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24 Dec 2009, 5:47 am

I dont think it should be removed from the DSM, I think it will turn out to be a heritable neurological condition.

I do think that profecionals should be much nicer to people with BPD and they should not be stigmatised, there is no excuse to treat people badly!

In the UK people with PBD are now being treated by DBT which is supposed to be very helpful.
http://en.wikipedia.org/wiki/Dialectica ... or_therapy



blue_bean
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24 Dec 2009, 9:03 am

Every mental disorder/illness I can think of has some sort of negative stigma attached to it.



i_wanna_blue
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24 Dec 2009, 9:14 am

TheHaywire wrote:
The reason that BPD is incurable is because it's impossible to kill all the people (whether they are rapists, abusers, neglectful parents, or combat soldiers) who gave the victims this "condition" in the first place.


Killing such people does not automatically mean that the sufferer will free him/herself from the horrible trauma he/she has suffered. It depends on the individual. Some people hold onto traumatic events, and others find it easier to let go. But if you look carefully at any psychological disorder especially personality disorders, there is no black and white cure for any of them. At best there are only suggestions which imply a hopeful 'cure'.

I think what you are trying to say is that if you know you are incurable you are going to feel worse about yourself. But no psychological condition is totally curable. It's more a case of being able to make peace with certain events or learning to cope better with certain triggers of abnormal behaviour. Also I think that BPD is something very personal. What one person would deem as self punishment may not apply to someone else.

But it's an interesting topic you have brought up. :)


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Fogman
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24 Dec 2009, 12:23 pm

TheHaywire wrote:
Here is my proposal. What do you guys think?

=============================

Borderline Personality Disorder is a label that has been given to people who have suffered from repetitive trauma and reacted in an aggressive manner. It is considered to be an incurable disease.

It is harmful to diagnosis a victim of repetitive trauma with an incurable disease. Judith Lewis Herman is a Harvard psychiatrist who has suggested that BPD be replaced with C-PTSD. (Complex Post Traumatic Stress Disorder)

By replacing the diagnosis of BPD with C-PTSD we are giving victims of repetitive trauma a chance to look in the mirror without having a negative stigma attached to their entire existence.


I would second this, as BPD tends to be a 'Garbage Diagnosis' for people who the diagnostician cannot find another more suitable diagnosis, or because the person being diagnosed is uncompliant with the diagnostician. -- FWIW, the behavior patterns listed for BPD are much more in line with those of PTSD and C-PTSD.


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arielhawksquill
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24 Dec 2009, 12:53 pm

Change the name, but the stigma will remain. Why would it be any better to have people dislike you because you're damaged, than to have them dislike you because you have a personality disorder? It won't make them treat you any better.



alana
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24 Dec 2009, 6:22 pm

Fogman wrote:
TheHaywire wrote:
Here is my proposal. What do you guys think?

=============================

Borderline Personality Disorder is a label that has been given to people who have suffered from repetitive trauma and reacted in an aggressive manner. It is considered to be an incurable disease.

It is harmful to diagnosis a victim of repetitive trauma with an incurable disease. Judith Lewis Herman is a Harvard psychiatrist who has suggested that BPD be replaced with C-PTSD. (Complex Post Traumatic Stress Disorder)

By replacing the diagnosis of BPD with C-PTSD we are giving victims of repetitive trauma a chance to look in the mirror without having a negative stigma attached to their entire existence.


I would second this, as BPD tends to be a 'Garbage Diagnosis' for people who the diagnostician cannot find another more suitable diagnosis, or because the person being diagnosed is uncompliant with the diagnostician. -- FWIW, the behavior patterns listed for BPD are much more in line with those of PTSD and C-PTSD.


Wow, that is really interesting, the thought of replacing it...it makes me wonder if there was a bias back in the day when there was such denial about sexual trauma, there have been studies that show that there is a bias to diagnosing females with BPD and males with ASPD when they show the same symptoms. So it's interesting to define the disorder by the root of the trauma rather than how it manifests. I think it would go a long way towards holding people accountable, I come from one of those families that sweep everything under the rug.



Meadow
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24 Dec 2009, 7:04 pm

TheHaywire wrote:
Here is my proposal. What do you guys think?

=============================

Borderline Personality Disorder is a label that has been given to people who have suffered from repetitive trauma and reacted in an aggressive manner. It is considered to be an incurable disease.

The reason that BPD is incurable is because it's impossible to kill all the people (whether they are rapists, abusers, neglectful parents, or combat soldiers) who gave the victims this "condition" in the first place.

It is harmful to diagnosis a victim of repetitive trauma with an incurable disease. Judith Lewis Herman is a Harvard psychiatrist who has suggested that BPD be replaced with C-PTSD. (Complex Post Traumatic Stress Disorder)

By replacing the diagnosis of BPD with C-PTSD we are giving victims of repetitive trauma a chance to look in the mirror without having a negative stigma attached to their entire existence.


Yes, absolutely. I have never been diagnosed with it but I agree with Judith Herman 100%. I received a diagnosis of PTSD back in 1996 and Major Depression. I don't know if C-PTSD is in the DSM but it should be and it would be a more accurate diagnosis in my case, as well.



makuranososhi
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24 Dec 2009, 8:55 pm

While I concur regarding the effects that stigmatization has on someone who has a label such as BPD applied upon them, I do not believe that it should be removed from the DSM, at least not on the basis described. First, there is no condition that is cured with the murder of another person; that concept rather horrifies me, to be honest. Second, BPD is not simply the diagnosis of someone who has reacted aggressively to trauma, whether a single incident or repetitive. In short from the DSM:

Quote:
A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness
8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms


Third, not every person who goes through the same traumas and situations will result in the same response or change in personality afterward. On this basis, one cannot invalidate that a difference exists in mental state, at some level; note that I am not making a value judgment regarding that difference, as it is not relevant and I do not personally find that a difference gives either a right to sense of superiority. Fourth, not all cases of BPD are considered to be the result of traumatic experience, with some evidence found among diagnosed individuals that shows a genetic/biological basis for their condition. However, I do agree that it would make sense to consider redefining BPD so that those whose history includes any significant trauma would first be evaluated for (C)PTSD instead.


M.


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24 Dec 2009, 9:06 pm

makuranososhi wrote:
While I concur regarding the effects that stigmatization has on someone who has a label such as BPD applied upon them, I do not believe that it should be removed from the DSM, at least not on the basis described. First, there is no condition that is cured with the murder of another person; that concept rather horrifies me, to be honest. Second, BPD is not simply the diagnosis of someone who has reacted aggressively to trauma, whether a single incident or repetitive. In short from the DSM:

Quote:
A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
5. Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness
8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms


Third, not every person who goes through the same traumas and situations will result in the same response or change in personality afterward. On this basis, one cannot invalidate that a difference exists in mental state, at some level; note that I am not making a value judgment regarding that difference, as it is not relevant and I do not personally find that a difference gives either a right to sense of superiority. Fourth, not all cases of BPD are considered to be the result of traumatic experience, with some evidence found among diagnosed individuals that shows a genetic/biological basis for their condition. However, I do agree that it would make sense to consider redefining BPD so that those whose history includes any significant trauma would first be evaluated for (C)PTSD instead.


M.


I was rethinking this myself and agree with you. I'm not sure yet how the word murder plays in here though. For some reason I'm not comprehending its relevance or context in this situation, if anyone can explain. Anyway, I totally agree.



makuranososhi
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24 Dec 2009, 9:14 pm

Quote:
The reason that BPD is incurable is because it's impossible to kill all the people (whether they are rapists, abusers, neglectful parents, or combat soldiers) who gave the victims this "condition" in the first place.


That's where it came from. Sorry I did not cite it originally.


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Meadow
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24 Dec 2009, 9:21 pm

makuranososhi wrote:
Quote:
The reason that BPD is incurable is because it's impossible to kill all the people (whether they are rapists, abusers, neglectful parents, or combat soldiers) who gave the victims this "condition" in the first place.


That's where it came from. Sorry I did not cite it originally.


M.


I read that before but I'm still confused by it. I can't tell what it's really saying. I thought it just referred to not being able to get "rid" of the people who perpetrate these sorts of abuses that cause the disorder in their victims in the first place and in this respect I had no issue with it, so I was confused with your take on it.



TheHaywire
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24 Dec 2009, 9:46 pm

Glad this has provoked so much discussion.

Just to be clear I am not advocating murder but stating that it is impossible to eliminate all the people who have caused this condition. The reason people are displaying BPD behavior is because they have been victims of repetitive abuse. The only way to prevent BPD would be to get rid of the people who targeted the victims. This is why BPD can't be prevented... and also why I think it should be replaced with CPTSD.

BPD is seen as a very negative label. Therapists refuse to treat borderline patients because they are "difficult cases" and that's only the beginning. Being slapped with the diagnosis furthers the individuals spiral into descent because they are told they are incurable. Nobody that is a victim of repetitive trauma should have to be subjected to such stigma.

"Why would it be any better to have people dislike you because you're damaged, than to have them dislike you because you have a personality disorder? It won't make them treat you any better."

People don't dislike you if you're damaged. (unless they're horrible people) They dislike you if you have a personality disorder because you're considered someone who damages the lives of others. BPD focuses on the negative behaviors of people with BPD while CPTSD would focus on the negative behaviors of the people who put this individual in their situation.



makuranososhi
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24 Dec 2009, 10:53 pm

But BPD is -not- the same as C-PTSD, or as simple as the reaction to what other people have done to an individual. As stated before, there are studies which indicate a genetic/biological factor in BPD that does not have trauma as a prerequisite. As I see it, BPD is a condition one is born with which may be triggered by later environmental events; C-PTSD is a reaction to one or more traumatic events that affects the individual in the short and long term, and in some cases on a permanent basis. I cannot agree that the two are the same condition; I have met people who were clinically diagnosed with each, and my impressions of their behaviors were quantifiably different. Admittedly, this is personal experience and a minuscule sample set, but they express in different ways. C-PTSD also does not take into account the difference between deliberate and resultant manipulations that can exist between it and those who fall under BPD.


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TheHaywire
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24 Dec 2009, 11:00 pm

Here is what I am curious about.

25% of people with BPD are not victims of trauma while the other 75% are. Why the similar symptoms? It can't be a coincidence that the majority of people with BPD are trauma survivors. This is why I feel like it should be changed to CPTSD. At least for the 75%.



makuranososhi
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24 Dec 2009, 11:07 pm

TheHaywire wrote:
Here is what I am curious about.

25% of people with BPD are not victims of trauma while the other 75% are. Why the similar symptoms? It can't be a coincidence that the majority of people with BPD are trauma survivors. This is why I feel like it should be changed to CPTSD. At least for the 75%.


There are a lot of conditions that share symptoms, whether dealing with physical, mental, social or emotional conditions. I can agree that those whose histories include trauma should be evaluated for C-PTSD first; that does not preclude that there is an overlap, either.


M.


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