Borderline Personality Disorder - Hope or Hopeless?
Posted by AEJ1967
17th Feb 2014

Someone asked me the other day if I found my diagnosis a help or a problem? It's a strange question to ask and answer, especially when I consider that (possibly with the exception of Sexually Transmitted Infections) no physical diagnosis carries with it the same level of judgement and/or stigma as some Mental Health conditions.

BPD is a label , I have discovered since my own diagnosis, which carries with it a whole heap of historical issues and assumptions.

Firstly, it has suffered from going through a long period during which it was considered to be 'untreatable'. Among some professionals it seems that this situation has not moved forward, judging from ongoing issues that people with the condition report in finding support and help from services during crisis periods. This is despite clear pathways being published by NICE and the Mental Health Act 2007 declaring that BPD should no longer be 'a diagnosis' of exclusion.

Secondly, it is problematic to pin down and explain how a diagnosis has been arrived at. This is simply because to fulfil a diagnosis of BPD a sufferer needs to show issues in five major areas, up to a maximum of nine symptom clusters - someone has estimated that this means there are a possible 256 individual symptoms which could indicate a diagnosis of BPD. This has meant that there is much scope for debate among Mental Health professionals - something which is probably not always good - as I feel that if you have a room with 5 Psychiatrists in it you will elicit five different responses to BPD each of which will have vastly differing impact on how treatment proceeds.

Thirdly, many service users do not like the label BPD because they feel that MH professionals view this patient group as exceptionally problematic to manage. I don't want someone to look at my file before they meet me and decide that I am going to cause them problems. I am a complex person, my mental health issues are complex and have long standing complex roots. My mood changes are volatile and can switch immensely in the period of time usually allocated for therapy sessions. It takes a special kind of understanding to sit with the kind of emotional distress I often express and help me to work through those emotions to a point where I can feel hopeful. I am grateful for professionals working with BPD as a specialism who have treated me like this. Above all, although I may have the same label as someone else and that helps to decide upon a course of action to take to help me, my needs are my own and more that clinical processes I need someone to listen to me, help me to sit with my emotional pain and, ultimately teach me the skills I need to manage my condition in the long term.

Most people who dislike the diagnosis of BPD dislike it because it essentially labels my whole person as being 'defective'. For me, terms like 'emotionally sensitive', or 'emotionally dysregulated' are more helpful in some ways, except they fail capture the all pervasive nature of the emotional and psychological distress experienced by me.

Ultimately, my diagnosis is so misrepresented and misunderstood that it gives me many opportunities to explain that Mental Health conditions have numerous causes and therefore numerous responses. BPD has allowed me to speak to lots of different people about the need to talk about Mental Health issues and to provide at least one example where any one of us could be diagnosed with a Mental Illness at any time. A label is helpful insofar as it helps me and those treating me to decide on a direction of travel towards recovery.

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