Borderline Personality Disorder - a feminist critique

by Quinn Capes-Ivy // 11 June 2010, 14:32

Tags: borderline personality disorder, disabled, health, medical establishment, mental health, psychiatry

Among my many diagnoses, I have what is known in the UK as Emotionally Unstable Personality Disorder (Of The Borderline Type), known elsewhere as Borderline Personality Disorder. BPD is described by Wikipedia as “a prolonged disturbance of personality function ... characterized by depth and variability of moods.” It manifests in many ways, including rapid cycling mood swings, ‘self-destructive behaviour’, black and white thinking, disassociation and extreme fear of abandonment.

BPD is a serious mental illness and is difficult to diagnose. Unfortunately it is also well-known as being used by psychiatrists and mental health professionals as a way of labelling ‘difficult’ or ‘problem’ patients - I know at least one woman who was threatened with a diagnosis of BPD by a mental health professional because she wouldn’t do as she was told.

Three-quarters of patients diagnosed with BPD are female. I’ve spent some time since my diagnosis wondering why that is, when one would expect the split to be roughly 50/50.

My first thought is that the diagnostic criteria cover much of what is considered to be “stereotypically feminine” behaviour, but to a more extreme level. For example, one of the diagnostic criteria, “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).” - well, women are supposed to be overly emotional people anyway, right? Another of the criteria is “Frantic efforts to avoid real or imagined abandonment.” We’ve all heard the stereotyped stories of bunny boilers, of women who get pregnant to ‘trap their man’, of women who are controlling and possessive and who are terrified of being alone. Women are supposed to be flighty, unable to control their emotions, and to have trouble navigating their interpersonal relationships.

The second thing I’ve been thinking about is that it’s possible that women get the diagnosis of BPD because some of the diagnostic criteria include things which are considered ‘normal’ for men, but ‘abnormal’ for women. For example, if a woman behaves in an ‘unfeminine’ way, say by expressing extreme anger (another of the diagnostic criteria is “Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)”), the label of BPD is slapped on her by the psychiatrist. “Frequent displays of temper, constant anger [and] recurrent physical fights” are not seen as disordered behaviour in men, they are seen as fairly normal. But it seems that when a woman displays those tendencies she is not normal, she is personality disordered.

Another of the criteria is “Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving).” Again, some of these things seen as “potentially self-damaging” (I’m looking at ‘promiscuous sex’ and ‘reckless driving’ in particular) are seen as normal behaviours for men, but in women are considered undesirable enough to be included in the criteria for diagnosing a serious mental illness.

And lastly, I’ve been wondering whether Borderline Personality Disorder is a mental illness/personality disorder at all. Considering so many more women are diagnosed with it than men, and considering it’s thought to develop in early childhood rather than being an innate mental illness, could there be something about being raised female which increases women’s propensity towards BPD-type thinking? Could that ‘inappropriate anger’ be not a disordered way of thinking, but valid female rage against a world which devalues women and things which are thought of as ‘traditionally feminine’?

As I said at the beginning of this post, I have a diagnosis of Borderline Personality Disorder and I believe this to be accurate because my life is severely impacted by my symptoms. But I often wonder if, in a world where men and women were seen as equal, where women were valued and seen as being as worthy as men, whether this diagnosis would exist at all. Or, in an ideal world where women were not seen as ‘other’ and our natural behaviours were not seen as ‘deviant’, whether the world would be more shaped for women (and men) displaying Borderline type symptoms and thus our lives would not be so devastatingly impacted by it. One thing I do know is that as a diagnosis in the current climate, it is extremely stigmatising and for many women it seems to do more harm than good.

Comments From You

angercanbepower // Posted 11 June 2010 at 15:27

Interesting stuff, thanks. I had no idea that there was such a disparity in the sex of those diagnosed.

With regard to your scepticism about whether BPD is real, any condition where you have to fulfil 5 of 9 diagnostic criteria to have it makes me doubtful at least about the accuracy of the diagnosis. Two people could have share only one symptom (e.g. impulsiveness) and both be told they have BPD.

On the other hand, it does seem to at least be describing something which can be treated. In a recent trial of schema therapy (described as "CBT with a psychodynamic component") 46% of people made a full recovery. Hard to argue with that.

Philippa Willitts // Posted 11 June 2010 at 15:35

I think another reason it's predominantly women who get diagnosed with BPD is that it's very, very frequently given to people who were sexually abused in childhood, and the figures for that are predominantly girls rather than boys.

But great analysis, cheers.

HarpyMarx // Posted 11 June 2010 at 15:39

V. good post Anji and it is good to have a feminist critique of personality disorder. Personality disorders (all different varieties) are politically loaded and it exposes the dominant patriarchal and capitalist ideology, unequal power relationships.

Number of women are labelled with a personality disorder who have self-harmed (and the criteria have so many broad definitions is could include anyone). There's a hideous form of so-called personality disorder called Histrionic personality disorder....and majority of labelled with this are women.

Rather like pychiatric labelling overall it is about whether you sorta fit the pick and mix criteria. When I was 17 I was labelled by a GP with schizoid personality disorder, a shrink pegged me as depressed and anxious and then changed his mind later to maybe schizophrenia.... The label changed a number of times... and from a personal/political standpoint it is dehumanising, and stigmatising to have these kind of labels.

Jennifer Drew // Posted 11 June 2010 at 15:51

Certainly mental illness in women is viewed from the male-centric gaze and all too often women's mental problems are pathologised because 'obviously' all women are inherently defective given we are not male and human.

How does one define 'inappropriate anger' given women as a group are socialised from the minute we are born that anger is not an appropriate emotion and we are expected to suppress our natural anger. Males however are encouraged to express anger because this is supposedly a sign of natural male assertive behaviour.

But as you rightly demonstrate mental illness is never neutral, because it is always subjected to a gendered analysis and one which is predominantly male-centric. This is why so many women who experience mental illness are pathologised instead of being given expert support and treatment.

Given that for women attempting to conform and enact 'femininity' as defined by our male supremacist society is never straightforward but involves constant suppression of emotions and feelings I too wonder whether BPD would lessen if women were allowed as children to develop their real character and not be constantly subjected to the strait jacket called 'appropriate feminine behaviour.'

Misogyny has never been eradicated and certainly within the male-dominated medical profession, there continues to be widespread male contempt for women patients - irrespective of whether or not they have mental problems. Meaning of course that women who experience mental issues suffer a double whammy because their mental issues are supposedly due to fact they are female not male and this alone supposedly means a woman's mental problems are due to the fact she is biologically female and hence 'defective' rather than male and hence 'human and rational!'

Politicalguineapig // Posted 11 June 2010 at 15:56

What's a bunny boiler? I've never heard of it before.
Other than that, great post. Here in the U.S. I think women are most commonly diagnosed with depression. I can't help wondering whether it's also used as a catch-all, as ADD is used in the case of boys. They're both legitimate conditions, but I think doctors and other professionals are a little triggerhappy when it comes to diagnosing those conditions.

Anji // Posted 11 June 2010 at 16:03

Philippa - I did think of that actually, but the 700-word limit prevented me from exploring that angle.

Interestingly, in one BPD community I'm part of, I seem to be one of the only patients who has no 'trigger' of childhood trauma which my BPD could be linked to. There are a couple of things it could be (my Dad being away a lot with the Navy, though I don't recall that being particularly traumatic - it was just normal to me, or the fact that huge swathes of my past are completely lost to my memory, so something traumatic could have happened that I don't remember), but on the surface I'm a 'Borderline without a cause' as it were!

For anyone who doesn't know much about the condition, what Philippa is referring to is the idea that BPD starts to develop in early- to mid-childhood, following a traumatic event (parental divorce, sexual, physical or mental abuse, abandonment by one or more parents or adult loved ones) which causes the personality development to go 'off-course'. The theory is that there's a healthy line of personality development and when the personality develops along a line which does not follow that healthy line, it is considered to be disordered.

Anji // Posted 11 June 2010 at 16:07

Angercanbepower - On the other hand, it does seem to at least be describing something which can be treated. In a recent trial of schema therapy (described as "CBT with a psychodynamic component") 46% of people made a full recovery. Hard to argue with that.

That's interesting, because when I first spoke to my GP about BPD, she was insistent that it is an uncurable condition, and most of the psychiatric professionals I've met seem to agree with that. But I know for certain that while borderline-type thinking might never go away, one can certainly with the help of medication and therapy (I did a great DBT (Dialectical Behavioural Therapy) based course of group therapy which has helped immensely) learn to counter that thinking and live a fairly 'normal' life.

E // Posted 11 June 2010 at 16:27

The gendered diagnosis is one thing, however the symptomology is neutral. It is more the environment and viewpoint of the psychiatrist that should be questioned. I do however think that the disorder would continue to exist even if a world where both men and women were equals ( in all senses of equality)

Kate // Posted 11 June 2010 at 16:43

Interesting points, although one explanation that you have missed is that women are more likely to be diagnosed with BPD, along with depression, because they have more contact with doctors. Men’s mental health problems are more likely to go undiagnosed because they are less likely to go to the doctor or talk about them. The impact of this can potentially be seen in the higher number of male suicides.

But the relationship between gendered personality traits and diagnosis is an important one. On the flip side, it now seems to be being acknowledged that women are less likely to be diagnosed with autism in part because female autistic behaviour is still within the bounds of what we consider “normal” overall.

Louise // Posted 11 June 2010 at 16:55

The diagnosis of BPD is controversial, with many mental health professionals questioning its existence. Some people (such as Hagop Akiskal) argue that most people diagnosed with BPD are actually suffering from subclinical (i.e., not quite severe enough to qualify as a clinical case) bipolar depression - which has many identical diagnostic criteria but a completely different treatment regime.

And the interesting part? Men and women are equally likely to have bipolar disorder... which makes the disproportionate diagnosis of BPD in women rather unlikely to have a purely clinical basis.

Great article, Anji! The issues deserves public discussion.


Sue Henderson // Posted 11 June 2010 at 17:27

A very interesting article, Anji, and especially since I diagnosed myself with bipolar a couple of years ago and appear to have very similar symptoms to yours. I should stress btw that I didn't just 'decide' I had bipolar, I did plenty of research first, including looking back over many years of depression and 'inappropriate' behaviour.

I agree that some of the symptoms are considered 'normal' in men (although they probably shouldn't be).

Labels can be a good thing - it certainly was in my case. I was so grateful when I realised I was bipolar. I finally had a name for it and could find ways of dealing with it, instead of fearing I was going totally out of my mind and liable to be sectioned any minute.

It's when someone feels that the label IS them that it's a problem. My bipolar is part of me but it doesn't define me, and that's the difference. I don't have to be controlled by the label and I think some people feel as though they are.

There have been some really good follow-up comments and I look forward to reading more of them.

Anji // Posted 11 June 2010 at 18:43

Sue - thanks! Funnily enough I'm bipolar too, and the two are very commonly comorbid. The problem psychiatrists have is with unpicking them to figure out what's the bipolar and what's the BPD. And like you, I diagnosed myself - with both conditions - before a psychiatrist did. I think it was Arwyn from Raising My Boychick who told me that she thinks BPD is actually a type of bipolar disorder rather than a personality disorder, too.

Gappy // Posted 11 June 2010 at 20:48

I work in domestic abuse service provision as a refuge support worker. BPD is an extremely common diagnosis given to women who have experienced trauma and who are anxious and depressed as a result. I personally have never been able to work out exactly what Borderline Personality Disorder even means. I do not wish to be dismissive - you probably know far more about it than I do seeing as you have received an actual diagnosis yourself - but it often seems to me to be a convenient label that male doctors slap on women who are simply displaying perfectly valid responses to prolonged fear and trauma.

Troon // Posted 11 June 2010 at 20:50

Thank you for this article. This was discussed in a very different way on the radio a while ago, but without the critique offered here:
http://www.bbc.co.uk/radio4/womanshour/04/2010_10_mon.shtml

maggie // Posted 11 June 2010 at 21:23

'valid female rage against a world which devalues women'

yes! I work in mental health and have often thought exactly this with many of the patients I see, no matter what the official diagnosis.

Alex T // Posted 11 June 2010 at 21:30

Hi Anji!

Very interesting, thank you - I was just thinking recently about the disproportionate numbers of males diagnosed as being on the autistic spectrum (I believe there's an fword article about it somewhere in the archives), when many typically masculine behaviours are also diagnosis criteria for autism, Asperger's etc.

@Politicalguineapig - I think the term comes from the scene in Fatal Attraction, where Glenn Close's character (called Alex!) boils the pet rabbit of the daughter of the married man with whom she is obsessed. I may be wrong though!

Eronarn // Posted 11 June 2010 at 21:34

One point that wasn't addressed in your post:

The public (and some therapists, though they're not supposed to do this) treat a diagnosis as an actual entity rather than a convenient model or therapeutic context. Mental health disorders are generally collections of symptoms that have been found to relate to each other often enough that there's probably some type of shared causal factor. However, there may actually be several similar-but-not-identical dysfunctions grouped together. Even if there is only one root dysfunction, it may manifest in differently in different individuals or have many causes that relate in non-obvious ways.

(For example, there's been recent research indicating that alcohol and tobacco addictions reinforce each other. There are also known genetic components to addiction, and people with higher levels of skin melanin may be pharmacologically prone to tobacco addiction too.)

Therefore, if someone says that you have BPD, but then someone else thinks that you have schizophrenia, this doesn't necessarily mean that either practitioner is wrong. What it does mean is that you have a certain set of symptoms that could be interpreted multiple ways. If there is some root cause(s), it could be the case that it's not the same or has manifested in an unusual way compared to whatever root cause(s) typically result in a diagnosis with that disorder.

(Another example: we've done a lot to determine the biological basis of schizophrenia. We may one day end up with a medical test for it. If that happens, some people diagnosed with schizophrenia may show up negative on that test. That doesn't mean they don't have schizophrenia, and certainly doesn't mean that they don't have symptoms, but it does mean that they are an identifiable subgroup of persons with schizophrenia (and the definition of schizophrenia may be changed to help clinicians make that distinction.).)

Of course, these diagnoses and the symptoms they are based on, are subject to cultural biases and can be used to oppress people. Probably moreso than medical diagnoses or symptoms, which can also be culturally biased or oppressive, but are usually less so because it is easier to construct an objective measure of physiological status than it is to construct an objective measure of psychological status. I have no problem with people criticizing the practice of psychology or psychiatry. I do think that it receives a disproportionate amount of criticism, however, and that it is not particularly nuanced criticism.

Oh, and I should clarify - your piece isn't bad or anything! It's mostly asking questions, rather than making proclamations. I only found one significant problem with it:

"Three-quarters of patients diagnosed with BPD are female. I’ve spent some time since my diagnosis wondering why that is, when one would expect the split to be roughly 50/50."

There actually is not any reason to expect a 50/50 split in diagnoses. Many mental illnesses are found more commonly in one gender than another. There's likely no one reason for this. Some of the time it may come from the likelihood of certain life experiences (for example, women are more likely to be abused, men are more likely to serve in the military). Other times, the difference may stem from cultural or social factors removed from any individual event (eating disorders being the biggest example here). And there may actually even be disorders where the difference extends beyond cultural factors to biological ones. This isn't to say that BPD diagnoses aren't based on sexism during the diagnosis process - I'm actually quite willing to believe that men with BPD-like symptoms are diagnosed with something else, such as antisocial personality disorder or sociopathy or psychopathy (not sure which terms are used in the UK) - but that a gender gap alone isn't compelling evidence for that kind of sexism.

polly // Posted 12 June 2010 at 10:40

What I'd like to ask is what.s the point of these diagnoses at all?

I can see the advantage of diagnosing someone with cancer, or bacterial meningitis, or AIDS because it then allows medical pracitioners to treat them. But it seems to me that a great deal of psychiatry is more or less a pseudo-science, which is based on 'this is true because we say it is' rather than any empiricial research. Disease categories that are just collections of behaviours/symptoms rather than descriptions of stuff that's actually happening physically seem worse than useless to me.

June // Posted 12 June 2010 at 11:25

It is my belief that BPD is often to the beginning of the 21st century what 'hysteria' was to the beginning of the 20th--another label applied to people, usually women, having reasonable reactions to unreasonable situations, such as trauma, abuse, or constant oppression.

sianmarie // Posted 12 June 2010 at 13:24

"Again, some of these things seen as “potentially self-damaging” (I’m looking at ‘promiscuous sex’ and ‘reckless driving’ in particular) are seen as normal behaviours for men, but in women are considered undesirable enough to be included in the criteria for diagnosing a serious mental illness."

well said. thanks for writing this post. xx

Jilly // Posted 12 June 2010 at 13:47

An interesting post, thank you. My first thought was that BPD seems to be applied mainly to women though Autism/Asperger's is applied mainly to men so I'm glad others had that reaction.

I find the bit about anger makes me angry! Who's to say what is innappropriate anger? If something makes you angry then it makes you angry. Surely it only becomes innappropriate if you act it out physically and damage other people or property - or yourself.

It seems we're back to the Victorian idea that if you don't conform then you're mentally ill.

Anji // Posted 12 June 2010 at 17:53

Polly - the point of these diagnoses is that mental illness has a big and very negative impact on the life of the sufferer. Just because it can't be seen or quantified does not mean that I, for example, am any less ill than someone with cancer, or bacterial meningitis, or AIDS. Certainly their problems are physical rather than mental, but they are still having the same negative effect which impinges on the ability to live life to its full potential.

Jilly - certainly for many patients with BPD, myself included, that 'inappropriate anger' does indeed manifest in violence towards other people or objects, or self-harm. And I think what is meant by 'inappropriate anger' is that the patient becomes disproportionately angry about things which a non-sufferer would probably see as mildly irritating. But I agree with you that "If something makes you angry then it makes you angry" and I believe that often what a psychiatrist (working as they are in a male-dominated field within a male-dominated society) believes to be 'inappropriate' is often not inappropriate at all, when one considers all the things there are for women to be angry about.

Sue Henderson // Posted 12 June 2010 at 21:15

With regard to the diagnosis being "Disease categories that are just collections of behaviours/symptoms rather than descriptions of stuff that's actually happening physically" - that's basically what a diagnosis of a physical illness is as well. Doctors listen to the list of physical symptoms the patient gives them and try to fit them into a category - and it's not always as easy as you'd think. How many times have you heard of someone being told they may have a particular problem, taking the drugs for it, the drugs not working and the doctor re-diagnosing the illness and prescribing a different treatment? Sometimes this can happen several times. So the diagnosis of physical conditions isn't an exact science either I'm afraid.

One think I've been finding recently is that my anger reactions - which were particularly noticeable around noisy children - were actually fear reactions. Discovering this has made it easier for me to deal with situations where I'm around noisy and intrusive children.

For those who have anger reactions so strongly they want to commit an act of violence I believe fear is a major factor and it could be worth exploring what that fear is. For me it was fear of what I might do - that I might react violently towards troublesome children because that's what my mother used to do to me. When I realised I have a choice as to how to act and that I've not hit a child since I was one (a good few years ago) it took the fear and thus the anger out of the situation. Ok I still don't like kids being overly noisy but an 'it's ok, you're not your mum, you're not gonna do anything violent' is enough to keep me calm and able to deal with it.

I hope those on this thread who have anger/violence issues can find their own ways of dealing with it. Anger isn't a problem, what we do with it can be.

Anji // Posted 12 June 2010 at 21:48

One think I've been finding recently is that my anger reactions - which were particularly noticeable around noisy children - were actually fear reactions.

I think this is a good point; a lot of the time when I feel 'inappropriate anger' it is actually 'inappropriate fear' - for example my fear of abandonment often manifests in anger towards my partner, almost as if I am pushing him as hard as I can because I'm convinced that eventually he'll snap and leave me.

I hope those on this thread who have anger/violence issues can find their own ways of dealing with it. Anger isn't a problem, what we do with it can be.

Writing has helped me a lot with this, as has the therapy group I did, and the antipsychotic I have been given. Another thing that's really helped is running, funnily enough. I have CFS so one would think that running would be out of the question but it has been so, so beneficial - both for the CFS and for my mental health. I find that going for a run clears my head and helps me find ways of focusing my anger towards something positive rather than something negative.

polly // Posted 12 June 2010 at 22:41

I'm not denying that mental illness has an impact on people Anji, in terms of the distress experienced being very real, but that's not the same as saying psychiatry is always right. It can be very far from benign in a lot of cases.

Sue is right that doctors can misdiagnose physical illnesses, because one set of symptoms can be indicative of more than one illness (eg the symptoms of a heart attack can often be confused with indigestion and vice versa). But that isn't the same thing as a physical illness just being a description of a random set of symptoms. Usually if appropriate diagnostic tests are carried out (which they frequently aren't, hence the misdiagnosis) the source of a physical illness is discovered.

However a personality disorder is simply a description of a set of behaviours. The official definition is "an enduring pattern of inner experience and behavior that differs markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment" So in other words it's just someone who constantly behaves in a way that is at odds with the prevailing cultural expectations.

It's useful to point out here that until 1973 the American Psychiatric association classified homosexuality as a mental illness. The world health organisation took until 1993 to decide the same thing.

While some people may find it useful to have what they feel is a concrete diagnosis, many others may not agree that it fits their personal experience. For instance most of those who experience hearing voices will be diagnosed with schizophrenia if they come into contact with psychiatric medicine. A diagnosis many don't accept. But they still face being compulsorily treated with powerful drugs as a result.

It's very rare for someone to be treated against their will for a physical illness, in fact it could only be done if they were also considered to be lacking capacity in some way - but it's still a relatively common occurrence for someone to be sectioned and compulsority treated for a mental illness. So not only can people be given a treatment that doesn't work, they can be given it against their will.

In 1973 David Rosehan carried out an experiment into the validity of psychiatric diagnosis.

(following pinched from the wikipedia entry)

"Rosenhan's study consisted of two parts. The first part involved the use of healthy associates or "pseudopatients" who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had not experienced any more hallucinations. Hospital staff failed to detect a single pseudopatient, and instead believed that all of the pseudopatients exhibited symptoms of ongoing mental illness. Several were confined for months. All were forced to admit to having a mental illness and agree to take antipsychotic drugs as a condition of their release.

The second part involved asking staff at a psychiatric hospital to detect non-existent "fake" patients. The staff falsely identified large numbers of genuine patients as impostors.

The study concluded, "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" and also illustrated the dangers of depersonalization and labeling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities.


Politicalguineapig // Posted 12 June 2010 at 22:45

Alex T: Thanks for clarifying! I was very young when Fatal Attraction came out, so I've never seen it, or appreciated that it might have a linguistic effect.
Eronarn: The problem with over diagnosing one sex with a specific disorder, is that it then becomes a catch-all diagnosis for other patients of the same sex.
(When you have a hammer, everything looks like a nail. Psychiatrists love the hammer of diagnosis.)
Also, people of the opposite sex with the exact same disorders will be overlooked and not given the help they need.
Polly: As a multiple diagnosee myself, I don't have much faith in psychiatrists either. I admit, I've gotten some help from them, but it's a process of trial and error, error and error.
At least I do all right by myself, but just last month a friend of mine came pretty close to the edge. She's all right now, but I still worry a lot about her.

Laurel Dearing // Posted 12 June 2010 at 23:56

i think about asking whether diagnosis are important... because so many of them seem to be decided upon due to certain symptoms and issues it might be more productive to focus on those problematic symptoms and experiences individually, as it gives the patient more power to think what stuff is a problem to them, rather than trying to get rid of it all at once? (hope that sounds sober...)

Frankie // Posted 13 June 2010 at 00:24

Sorry to do a bit of a book review, but... there is this really excellent book called 'Trauma and recovery' by Judith Herman, a psychiatrist who writes from a feminist perspective. She compares the experiences of soldiers and war veterans with those of women and children in society and finds lots of similarities.

She argues very convincingly that BPD is a special form of Post Traumatic Stress Disorder that people display after being exposed to trauma in childhood ie it's not a valid psychiatric diagnosis but rather a set of normal behaviours in response to horrific events/ situations.

She suggests the reasons why women suffer from it more is not only because they are more likely to have been abused. But also, and I think this is the main point of her book, because they live in an environment which is frankly hostile to people who have been victimized. So their trauma remains unacknowledged or worse is derided and they never get the social support they need to recover their trust in other people /life /the world. And if this happens at certain stages of development like in childhood the result is bpd.

I think she pretty much suggests that psychiatry is a institutionalized extension of the hatred towards victims (by locating the fault in them) and notes that childhood abuse is near universal among psychiatric inpatients.

I can't recommend this book enough, its very astute and accessible too.

polly // Posted 13 June 2010 at 09:40

To do a few book reviews, a couple I'd recommend are 'the female malady' by Elaine Showalter (a history of women diagnosed mentally ill) and 'against therapy' by Jeffrey Masson. The second is particularly fascinating because Masson was a Freudian psychoanalyst before deciding the process was essentially corrupt because of the power relationships involved.

The turning point for him was finding documents which indicated that Freud knew his female patients had been abused as children, but denied this and described them instead as hysterical because the truth wouldn't have been publicly acceptable.

As Frankie points out, the incidence of childhood abuse is still completely overlooked/ignored/stigmatised today. And women frequently suffer more abuse in the psychiatric system. Take this case for instance:

http://www.independent.co.uk/life-style/health-and-families/health-news/women-at-broadmoor-used-as-guinea-pigs-for-male-sex-offenders-says-former-patient-600710.html

"A former patient at Broadmoor, the high-security hospital, has told how she and other women were used as guinea pigs in the attempted rehabilitation of dangerous sex offenders and convicted psychopaths.

The extraordinary allegations of sexual abuse and rape are revealed today in an interview given by the former patient. Such disclosures by women are extremely rare, not least because of fears of reprisals and the stigma surrounding any stay in Broadmoor.

The woman, Catherine, (not her real name) was a patient at the hospital for three years. Now living in the community, she has revealed that female patients were ordered to pair up with male offenders at a special event dubbed "the clinical disco" by staff.

The youngest female patients were also frequently "groomed" by paedophiles and then sexually abused.

These revelations come only a week after Julia Wassell, the hospital's former director of women's services, told how she was driven from her job when she reported to her superiors more than 1,000 allegations, including rape, sexual harassment, indecent assault and verbal abuse.

Now aged 55, Catherine was sent to Broadmoor after she set fire to a wastepaper bin in her office and was convicted of arson. Sexually abused as a child, she found herself locked up with men who themselves had been convicted of sexual crimes against women.

"The arson charge came at a time when I was feeling desperation and panic," she said. "I had been a long-term victim of serious abuse and was also separating from my husband.


Anon // Posted 13 June 2010 at 21:34

Polly - I agree with much of your later comments, about how people with severe mental illness and especially women are abused within and by the system. However I can see why people interpreted your initial comment as dismissing mental illness as not real. It is, and it causes real problems. Tell me my diagnosis of depression is made up when I cannot get out of bed, even though it makes me late for work. And I'm *lucky* in that I only have 'mild' depression due to stress. It's not that I'm told I'm depressed because I'm a woman - it is real. Oh and treatment does work. Antidepressants allow me to keep my job, and friends.

Actually, I don't conform to expectations of women in finding it easy to talk about emotions so my GP did not believe I was depressed for some time.

There's no distinction between mental and physical illness. Mental illness is due to actual imbalances in neurotransmitters in the brain.
Of course that manifests differently in men and women due to socialisation. People have already mentioned how women with Asperger's are missed. Another example, men with depression are often missed because they won't admit - even to themselves - they have such 'feminine' things as emotions, and are more likely to have physical symptoms such as pain. (Despite the perception that women are more likely to experience physical symptoms that are actually all in the mind, ironically, men are more likely to do this).

And if you think physical illness is that easy to diagnose, you are wrong. I have also been chronically ill and it just isn't as simple as 'test says no' you don't have this condition, or yes you do. Automimune issues, for example, often aren't detected by current tests. Essentially it is just a case of 'collections of behaviours/symptoms'.

I am not subscribing totally to a medical model of mental illness, though. I am just saying that there isn't necessarily a neat separation between 'mind' and 'body'. I totally agree with posters saying that it's not surprising women become mentally unwell, due to suppressed anger at inequality, oppression, abuse etc. That is absolutely true. But it's really hard to do things that might be therapeutic, whether that's exercise or get involved in feminist activism, or leave a bad relationship, when you lack the energy to move from the sofa. So if medications help I don't see a problem. And that does require a diagnosis.

Sheila // Posted 14 June 2010 at 13:44

Thanks Gappy and June in particular for your posts. This is an interesting thread. The danger of a BPD diagnosis for women abused in childhood has many facets. It seems that part of the integral diagnosis of BPD includes inappropriate anger, or maybe better put inapprpriate expressions of anger. Telling a woman who has experienced CSA and is on the painful and slow path to recovery that her anger, which in all statistical likelihood she had to suppress for years for self-preservation reasons is "inappropriate" is wholly inappropriate of itself. The BPD diagnosis is frequently given to CSA survivors. CSA help groups and supportive mental health care academics fight hard against this diagnosis. The trauma of CSA does not cause or trigger CSA, any more than, as some ignorant people used to argue - believe it or not, that CSA can "trigger" someone into being gay who wouldn't otherwise have been. Given the increased incidence of CSA amongst women as compared to men and the need for a clinical condition, it is small wonder, though disappoiting, that the psychiatric community hit upon BPD as a diagnosis for many women who are suffering mental trauma but not mental disorder. To have such a diagnosis during recovery from CSA is a highly damaging thing and more should be done to prevent this - for example, do psychiatrists actually follow a protocol requiring CSA to be taken into a account when assessing for BPD - answer no! The thing about BPD is that there are recognised drug treatments and there are recognised behaviours that can be dismissed with the modern equivalent of "don't mind me, I'm having one of my nasty turns" when in fact the more accurate diagnosis of post traumatic stress (disorder) - how I hate the word disorder(!) is more costly in terms of talking cures and acknowledgement of a social wrong and true trigger. If this wrong could be acknowledged recovery would be more certain. For the time being, we have this largely false diagnosis of BPD which attracts the stigma of a mental illness and the wrong drug regimen for literally hundreds of thousands of women. If the system weren't flooded with these false diagnoses, then those people who really do suffer from BPD could be better helped and understood also.
In the meantime, please don't post to say CSA "causes" mental disorder. It causes mental trauma, not disorder. SUrvivors have enough to deal with without this sort of assertion as well.

Esmerael // Posted 14 June 2010 at 14:12

I got slapped in a specialist psych unit with an incorrect diagnosis of BPD from a (patronising, borderline abusive, male) psychiatrist. Of the 31 residents, 28 were female and 25 revealed they were victims of childhood sexual abuse. But calling it a "personality" disorder makes it seem like there is something wrong with them as people... x

Sheila // Posted 14 June 2010 at 14:50

@Esmerael
Not sure if you saw my post before posting yours. Sending you very best regards and hoping that you are feeling strong and on the path to recovery, albeit more despite rather than thanks to the intervention of mental health professionals. CIS'ters call it "not mad, not bad, but traumatised" and can be a big help.
All the best

Laughingrat // Posted 14 June 2010 at 16:40

Fantastic and necessary analysis. Thank you.

Anecdata: A (male, sexist) psych researcher I once dated bragged proudly about how BPD was basically "invented" as a diagnosis as a way to control women who got out of line. He saw nothing wrong with this, and saw nothing wrong with slapping the label on me when I wouldn't, say, clean his house or cook for him like a "proper woman." There were no professional consequences for his thinking like this, and no framework in his profession for addressing or correcting such hateful views or abuses of psychology, so he had no incentive to change. Given the history of psychology as a tool for social control, it seems unlikely that he was exceptional.

Anon // Posted 14 June 2010 at 21:36

Sheila: 'In the meantime, please don't post to say CSA "causes" mental disorder. It causes mental trauma, not disorder. SUrvivors have enough to deal with without this sort of assertion as well.'
Are you saying there is something shameful in experiencing mental illness? Because you sound as if you are.

Why does it matter whether sexual abuse 'caused' a mental health problem (as if we'd ever know anyway)?

If someone is in mental distress/ trauma/ 'disorder', whatever you want to call it, they need help. Now I am sure you're right that many PTSD sufferers are mislabelled as having BPD, and no, the mental health profession isn't perfect. But don't sound so dismissive of people with mental illness, as this 'it's OK, you're NOT mentally ill, like those scary mad people, just traumatised' idea sounds like you are doing just that.

polly // Posted 14 June 2010 at 23:16

Anon, I haven't at any point said that mental illness isn't real: I said that I didn't think the concept of 'personality disorders' useful. Personality disorders AREN'T (traditionally) regarded as mental illnesses, in any case.

http://bjp.rcpsych.org/cgi/content/full/180/2/110

The traditional line has been that personality disorders are 'untreatable' so what is the point of slapping a label on somebody that just stigmatises them?

There are indeed physical conditions (such as ME/chronic fatigue syndrome) which don't have obvious physical causes and quite often people with these conditions will be told they're just malingering. I'm not saying medicine knows everything. But with physical diseases (a large number of them) you can find out what's going on. And thus know what treatment to use. That doesn't mean doctors don't let their own bias influence them in their diagnoses and get it wrong though.

I've been told by my doctor that what I was quite sure were menopausal symptoms were 'reactive depression' because I was 'too young' to be menopausal. The point being I could insist on a blood test that immediately proved him wrong, and me right. (He actually apologised, which is the first time I've ever heard a GP do that).

Would I have been listened to though, if I was in the psychiatric system by then? I doubt it. Suppose I hadn't been able to work out what was wrong with me myself, and been referred to a psychiatrist for my 'depression'. Would my insistence that I wasn't depressed be taken as a sign of a personality disorder? (Argumentative, think I know better than the doctors etc).

Yes anti depressants work for some people, it's true. But for most people they are actually not any more effective than a placebo.

http://news.bbc.co.uk/1/hi/health/7263494.stm

My point was about the usefulness of 'personality disorder' as a diagnosis and the empirical basis (or lack of it) of psychiatry.

I could probably apply the 'borderline personality disorder' diagnosis to about half the people I know. Because it's just a description of behaviours most of us exhibit at some time or another in our lives.

Psychiatry seems to be more bothered with categorizing people than in any way assisting them. Although physical medicine may be seen in some ways to have aspects of social control, this has always been overt in the history of psychiatry. We're mistaken if we think modern psychiatry is removed from its roots.

Sheila // Posted 15 June 2010 at 08:44

@anon
I think I must have expressed myself badly if you think that I am not sympathetic to people with mental illness. I've had it myself and recovered. I serve as a governor on an NHS Mental Health Trust. What I'm saying is that CSA survivors get misdiagnosed. Misdiagnosis is damaging. To be misdiagnosed with a mental disorder when mentally traumatised can have a severe effect, including suicide. I did not say that society is right to stigmatise people with mental illness, but that stigmatisation certainly happens. I don't want it to happen to anyone, whether suffering from a mental illness or not, and - because I feel strongly about the lack of resources and support for CSA survivors - I feel that I particularly do not want that stigma for those people. There OUGHT to be nothing shameful in experiencing mental illness, but we live in an imperfect world where that unfair stigma has to be acknowledged rather than pretending it doesn't exist.

Sigrun // Posted 15 June 2010 at 10:36

Also I like professor Judith Lewis Herman's book. She wants a new diagnosis, Complex Post Traumatic Stress Disorder, instead of BPD. I found the book on the Internet:
http://scr.bi/ahGyzL (on page 82 she writes about it).
The new diagnosis is not stigmatising. But it will not be included in DSM-5, of course.

Anji // Posted 15 June 2010 at 11:39

I'm not sure I really agree with changing the BPD diagnosis to a post-traumatic stress disorder diagnosis, because I feel it erases those like me who have the disorder without having suffered trauma. I agree that many people with BPD are probably actually suffering with PTSD, but certainly not all of us.

Anna // Posted 15 June 2010 at 12:07

Anji's right - I've been diagnosed with (comorbid) complex/chronic PTSD, and later BPD.

I agree BPD is a stigmatising diagnosis, which is why I fought against it for so long - I agree I fit the symptoms, but my psychiatrist only diagnosed me with it to label me a 'difficult' patient after I complained.

Sigrun // Posted 15 June 2010 at 12:20

CPTSD (Complex Post Traumatic Stress Disorder) is not the same as PTSD. In fact, a person can have both.

Sheila // Posted 15 June 2010 at 12:24

@anji
I hope you don't feel anyone is trying to change a diagnosis for you which is appropriate for you. What many on the thread are saying is that BPD is an overly used diagnosis, not that it is never appropriate. I feel you would actually get better treatment if fewer people were misdiagnosed as the treatment of those misdiagnosed people will have an impact on your treatment as regards practitioners' observations of flawed groups which contain people they shouldn't contain. Prof Herman's book hopefully doesn't say Complex PTSD INSTEAD of BPD in all cases, but as an alternative diagnosis for a doctor to consider. Otherwise we end up with PTSD being the new "hysteria" instead of BPD being the new hysteria, with no obvious benefit to anyone.

Anon // Posted 15 June 2010 at 12:58

Polly, you were not clear that you were only talking about personality disorders. I agree, they are of dubious value as diagnoses.
Your article doesn't contradict the life experience of thousands of people for whom antidepressants DO work. You don't know better. Don't tell me what my experience is.

Sheila, yes indeed. Of course that stigma exists, but the point is that it shouldn't. I still think the line 'I'm NOT mentally ill, just traumatised' plays on that stigma.

Think about what you're saying. So you want to help survivors of sexual abuse avoid the stigma, good for them, but what about the people you're throwing under the bus who DO have mental illness.

Does it *matter* whether a trauma such as sexual abuse caused symptoms of mental distress? Isn't it possible that survivors of sexual abuse *are* suffering from mental illness, whether depression, PTSD, whatever - no doubt at least partly due to the abuse, but again, why does that matter? Most people with mental illness have had unpleasant experiences in their life.

Of course misdiagnosis is damaging - but *everyone* with mental health issues deserves humane and empathetic treatment, even if they do have BPD. I am not arguing with that. I am saying 'these people are misdiagnosed' is one thing, 'how dare you, these people are NOT euw scary mentally ill' is another.

@ both - I insisted I was not depressed, just physically ill for a while. I was sure my GP would dismiss my ongoing physical health conditions as soon as I admitted that.
They didn't.
I want to end stigma, because it stops people from getting the help that they need.

Briana // Posted 15 June 2010 at 15:32

My sister was diagnosed with BPD for a little while, and I made her question it because I have actually heard some psychiatrists laughing about the joke "You know your patient is BPD when you want to punch them in the face." leaving out the "hilarity" of assaulting patients, how the HELL is that diagnostic criteria? Fortunately, when my sister saw someone OTHER than an emergency room social worker, the label got taken off. I really do see it as a way to control patients with meaningless diagnoses. as said earlier, if there's no way to treat it, no way to "recover" from it, what's the point of giving the diagnosis? Especially because 90% of the criteria overlaps with tons of other disorders.

Lauren // Posted 15 June 2010 at 18:13

Briana, how strange. I overheard a psychiatrist on the train the other day - talking about wanting to cut his patients' arms off! Wtf?!

Sheila // Posted 15 June 2010 at 22:39

Dear Anon
I do feel so sorry that I am not getting across to you the point I am trying to make. I don't want anyone to be stigmatised. I have fought hard about it as a mental health governor and I've certainly felt it myself when ill. I do think it is very important however to distinguish mental illness from mental trauma, same as it's important to distinguish one mental illness from another just like a physical illness is distinguished from another. Whether we have faith in medical science or not, we have to see it won't advance very much if every mental illness is lumped together without analysis of cause or symptom. I will not win you over, because you do feel stigmatised and seem not to care who feels that too, which I believe is unfair of you and not medically beneficial to anyone. I hope you stop feeling stigmatised. I hope you feel better soon.

Sigrun // Posted 16 June 2010 at 02:34

@Anon: How can you call severe trauma in childhood "unpleasant" experiences?

I was abused from the age of three (or earlier) and until I was 16, partly severeal times a week. "

frankie // Posted 16 June 2010 at 20:04

@ anon

There is stigma attached to being abused too, and though its probably not helpful to do so, I'd wager that its greater than that attached to being mentally ill.

Knowing the cause does matter - it helps people make sense of their experiences and it also leads the way to a resolution. Eg a totally organic illness might be treated with drugs; and one caused by being abused by another person might better be treated socially.

MC Kean // Posted 17 June 2010 at 16:28

BPD is a diagnosis a patient gets when they piss the health provider off. Take a look at the symptoms. IF you were male you would be diagnosed w/PTSD. So ask youself, what happened? Abuse, intense ongoing sexual harassment, police violence, medical rape? My bet is you have PTSD, not BPD. You are right on that the diagnosis is sexists. Women who have a mind tend to piss off some male docs.

Anji // Posted 17 June 2010 at 21:00

MC Kean - as the conversation above indicates, I mostly agree with you but am loathe to make sweeping statements like that because not all of us BPD patients are in fact post-trauma. Some of us have it for no reason at all.

David M. Allen M.D. // Posted 22 June 2010 at 19:58

Even though I am a therapist who specializes in borderline personality disorder, in a way I do not believe in it. It is not a mental disease in the way that schizophrenia is, but a group of very understandable traits that were once adaptive to a highly dysfunctional family environment .

The diagnosis is only a very loose guideline as to what issues a good therapist will look for in a particular patient who meets criteria.

The diagnostic criteria for all personality disorders, unfortunately, have a rather pejorative connotation.

Trauma is frequently involved in the genesis of BPD but is neither necessary nor sufficient to cause the disorder.

Males with bpd tend to be more sociopathic than their female counterparts and are therefore less likely to come to clinical attention.

Gender issues are highly prevalent in the genograms (three or more generational emotional family trees) of patients with BPD, which may also explain why it seemed to be more frequent in females while its flip side, Narcissistic Personality Disorder, was usually diagnosed in males.

Interestingly we are seeing a lot more narcissism in female patients and BPD symptoms in male patients than we did when this diagnosis first hit the DSM in 1980.

Politicalguineapig // Posted 23 June 2010 at 00:53

Dr. David M. Allen: Interestingly we are seeing a lot more narcissism in female patients and BPD symptoms in male patients than we did when this diagnosis first hit the DSM in 1980.
I suspect that's because "trying to stick up for yourself" is read as narcissism.

Megara // Posted 23 June 2010 at 03:17

I am a woman with BPD, and I view it as the mechanism I used to deal with the physical and mental abuse I suffered as a child (abuse perpetrated by a woman, btw). It worked to protect me *then* but now it's just hurting me more. It's almost like my abuser is still abusing me with this disordered way in which I encounter the world. And it is disordered, because it often prevents me from having and doing what I most want. It causes me to hurt those I most deeply care about out of a deeply seated fear that they will inevitably harm me. It comes from latent anger inside me that built up over the years against my abuser but that now will randomly burst at anyone who mildly annoys me. My BPD diagnosis has been imminently helpful as it tells me that I'm not evil. That my behavior has a cause, and I can change it with DBT.

Maybe more women are diagnosed with it because more of us are abused? Who knows.

David M. Allen M.D. // Posted 23 June 2010 at 16:11

Politicalguineapig: The phenomenon of which you speak is absolutely real. I'm originally from LA, where male movie directors who were control freaks had "high standards" while women directors like Streisand with the exact same characteristics were "bitches."

However, what I was referring to was a more problematic type of narcissism, in which people with hidden low self esteem compensate by trying to dominate and intimate others. That used to be primarily a male trait.

Megara: I didn't mean to imply that the diagnosis can not be helpful in many cases. You are of course not evil but you are not sick either. Your current behavior sounds problematic to be sure, but in context I bet a certain type of therapist (one sensitive to family systems issues) can make sense out of it.

DBT is very helpful in reducing problematic behavior, but so far, by itself, it has not demonstrated a lot of effectiveness in the interpersonal realm.

Anon // Posted 23 June 2010 at 19:20

Sheila,

No, it is you who seems not to care who feels stigmatised, other than your BPD patients.
Mental illness *is* mental trauma, I think is what I am trying to say. Nobody just has a mental illness for no reason. There is a complex mix of biological vulnerability and environment. The fact that not all abuse victims go on to develop any mental illness shows that.
But I don't think you want to listen as your rather passive-aggressive post indicates. I won't respond again.

Megara // Posted 25 June 2010 at 00:48

@David That is total bullshit. I suggest you do some research on PubMed into the effectiveness of DBT for treaching BPD, particularly looking at the work of Dr. Mary Zanarini. She has proven DBT can put BPD into remission, often times in as little as 2 years, and remission INCLUDES in interpersonal relationships.

Evidence-based medicine. Heard of it? I doubt it.

Politicalguineapig // Posted 25 June 2010 at 06:12

David M. Allen: I was actually being snarky, but I'm glad you got my point. The problem seems to be that we can't, at this point, trust a health care provider to give an accurate diagnosis if they use personal opinions, rather than going by the book.
The DSM does have its problems, but practitioners simply slapping a label on real live women seems even more problematic to me. If the label works against the patient rather than helping her, should the label be rethought or scrapped altogether?

David M. Allen, M.D. // Posted 25 June 2010 at 15:32

Megara,

I didn't mean to imply that DBT isn't helpful. Clearly it was helpful to you, and I say that's great.

No offense, but I'm probably more familiar with the so-called evidenced-based literature about BPD (as if years of widespread clinical experience is not evidence) than you'll ever be, including Mary's work (I've read all of it, and we both belong to a group of personality disorders researchers).

DBT may well work on family problems, but even Marsha Linehan acknowledges that DBT therapists don't even get to that part until after the first year of therapy, which is the part that's been studied primarily. Working with families only merits a brief mention in most of her work. Her claims on this score are therefore only as valid as most other well known therapist's claim.

The DBT therapists who work with families like Perry Hoffman tend to work with those families in which childhood physical and sexual abuse is not a big issue, because the abusive parents will not come to DBT groups for obvious reasons.

The only large, well-designed randomized clinical trial on DBT that goes over a year is actually the study from the Netherlands comparing schema therapy to DBT. That went three years. DBT did OK in the longer study, but not great.

Treatment as usual, which is what DBT is usually compared with, is better than no control group at all I guess, but almost any well-designed and well-applied treatment done by therapists with very few clients will beat it.

Linehan turned down an invitation to go head to head with Kernberg (although I'm no fan of Kernberg, who I think is invalidating to his patients in a less-than-obvious way).

Long-term follow up on patients with BPD indicates that a lot of them get better on their own after a couple of years, although their personal relationships often don't. That's why long term studies can be misleading.

polly // Posted 26 June 2010 at 20:47

***However, what I was referring to was a more problematic type of narcissism, in which people with hidden low self esteem compensate by trying to dominate and intimate others. That used to be primarily a male trait.****

David, I referred above to the Rosenhan experiment, which illustrated the highly subjective nature of psychiatric 'diagnosis'. You refer here to diagnosing 'hidden low self esteem'. How on earth is that done, if it's hidden? You seem to be referring in fact to classic bullying behaviour - I seem to remember reading somewhere recently that bullies in fact have high self esteem!

The simple fact is that - as the Rosenhan experiment showed - if you put anyone in front of a mental health professional, most of the 'diagnosis' will be nothing other than that person's preconceived ideas. No matter how many letters you have after your name, psychiatry is no more 'evidence based' than phrenology was, because it's not based on anything that can be objectively measured. You can measure someone's heartrate, you can measure their pulse, you can measure the composition of their blood. You can't measure their narcissism levels.

Natalie // Posted 27 June 2010 at 04:59

i was also diagnosed with borderline personality disorder...i believe that BPD is an actual disorder...yes its true that more women are diagnosed with it...but men with BPD are more likely to end up in prison and not seek professional help...whereas women are more likely to seek treatment...
http://www.tressugar.com/Borderline-Personality-Disorder-Sex-8878131

David M. Allen M.D. // Posted 27 June 2010 at 17:37

Polly,

All psychiatric diagnoses are not created equal. Some, as you point out, are complete B.S. ("bipolar spectrum" is a perfect example of a proposed diagnosis whose initials are appropriate). I have a book coming out at the end of August that goes into this in detail.

Low self esteem is not a diagnosis at all but merely a mental phenomenon. People who come to psychotherapy keep all sorts of things hidden - at first. Of course we can't read minds, and if you ask someone why they do what they do, they may not know, they may lie to you, and/or they may lie to themselves

Just looking at a given bully superficially tells you nothing about what is really going on inside them. However, the ones that come to treatment eventually open up and start to be more truthful, so that's how we know.

Of course, they may still be lying, but when they are (such as in cases in which they tell the therapist just what they think the therapist wants to hear), their stories become inconsistent and develop plot holes (forgive the Hollywood jargon) big enough to drive a truck through.

polly // Posted 27 June 2010 at 22:40

Anon I said this:

"Yes anti depressants work for some people, it's true. But for most people they are actually not any more effective than a placebo. "

That's not denying your experience that anti depressants work. It's saying that they are not usually more effective than a placebo.

Placebos are actually pretty effective. So yes antidepressants do work for thousands of people. Because thousands -well millions actually - of people take them. Most will gain some benefit. The point is that a lot of those people would gain a similar benefit from taking a placebo. Some might not - the study did indicate that more severely depressed patients were more likely to benefit from an actual antidepressant than a placebo. So it seems likely that in some cases antidepressants are being inappropriately prescribed.

The interesting thing about the piece I linked to is that the researchers used the freedom of information act to obtain unpublished research. Thus avoiding 'publication bias' where unfavourable studies on the effectiveness of drugs are just never published.

Given that 32 million prescriptions were written for anti depressants in the UK in 2008, and that the drugs aren't side effect free, the NHS needs to be taking information like this into account.

Politicalguineapig // Posted 28 June 2010 at 16:44

Polly: Yes, I have to agree that anti-depressants are overused and over prescribed- so are ADD drugs and anti-anxiety drugs. I actually took one anti-anxiety drug that had about the same effect as an average placebo.
David M. Allan M.D.: Of course people hide things from their psychotherapists. Many of the therapists try to fit their patients into neat little boxes, and will bully the patients when they refuse to fit. And some of the therapists are not fit to be trusted and just get into the business for the power rush.

Feminist Psychologist // Posted 01 July 2010 at 12:58

I'm a little bit concerned about the number of myths and misconceptions on this thread. I am a mental health professional and also a passionate feminist so I hope this is taken in the spirit it is intended. I can only speak about how things are in the UK:

- Personality disorders are not mental health problems. They are fixed patterns (or traits) of thinking, behaving and relating to other people. They are understood to arise out of early childhood experience, and would have been functional and appropriate to those circumstances at the time, but have not been adjusted, for whatever reason, now that those circumstances have changed, and remain stuck and inflexible, leading to a variety of difficulties for the individual. In the case of BPD, this may include mood-swings (including depression and anger), self-harm, criminal behaviour, and most critically, difficulty with relationships and fear of rejection. Obviously these can have a huge impact on peoples' abilities to lead happy and fulfilling lives, and often people come to the seek help from services because they are unable to work, to stay in a relationship, or to maintain friendships.

- The diagnosis of BPD (or indeed any personality disorder) isn't something issued in anger or resentment. Whilst it is true that some professionals find people with some PDs hard to work with (which, I think, is mainly about what it elicits in them - the transference and counter-transference; although also a fact that this type of work takes more patience than some old-school psychiatrist have!) - there are clear diagnostic criteria, which are meaningful, and which link in with a clear clinical formulation. I.e. as with any other diagnosis, it is shorthand for a more in depth understanding for what might be really going on for that person (this is just a basic understanding, there should always be a recognition that all people are individuals).

- The ICD10 (the diagnostic criteria used in the UK) now refer to this PD as "Emotionally Unstable (Borderline) Personality Disorder". This is because due to previous confusion around the terminology "borderline".

- The criteria: "Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions" is of course subjective, but does require that the second part is fulfilled. Feelings of anger, even when disproportionate to the situation, is not something in itself that any mental health professional I know of would use to diagnose someone [i]even/[i] if the person feeling that anger is a woman! However, when that anger, for example over a friend cancelling plans due to childcare problems, or your bus being late, or your relationship ending, provokes you to cut yourself, or smash up the bus-stop, or try to burn down your ex's office block, then those are the kinds of things that get included under that diagnostic category. It's all about proportion and consequences.

- It is in my view, a very helpful criterion, as it enables a lot of vulnerable women to be picked up in the prison system, who have ended up there as a result of years of abuse, rejection and violence in their childhoods, who snap over small rejections and commit violent offences as adults, and clearly cannot use a self-defence plea. What these women generally need is support, therapy, and the opportunity to develop independence that they never had in childhood - not to be thrown in prison, to experience more violence, abuse, rejection, and unhealthy dependence. Just my personal opinion though.

- There are treatments for BPD, and they can be very effective. It is a very, very old-fashioned view that PDs can't be cured, and any GP still saying that needs to catch up on their training. However, given the mechanism underlying it, medications don't work (I would personally argue the same for many mental health problems, but hay). They may be prescribed for some co-morbid problems (such as depression), and occasionally a sedative may be prescribed for someone with BPD is crisis. I realise how this sounds. I myself am against 'drugging people up' and cannot abide the thought of drugs like these being given to calm people down and keep them quiet. However, having seen people in a state of crisis, I do understand the need for this.

- NICE (National Institute for Clinical Excellence) guidelines emphasise the role of psychological treatment, and both CBT (cognitive behaviour therapy) and psychotherapy in particular seem to have good outcomes, although there are a lack of RCTs (who will fund them when there is no money to be made from drugs?)

- There is a significant difference (and only a small amount of overlap) between BPD and PTSD, both in terms of diagnostic criteria, and more importantly in terms of underlying mechanisms and helpful interventions. My formulation for somebody with complex PTSD would generally look nothing like one for someone with BPD, and not because I hold any credence to diagnoses (I usually ignore them, try to get to know people as individuals when I meet them, and assess again from the beginning). The recommended interventions for PTSD, which in general are very effective, and work surprisingly quickly (although can be extremely difficult and traumatic to go through as a client/patient), would not be effective for BPD.

I hope that is helpful and I haven't blabbered on too much. I myself am a fan of Jeffery Mason's work, and have read 'the female malady' by Elaine Showalter more times than I can remember, as well as actively supporting http://www.nofreelunch-uk.org/ it is just hard reading so much misinformation about something I am passionate about, especially on an issue that effects so many lives.

Bonnie // Posted 09 July 2010 at 18:27

Borderline personality disorder is a real diagnosis and very much alive. Four years ago, I befriended a girl who had it. She isolated me from all my other friends and made me grow to crave her like a drug. She would routinely abuse me, and yet, I would always come back to her in the end because I didn't know. I routinely cheered her up and saved her, even calling her parents when I found out that she had cut herself with a knife. My parents had no idea what was going on and were powerless to stop it. When she found a boyfriend, she completely dropped me, leaving me to suffer panic attacks every day; I had to be put on Zoloft. It's been a long time, but I still blanch at the sound of her name. Anyone who says that BPD is not real has never experienced how painful it can be.

MC Kean // Posted 09 July 2010 at 21:55

Bonnie, you sound like you have your own issues.

Feminist Psych. Ok, so a person w/childhood trauma may get a diagnosis of BPD and a person w/adult trauma and like behaviors a diagnosis of PTSD? No?

I still think the distinction is not a very good one. I do understand what you are saying about degrees of response.

It seems to me, a person w/PTSD who has been misdiagnosed w/BPD the fact that my responses tend to be political and legal in nature rather than personal and illegal, makes my response indicative of PTSD rather than BPD? Yet, I feel like responding with personal and illegal attacks and attribute my more civilized responses to no more than education and empowerment as an activist. So, if I were less educated and had less avenues of resistance and response I might have BPD, rather than PTSD? Is this not rather arbitrary?

polly // Posted 10 July 2010 at 10:51

I agree with a lot of what you've said feminist psychologist - particularly re women in prison needing support, but I don't see why support can't be provided without labelling.

I do also agree by the way that is sometimes necessary to treat someone without their consent to save their life if they are suicidal, or if they are a danger to others.

But outside these situations, I think the power relations inherent in psychiatry/psychology, by their very nature, disempower clients, and ironically prevent them from developing effective life strategies for themselves. The process of 'diagnosis' is a part of these power structures. How about setting out to agree WITH THE CLIENT on the way forward for them? Rather than just imposing it?

There is no need to have a diagnosis to provide support - you just need to listen to the client.

Politicalguineapig // Posted 10 July 2010 at 15:30

MC Kean: Psychiatry is a rather arbitrary science. What do you expect of a science that was founded on Victorian misconceptions of the world?

Bonnie: Even as a feminist, I know that there are horrible and unpleasant women in the world. I had two awful examples of them in grade school, which keeps me leery of women even now. (I'd rather have been born a boy for that reason- if I'd shown up bruised and bloody every day the school would've had to act.)
Nevertheless, please don't throw diagnoses around.

Eronarn // Posted 10 July 2010 at 21:28

MC Kean:

Comments like "[Y]ou sound like you have your own issues." are imprecise and stigmatizing at worst. Someone doesn't have "issues" because they have memories of a negative time in their life, whether their reactions to those memories are within the expected human range of experience or closer to PTSD/BPD.

As for this comment:

"So, if I were less educated and had less avenues of resistance and response I might have BPD, rather than PTSD? Is this not rather arbitrary?"

In one sense, yes...ish. There are clusters of behavior that psychologists have encountered in practice over decades. These clusters are mapped to diagnoses. Sometimes, a cluster has a well-documented, obvious causal factor (such as PTSD, or brain abnormalities leading to schizophrenia or autism, even though we aren't sure of what causes the abnormalities). Other times, the relationship is less clear: BPD has an association with childhood trauma, but that can't account for all people with BPD-like symptoms. There are reasons for assigning certain clusters to certain diagnoses, but the assumptions that this system of classification operates on are arbitrary on some level. Some factors that go into deciding whether something is a disorder are whether it is abnormal, whether it is disturbing to that person, whether it is disturbing to others, and whether the behavior causes harm. Since these are somewhat arbitrary points to begin classification from, then yes, the rest of the system inherits some arbitrariness.

That being said, psychology is not just the study of human cognition but the study of human behavior. In fact, one of the most persistent findings of psychology is that persistent patterns of cognition are rarer than we believe them to be. Much of our cognition and behavior is based on our environment. It is perfectly reasonable for a diagnosis to be made on the basis of behavior. This can be the difference between a petty criminal and a kleptomaniac, or between an abusive husband and a BDSM-dominant husband who is otherwise normal.

I can't speak to your specific case, of course, but the nature of clustering plus the lack of specific treatments means that to some degree it doesn't matter what you 'actually' have. What does matter is whether the label helps you overall. I would argue that the PTSD label is a very effective one, for example. People can be burdened by a diagnosis, but others will benefit from the increased awareness that comes with medicalization (e.g., it is my understanding that people are much less likely to expect others to "just get over it" than they were in the past).

I don't have numbers in front of me, but I believe that people diagnosed with BPD have more negative outcomes than people diagnosed with PTSD. Some of this is probably due to the label, but some of it is probably due to actual differences in the diagnosed persons. Consider this thought experiment: what if BPD and PTSD were 'actually' the same disorder manifesting in different ways? We would still expect people with BPD to do worse because of selection bias in the diagnosis - people with more severe, poorly controlled behaviors would be more likely to be diagnosed with BPD.

(This is just a thought experiment, but this sort of thing actually happens in practice! Researchers have found that autism diagnoses are "contagious" within a small area. By examining school district lines they discovered that this effect wasn't because of some shared environmental factor. Instead, a child receiving a diagnosis of autism resulted in children in the nearby area being diagnosed with autism instead of some other disorder. The key finding was that the effect didn't cross the school district lines because the parents in different school districts didn't associate as often. The moral of the story: reliable, accurate diagnosis is very hard when you can't see someone else's mind!)

polly:

In the United States, at least, labeling can be very important for ensuring that people receive appropriate services (or even services at all). For example, this is why there has been so much discussion about where Gender Identity Disorder "belongs" (psychology vs. medicine). Whether it's classified as a problem of the mind or a problem of the body will help to define how it is treated, how it is paid for by insurers, and so on.

I agree that a diagnosis can rob a patient of their feeling of agency, or even actually limit their choices rather than just make them feel limited. But this isn't just a psychology problem: some of it is the way that psychology interfaces with medicine, politics, insurers, bureaucracy (for funding), and so on. An example of this would be ID requirements for certain services because there would be extreme amounts of public outcry if there were not "accountability" or it were perceived that people were gaming the system. In theory there's no reason why someone could not come in for, say, a totally anonymous therapy session where their prior diagnosis will not burden them. In practice, it is difficult to get someone to provide funding structured to permit that.

That being said, support is also provided with no specific diagnosis (again, my experience is with the US system here). For example, support may be provided to families with an incarcerated relative even though there is nothing 'wrong' with the family: even aside from the stress of knowing that a loved one is incarcerated, it is also acknowledged that the family may have lost an income earner or a parent, and also may be at risk from the very act of the family member returning (e.g., if the incarceration was due to domestic violence or gang related activity).

Politicalguineapig:

Your criticism of psychology is not a fair one. Modern physics was founded on Victorian misconceptions of the world, too! Indeed, many sciences have their modern roots around the era of the Industrial Revolution, and many of them were wrong for a great deal of their history. A field's history is important, and psychology has many blemishes on that history (both in an absolute sense, and relative to other sciences), but it's come a very long way even over the past fifty years.

Politicalguineapig // Posted 13 July 2010 at 06:02

Eronarn: Okay, maybe psychiatry has advanced- I'm not a professional, merely a patient- but, unlike the hard sciences, psychiatry is practiced through the filters of the practitioner's perception, much as it was when the science first got started. Thus, unlike physics and biology, the field and diagnostic criteria have remained subjective, and women have to be very cautious not to run afoul of their psychiatrists, just as they had to do in Victorian days. So very little has changed, except for the weight of the DSM and the options the psychiatrist has to treat the patient.

MC Kean // Posted 14 July 2010 at 16:37

1. I was critical of diagnosis of BPD for women when men with the same history and behavior would be diagnosed w/ PTSD.
2. Furthermore, when diagnosis is all over the board, depending on what professional you are seeing at any given moment, it makes it a bit difficult to have much faith; and indeed patients self diagnoses are often most on target when they are given the right tools.
3. Psychiatry has been too closely linked to allopathic medicine and big pharma to have a lot of faith in the treatments.
4. For example, many people getting very harmful drugs for bi-polar disorder, may have malabsorbtion sydrome and be treatable by diet and additives.
I could go on. It is not that I do not seek health care, mental and physical, but any sort of faith in the system or the providers skills is quite simply misplaced. They can only be assistance, to the patient, and the patient must take what they get from them with a grain of salt and respond with a lot of research before they do anything that is invasive or involves drugs.

MC Kean // Posted 14 July 2010 at 16:44

My personal experience.
After being inappropriately examined by a physician in a military hospital; I suffered mild symptoms of PTSD for a couple of years. Over the long run, I simply learned not to trust male health care providers; to seek women when I could.
Then the V.A. health care system subjected me to "medical rape" in the interest of educating OHSU students, interns, and residents, a fellow in one case. Once I became aware of the betrayals; I checked into my medical records, investigated, and filed a complaint. In response, I rec'd a dignosis of BPD from the V.A.
Of course the outside professional opinion has been PTSD.

MC Kean // Posted 14 July 2010 at 16:58

No, I do not think my comment about empowerment tools, (like a liberal education and history of activism) making a difference between BPD and PTSD, based on your criteria for BPD, is arbitrary.
What I am saying is that if one does not feel powerless, one may be less likely to act out in ways that are violent. It is a matter of seeing constructive alternatives.

MC Kean // Posted 14 July 2010 at 17:08

Not ALL health science history is so negative. However, the alliance between eugenic philosophers, big pharma, and the A.M.A. set the tone for both allied medicine and traditional mental health care. It has warped the science.
On the other hand herbal health care has centuries of empirical data collected, research proves the superiority of midwifes in terms of outcomes, and yet the A.M.A. continues fascist medical care.

grasshopper // Posted 15 August 2010 at 04:01

New here, love this discussion, glad to see so many women questioning the culture's lame and destructive attempts to 'keep us in our place' (meaning women) in the form of bogus 'mental health' diagnoses. And that's not to dismiss anyone who finds a diagnosis useful or helpful, everyone has their own experience.

From my own experience and what I'm reading here and elsewhere, bpd is a catch-all label for women who are mad as hell and aren't going to take it any more. Women are stigmatized for expressing anger about things that we are rightly and rightfully angry about, as others have already commented.

Sorry for leaping in like this, lots of thoughts, but wanted to respond to this comment:

Long-term follow up on patients with BPD indicates that a lot of them get better on their own after a couple of years, although their personal relationships often don't. That's why long term studies can be misleading.

Women who finally get angry enough to break free from their dysfunctional families of origin (or other traumatizing relationships/situations) may well 'get better on their own'. This matches my own experience, that as I've removed myself from destructive contact with my family, I've been less angry, and therefore I'm 'better' now in the sense that I'm no longer violating the social requirement for women to never show open anger or aggression.

I'm guessing that, if true, the reason women "get better, but their personal relationships don't," is because the high cost of self-healing, on our own terms, is that we have to cut off from all damaging relationships. In a patriarchal, male-dominated, male-centric world, this may mean that it's very hard for us to find anyone to trust at all, including other women, who are, often as not, involved with men themselves, and therefore complicit in the oppressive system. Stockholm syndrome and all that.

Feminist Psychologist // Posted 15 August 2010 at 23:46

Polly - so sorry I haven't had chance to respond to you sooner, things have been really busy this last month. I just wanted to say I totally agree with you, and I think it is the general tone amongst most UK psychologists (to make horific generalisations about a whole profession - clearly I can't speak for everyone, but this is how I was trained, and this is how my colleagues work) that we are generally often against diagnosis to some degree or another unless the person we are working with sees it to be helpful in some way, we do not normally see ourselves as diagnosticians, do not generally work that way, and there is often a lot of reflective talk about the impacts - both ways - that labels can have.

MC Kean - It's complex, but poor childhood attachment and complex childhood trauma appears to be the primary cause of bpd. PDs are understood to develop in childhood (before the age of 18). Therefore adult trauma in the context of good childhood attachment and no childhood trauma (or a no 'pd' problems as an adult) will not suddenly trigger a pd; but they may trigger PTSD. That is not to say that someone with bpd may not experience adult trauma (including ptsd) or that children don't experience trauma and either cope without psychological consequences, or experiences ptsd but no bpd. Not sure that that clears anything up?!

JJ // Posted 19 September 2010 at 22:30

I know I am a few months late with this response, as I just stumbled on this article and thread, and all I can say is WOW. It seems like everyone on here has some issue with the diagnosis of BPD, whether believing it does not exist at all, or that is is often given to people who, more appropriately, should be recognized as having PTSD or complex PTSD (please don't slaughter me for listing both, I have read several of the books sighted, including Judith Herman's book; I am simply pointing out that both were mentioned here), and I believe that these are reasonable concerns, and should be discussed, and debated, at length. The problem, as I see it, on this thread is not that there are debates, which are always essential in intellectual discourse, but the insults being hurled in the context of what should be a well reasoned debate. Almost everyone on here (I read most of the responses, until I grew nauseated by the frequent personal attacks, which have NO place in a debate), as I said, seems to agree that BPD is, at least often (if not always), a misdiagnosis. Why then the attacks? Why not acknowledge the common ground and work from there, despite differing views, with the goal of achieving increased understanding? Everyone has the right to disagree with another, but it is useless to attack each other personally, and serves only to remove the possibility of increasing understanding, thereby actually directly preventing any real progress. I find this problem so frequently, not only here, but in the BPD discussion in general (and elsewhere, of course), wherever it is found. This disturbs and saddens me, as I am disturbed and saddened whenever I see personal attacks getting in the way of genuine, constructive, reasonable debates (which are so necessary to intellectual progress-- or progress of any kind, really). By the way, I have been Dx'd as bipolar, then BPD (amongst many, many other things), and now the view is PTSD with suspected Asperger's (I'm waiting to be tested by specialists on the advice of my therapist, not self-diagnosing), which seems to fit me better than anything else so far.

Sheila // Posted 20 September 2010 at 12:16

Well said JJ. It's a common occurence on this website unfortunately, that things get personal and heated to no one's benefit and to the detriment of informed debate.

Franny // Posted 06 March 2011 at 01:37

I feel so abused and put down by the Psyche medical field. When you are raised to be who you are, then you enter the adult world where they give you a sickness label about who you are, it is abusive.
I dated a sociopathic personality and he tried to tell me I had Borderline personality to keep me in line with his abuse. I have chosen to dismiss the disorder, but it haunts me. The professionals who gave me this diagnosis have also abused me. I have Multiple Sclerosis. My brain and body are falling apart. The professionals never took that into account when sentencing me to a BPD-death.

Anti-psychiatry // Posted 25 December 2013 at 19:32

I know that I'm getting into this a little late, but I agree with the OP here (other than the feminist viewpoint because I've witnessed psychiatric atrocities equally with both sexes). I practically grew up in psychiatric facilities, compliments of my narcissistic mother. I may have to post twice, consecutively, but I wanted to share a paragraph of information from a psychological report I had during a 9 month institutionalization when I was 14 to demonstrate just how horribly inaccurate these "professionals" can be ( I have changed my name as it appears in this paragraph a few times).
Mental Status Exam
Katherine is a petite 14 year old with clear skin and light, strawberry blond hair. She was initially very polite and quiet. She gained momentum and speed with her speech as she went along. She sounded anxious as she talked. When asked about this she responded she was anxious because she needed to convince me there was nothing wrong with her. She also went on to diagnose herself with PTSD and agoraphobia. She was very clear about not trusting doctors or medications she might be put on. Her speech was coherent and of normal rate and volume, though, she did speed up her speech and sound anxious as noted above. She describes her mood as fair and admits to some anxiety. She also admits to some past history of depression. She has a clear tendency to blame other people for her moods and her responses. She expressed a great deal of anger toward her mother who she feels is solely responsible for her multiple diagnoses and placements. She denies any suicidal or homicidal ideation, though earlier this morning she stated she was going to starve herself because she would rather be in a physical hospital than a mental hospital. She agrees at this time that she will eat and that she will not follow through with this threat. This was based on feedback given to her that any physical hospitalization would ultimately end and she would return to this placement at the end of such hospitalization. Though she responded rather quickly to what made sense to her as an unwinnable situation. Her intelligence is above average with a strong use of vocabulary and evidence of a strong knowledge of the mental health system and the DSM diagnostic criteria. Her judgment is limited with impulsivity and limited coping strategies and her insight is probably limited as well. It is my suspicion that much of what Katherine reported had strains of truth in them, but was likely laced with exaggerations based on her fairly dramatic presentation of her history.
diagnostic Impression
Axis 1: Oppositional Defiant Disorder
R/O ADHD combined type
R/O Mood Disorder NOS
She has previously been diagnosed with Bipolar Affective Disorder but it seems to be more personality based problems than Axis 1 based problems from my impressions from my interview with her today. Her most recent diagnosis from the Genesis program was of Adjustment Disorder with depressed and anxious mood and ADHD both of which make sense in terms of her presentation.
Axis 2: Borderline narcissistic and histrionic features fitting into a cluster B personality Spectrum.

Recommendations
At this time I would recommend we go along with Katherine's plan of trial off medications. She's been on a relatively low does of both Adderall and Seroquel and it may or may not have been helping with her primary symptomatology of impulsivity and labile affect. I would like to give her some time off medication to see how she presents in a structured setting with no treatment medications on board. We will watch for symptoms of mania and depression. We will also watch for anxiety symptoms, PTSD symptoms, as well as ADHD symptoms.


Now I posted all of that to say this. My treatment history dates back to the age of 5. I was diagnosed ADHD. Sometime between then and the time I was 10 I was diagnosed with Bipolar disorder. I had been hospitalized a myriad of times between those five years as well. At the age of 10 I was diagnosed ODD, ADHD, MDD. By the end of that 9 month institutionalization when I was 14 these were my diagnosis in addition to the PTSD.

Axis 1: Oppositional Defiant Disorder 313.81
ADHD 314.01
Axis 2: Borderline personality features 301.83
Narcissistic Personality Features 301.81
And I found it funny that I "lacked insight" but they went along with my recommendations and I was 14!

Philippa Willitts // Posted 26 December 2013 at 00:58

Thanks for this comment. If nothing else, those case notes clearly describe behaviour that is pretty typical teenaged. The degree to which these thoughts and actions have been pathologised is very telling.

Wynne // Posted 21 February 2014 at 01:15

"And lastly, I’ve been wondering whether Borderline Personality Disorder is a mental illness/personality disorder at all."

While it could be that you have been misdiagnosed or have tendencies rather than the full-blown disorder, BPD is in fact a legitimate mental illness. Please see the documentary "Back From the Edge" which can be found on Youtube for more information--it is an overactive amygdala at work, the fight-or-flight mechanism in the brain which causes those mood swings and emotional symptoms. It is *not* the fault of the individual who has it, although environmental factors, personality, and cognitions can activate the genes and worsen the severity of symptoms.

"Three-quarters of patients diagnosed with BPD are female. I’ve spent some time since my diagnosis wondering why that is, when one would expect the split to be roughly 50/50."

Your concerns are astute and your observation is correct. This is most definitely gender bias at work: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676679/?report=reader As you can see, "Prevalence of lifetime BPD was 5.9% (99% CI: 5.4–6.4). There were no differences in the rates of BPD among men (5.6%, 99% CI: 5.0–6.2) and women (6.2%, 99% CI: 5.6–6.9)." The rates are not statistically significant.

Someone very dear to me had his clinician in Denmark attempt to diagnose him with Asperger's when he clearly does not fit the criteria (having lived with someone who has Asperger's for the last 6 years, I can confirm he most definitely did not have Asperger's.) So Borderline males and Asperger females are often misdiagnosed because of the false gender-binary thinking of "Borderline=extreme female behavior" and "Asperger's=extreme male behavior." The disorders present differently across genders, partly because women are pushed to be social and men to be stoic and there are some differences in the working of the brain (corpus callosum and all that), but nevertheless, both categories deserve better from their clinicians than to be boxed in and mislabeled in such a fashion.

I hope that this helps to clear some things up.

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