‘Borderline’ diagnoses

// 3 May 2011

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This will be the last of my posts as a guest blogger, a role I have greatly enjoyed. Many thanks to everyone who has read my posts, in particular those who took the time to leave comments and criticism from which I have learnt a lot. I wanted to take some time to write briefly about my experiences with mental health because I have found some cross-over between these experiences and my identity as both a woman and a feminist.

Within the last year or so I have been given the diagnosis of ‘borderline traits’. This means a case of borderline personality disorder that does not currently meet five or more of the nine criteria outlined in the DSM-IV. ‘Borderline’ diagnoses have for some time now been controversial in feminist terms. The emotional lability associated with a borderline personality has echoes of the ‘hysteria’ to which women’s feelings were frequently attributed in the second half of the 19th century.

In Anji Capes’ feminist critique of borderline personality disorder, she writes:

“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.”

This highlights the crux of the issue for me, and goes some way to explaining why three-quarters of people with a borderline diagnosis are women. I agree with her viewpoint of finding the diagnosis helpful while at the same time questioning whether the diagnosis would exist in a gender equal society.

By finding the diagnosis useful at a personal level, I find myself in a dilemma. I do not want to perpetuate the use of a label which I suspect to be fundamentally sexist, but at the same time I identify with the criteria. Also, the system is flawed in such a way that there is considerable relief that comes with fitting into a category as being categorised seems to result in improved access to mental health services. This is a problem in itself; both for those whose difficulties do not fit neatly into one box, and for those who get labelled inflexibly with particular diagnoses.

I think it is important to keep having this discussion. Psychological diagnoses should always be viewed in terms of what is considered the norm for a particular person (or gender, for example), in a particular society, at a particular moment in history. A lot of the issues contained within a borderline diagnosis may be more indicative of society’s own sickness in relation to gender than sickness in the individual themselves. Despite this, the individual at the centre who is experiencing these difficulties will need support, which is the context in which I still find the diagnosis a useful term.

Comments From You

Marge // Posted 3 May 2011 at 9:43 pm

The old cynical view is that you only get diagnosed with a personality disorder if your psychiatrist doesn’t like you or you consistently fail to get better. Ever since someone I knew was diagnosed with a personality disorder for, as far as we could tell, making a complaint about a psychiatrist I’ve held the diagnoses in deep suspicion.

And while women are massively more likely to be diagnosed as borderline, men are massively more likely to be diagnosed as having antisocial personality disorder. You could read the diagnostic criteria of the two as pathological examples of male versus female socialisation – for example, antisocial has aggression and borderline has self harm.

FeministTherapist // Posted 3 May 2011 at 10:09 pm

my opinion as both a service user and a mental health professional is that Borderline PD is given when people don’t quite fit into the *neat* Bipolar, Schizophrenia, OCD etc boxes. PD in general is a bit of a controversial diagnosis, there’s no established ‘treatment’ for PD, so why diagnose people in the first place if you can’t actually help them? I’m sure you know that homosexuality used to be a diagnosis, and that transgenderism still is (sort of). How long will it be before other forms of ‘mental illness’ are classed as just ‘different’ and someone society has to accept rather than something to medicalise and ‘cure’? Not too long I hope, then people can finally get on with dealing with their issues rather than waiting for a miracle cure. In my opinion diagnoses don’t empower people, they just put them into neat tickboxes. Feel free to disagree with me…

Sue Henderson // Posted 3 May 2011 at 11:32 pm

What I’ve found is that there really is no border between mental health and mental distress – or at least that it’s so indistinct as to be meaningless. Labels can be useful in giving a person something to latch on to, to realise they’re not mad but merely in need of help. But they can also be a life sentence and that’s where they fall down.

One of the key things I had to discover was that I’m not a problem to be fixed. Also that depression is an extreme reaction to extreme circumstances. Those extreme circumstances are incredibly important. You can’t label someone without first realising where they’ve come from and why they are where they are.

I can’t speak for every kind of mental issue of course. All I can do is to give my own perspective which is that it’s ok to feel bad about things. If you’re hurting that’s ok (the cause isn’t ok but your feelings are).

I’d also like to say that if you’re suffering mental distress get all the help you can lay your hands on. The NHS is totally useless. Depending on where you live it will probably take between 6 and 12 months to see a counsellor. But there are loads of local services which can help. Your local Mind office is a good start and even if they can’t help themselves they’ll know other counselling services in the area (some free or by donation only). Be open with family and friends who you trust, tell them what you need, how you want to be treated when the depression really bites, ask them for help. See if your local library or wellbeing centre does the computerised cognitive behavioural therapy (Beating the Blues) or if anywhere has confidence courses or social groups. It all helps.

Be honest with yourself. You’re a dear, fallible human, and you’re entitled to feel however you feel (don’t add guilt to the equation), and you will get through this. Acknowledge your victories (for some even getting out of bed is a victory). Give yourself time and space and compassion, and heal in your own way. You will heal, at the right time. You’re where you need to be right now.

vicky // Posted 4 May 2011 at 11:10 am

This doesn’t really add much to the discussion in this comment thread, sorry.

i just wanted to say thank you to sue henderson. I’m not having a good day today (yay for mental health struggles) and Sue’s comment has helped a little.

Thank you

Pandora // Posted 4 May 2011 at 7:15 pm

I have recovered from borderline personality disorder, but still have issues with the related condition of complex PTSD (as well as major depression and anxiety, with psychotic and dissociative symptoms). At the time that I was diagnosed with it, I was glad; it was a name for this thing that had afflicted me for years, and gave hope for recovery.

However, although I have an excellent psychiatrist and now a caring CPN, accessing therapy within the NHS was a disaster. I believe this was because the Trust still held a prejudice against BPD; on the one hand, they refused to continue what I had found to be a helpful therapeutic relationship (of, broadly speaking, the psychodynamic school), but simultaneously they consistently moaned about the lack of “PD specific services” and cited that as their excuse for failing to treat me. Go figure.

So basically, I agree with Sue – the NHS is, for the most part, rubbish in terms of mental health. I eventually found trauma therapy in the voluntary sector which has been very effective, but the severance of my NHS therapy pretty much ruined my life at the time. It’s such an intensely personal relationship, so endings at inappropriate times are highly traumatising.

And on that note, the traditional view of ‘the borderline’ is of attention-seeking, manipulation, etc etc. This is only true in extreme circumstances – but even where it is, rather than approach the person with prejudice, psychiatrists/CPNs/therapists ought to be professional and ask *why* (s)he is behaving this way. As you probably know, a high proportion of people with BPD have a traumatic history. Some commentators hold that it is on a continuum with PTSD and even DID/MPD.

I have known a few men with BPD, but as noted above, they tend to more often receive the ASPD diagnosis. I read somewhere that BPD diagnoses are 75% female, ASPD 75% male. This led the article (I wish I could find it for citation, sorry) pondering whether or not the two diagnoses are directly correlated in symptomology, even if they aren’t exactly stated to be in the DSM. I think they concluded that the traits of BPD are, generally, seen by professionals to be more applicable to females, and vice versa.

I am grateful to the psychiatric profession for all it’s done for me, but I’m one of the lucky ones. I think BPD *can* be a valid diagnosis, but more often than not it seems to be a pejorative term applied to women seen as ‘difficult’. *sigh*

Sheila // Posted 5 May 2011 at 12:17 pm

There has been a substantial amount of very well thought out academic and clinical work done into the misdiagnosis of women who have suffered childhood sexual abuse or other traumatic sexual attacks as borderline personality disorder sufferers. It is a label that can help some and hinder some. What matters is the effective and sympathetic treatment that we ought to be getting but aren’t.

makomk // Posted 7 May 2011 at 9:32 pm

Marge: I’ve actually been wondering about a similar possibility for a while, namely whether some women that are diagnosed with BPD would’ve instead been perceived as sociopaths or similar if they were male. There certainly seem to be good reasons to suspect so. Not only do a lot more men get diagnosed as having ASPD, socipathy, etc, but recognition does seem to rely a lot on the person being unable to fake conformity to social norms effectively.

We already know that with less dangerous conditions like autistic spectrum stuff, women are better at learning to understand and simulate social norms – at a guess, probably due to differences in socialization – and there’s no reason to think they wouldn’t have an advantage when doing so for other reasons. In fact, it makes sense that different socialisation would lead to different symptoms and behaviour in general.

(This is idle speculation – I have no qualifications in this area. Mostly, I’ve been thinking about this due to online chats with a diagnosed and self-described sociopath, and partly due to an interesting incident when a woman diagnosed with BPD escaped from prison after murdering her husband and convinced a newspaper reporter not to turn her in.)

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