Trash talk – Controversy in BPD

Myth: BPD is a “wastebasket definition.” Clinicians give patients this diagnosis when they can’t figure out what’s wrong with them.
Reality: “ BPD should be diagnosed only when patients meet the specific clinical criteria.
Janice Cauwels (1992) wrote: BPD is still a wastebasket diagnosis, a label slapped on patients by therapists trying to pretend that their illness is understood. It is also used to rationalize treatment mistakes or failures, to avoid prescribing drugs or other medical treatments, to defend against sexual issues that may have arisen in therapy, to express hatred of patients, and to justify behavior resulting from such emotional reactions.
In other words, some clinicians use the word “borderline” like some schoolyard bullies use the word “cooties.” But the fact that BPD is used as a wastebasket definition doesn’t make it a wastebasket definition, any more than calling grapefruit a fat burner makes it a fat burner. A patient should be diagnosed as borderline only if they meet the clinical criteria and only after a clinician has worked with the patient over time to verify that the BPD symptoms are persistent, extreme, and long standing”.
Basically this is more the fault of therapists. It comes about when a patient’s problems are not so clean cut and identifiable. A patient may have one or two or many problems but instead of taking the time to understand if these are separate issues the patients are thrown under the heading of BPD because it’s a disorder that encompasses such a wide range of symptoms. Actually getting to know the patient would require more effort on the therapist’s part. It’s easier to lump them under a more general category.  Regardless of whether these people meet the designated criteria. Because as we know, any patient that is emotionally problematic must have a personality disorder. Dumping them under the Borderline Personality Disorder label allows them to utilize the stigma associated with BPD and dismiss them as untreatable or as a disorder that they are not equipped to deal with {read: biased against}. In short, it’s easier for the therapist to not deal with a challenging patient.

::Alternatively::

Like many clinicians, my roommate who has her M.S. in clinical psychology, describes it differently.  They do not believe that BPD is an actual mental disorder. It’s not like Bipolar or Depression that is a chemical imbalance and can be quantified.  She does see it as a wastebasket definition. This stems from the fact that the Borderline Personality Disorder does encompass such a wide range of problems, it’s as if any problem that cannot be explained by another disorder/diagnosis is swept together into a catch all category and filed under BPD. There is no reason that the co-morbid symptoms that comprise BPD can’t simply be separate co-morbid symptoms. For example, she’s not convinced that all of my issues don’t stem from Depression and a General Anxiety Disorder (which was the diagnosis I received from my first therapist). Except my depression and anxiety are alleviating and I still have a mess of issues.
I can understand this perspective even if I don’t agree with it. Even if it were a catchall for all these extraneous symptoms it doesn’t make it an invalid designation. Again, it provides a label that helps identify the wider range of problems that comprise the patients’ symptoms and allows for a means of recovery. Recognizing BPD as its own disorder also recognizes that these symptoms contribute to one another, compound, and are not necessarily separate entities. That there are co-morbid symptoms does not mean that these symptoms don’t stem from a common origin.
Personality disorders are tricky little bastards. You can’t quantify a personality. You can’t quantify emotional experience or relationships. All we have are our reactions and responses to the world around us. Personality is the lens through which we perceive that world. It permeates our entire being providing the means to interpret what we see and feel.  Recognizing how we relate to the world around us is what allows us to function in it. For someone with a Borderline Personality Disorder, that range is expansive, so yes, it does encompass a lot, maybe too much, but then again, most days we feel too much.
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4 comments on “Trash talk – Controversy in BPD

  1. I don't think there is anything wrong with having a sort of "waste basket" definition but it should be a last diagnosis not a first. There are bound to be people who don't fit into other disorders. Every personality is different and having a sort of catch all would at least help those who don't necessarily fit into other disorders get the help they need.

  2. Hm. I agree that it should be a last diagnosis, not a first. However, at that point I'm not sure how much good it would do. When do you come to the point where you let go of the label and just begin treating the symptoms. I know, this is kind of contradictory of me because I do believe that having a focus for a problem is helpful for recovery… but if they don't fit any designated issue, then having a label won't necessarily help them as much as dissecting and focusing on individual symptoms will. At least not until more research can be/time spend with the patient, in order to gain more insight into their problems as a whole. Having the Wrong label is just as unhelpful as No label. Maybe moreso bc you're treating the wrong problems.

  3. No two people will have express the same symptoms in the exact same way. That is what makes it so hard. They want the crazy to be wrapped in a nice shiny box and it will never be. I have been doing alot of reading lately and noticed the majority of disorders have basically the same symptoms to varying degrees. Maybe the label really doesn't matter at all. Treat the person based upon their unique experience not according to what hole they fit into best.

  4. You're absolutely right, no two people express symptoms the same way. Ultimately yes, a label is just a label and treatment is all about the individual patient.Where labels do come in handy is helping to figure out a course of action. You wouldn't treat someone with an Eating Disorder the same way you would treat a Narcissist yanno? So slapping the wrong label on them is only going to do more harm then good.

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