Does Borderline Personality Disorder exist? – Controversy in Borderline Personality Disorder

 

There is a lot of myth and controversy surrounding Borderline Personality Disorder. This is due to the fact  that the nature of BPD is very complicated.
Controversy ranges from Diagnostic criteria, usefulness of medication, effectiveness of therapeutic techniques, gender discrepancy, possibility of recovery, Axis location, terminology, and whether it even exists as an actual disorder at all. There are many, many more. I can’t say I’m surprised though, we’re a pretty controversial group of people.
This will be the beginning of a series of entries surrounding the controversies with BPD.
So to start; I think it’s appropriate to begin with:
Does Borderline Personality Disorder even exist?
One of the myths I’ve found is that there is no such thing as BPD. However more than three hundred research studies and three thousand clinical papers provide ample evidence that BPD is a valid, diagnosable psychiatric illness.
The question about the existence of BPD comes from several claims.
1.)     The first being shear ignorance of current psychological research. Definitions and diagnosis of BPD have changed drastically in the decades that it has been recognized as a disorder and some clinicians may be overwhelmed, or choose, to focus on many other areas of specialization and just not know how this subject has developed.
2.)    Some clinicians believe that it is not a separate disorder. They believe it is a collection of symptoms that are better encompassed by Bipolar Disorder or Post Traumatic Stress Disorder.  I’ve talked about PTSD before {here} and why I believe these are different disorders.  Bipolar II is a bipolar spectrum disorder characterized by at least one hypomanic episode and at least one major depressive episode; with this disorder, depressive episodes are more frequent and more intense than manic episodes. As far as Bipolar is concerned; I can see how Borderline Personality Disorder could be confused with Bipolar II (Bipolar depression) from a mood disorder standpoint. People with BPD tend towards a chronic depressive state with instance of hypomania (this certainly fits me). However BP II doesn’t the address the “instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts,” markers that define BPD. (More on Bipolar II)
3.)    Some simply reject labeling because of the stigmas associated with BPD and find all psychiatric diagnosis limiting and misleading. This one in particular I find to be ignorant. Yes, BPD does have a lot of associated stigmas (which I will also discuss in a later post), and avoiding stigmas is beneficial to the personal interactions of a patient in the outside world. However, by refusing to provide a diagnosis it can be very difficult to provide a clear course of action in therapy. By extension, it makes it more difficult to find a path to recovery. Not to mention, someone with BPD doesn’t have to tell anyone that they have been given this diagnosis, which will also allow them to avoid the general stigmas. If the psychiatrist/ologist/therapist holds onto these stigmas, it’s best for the patient to find a professional that is better equipped to handle the challenges associated with the present symptoms.
4.)    Another reason stems from the fact that the categorical diagnosis and causes for BPD are often disputed among professionals.  While the DSM does provide a list of criteria, there isn’t a single dimensional model that clearly maps how to identify traits and how, or if, they correlate to one another. This means there is dispute over the importance of various criteria, whether they are related to one another at all or just coincidentally present in the patient, existing as distinct problems or pieces of various other disorders. So the root causes that are traditionally used to classify BPD are called into question.  
“There continues to be some debate as to which personality variables should be assessed to make a diagnosis of personality disorder in the normal/abnormal personality continuum. It would seem to be appropriate in this approach to choose those personality variables more likely to be personal and concerned with functioning, in order to assist in understanding the patient’s disabilities and obtain strong clues about them. The difficulties encountered in the diagnosis and study of personality disorder include inconsistencies in assessment across both instruments and raters. “

Most professionals agree that the symptoms that compose Borderline Personality Disorder are part of one clinical diagnosis. The symptoms themselves are not deniable. No doctor or therapist would look at a patient talking about their problems and tell them these issues do not exist. That is not the question. The question is mostly one of definition and categorization. Regardless of what anyone thinks, the problems are real and having the ability to recognize the distinction of various symptoms is an important tool in order to deal and work to recover.
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Medication-go-round

Emergency appointment with my psychiatrist. Had to change meds. To give you an idea of me; I’m 5’3” and very athletic. I’ve always been what people consider thin. I work out 5-6 days a week and maintain a very good muscle tone. Also having been eating disordered since I was very young I am incredibly conscious of my body, and the changes in it. My body image is often unstable, a grasp I hold tenuously. The medication that my psych had me on made my weight skyrocket. Ok, so I only gained like 15 pounds, but for someone like me, it felt like my world had come crashing down. My body image is destroyed. All these years of hard work and careful maintenance, gone. I’d done a fair amount of research into this drug and weight gain is a very common side effect. On the one hand I’m incredibly pissed off that my dr. would put me on something that he knew was likely to make me gain weight when he also knew I was eating disordered. On the other hand, I also understand that he thought my problems were urgent enough that the side effects would be less an issue than the potential benefits of the medication. I stopped taking my medication. Cold. I was worried that I’d have a slew of bad withdrawal but so far, nothing, and it’s been almost a week.
I’ve been on Lexapro, which worked for my anxiety and depression but destroyed my sex drive. Correction, my libido was still incredibly high but I could no longer orgasm. Problem. I quit taking it.
I was on Zoloft which removed my anxiety but did nothing for my depression. Fail.
Symbyax, (combination anti-psychotic/SSRI) which stabilized my mood swings but still left me at a baseline of mild depression on the one hand, but in destroying my body image sent me spiraling down in a different direction. Also, did nothing for my anxiety. Not to mention, even after insurance Rx coverage, a months supply cost me over $300. Fail.
He also has me on Trazadone, which is technically a mild antidepressant but prescribed to help people sleep. The dose I was on, didn’t help me sleep, so he upped that. 
My new medication is Lamictal. Traditionally Lamictal is an anti-convulsant but with good results for bipolar II (which I’m not). Bipolar II is essentially chronic depression without the manic upswings, which is close enough to my problem. He said he expects no side effects. It will balance my mood AND my anxiety. Won’t effect my sex drive, bonus. And finally there has been next to no reported weight gain from it. Awesome. So here’s hoping this does more good then the meds I’ve tried before. I’m hopeful at least.
Oh the joys of the medication-go-round.