A rose by any other name…

Still dies, rots and decomposes like anything else, I suppose.
  

Last week I talked about where Borderline Personality Disorder got its name. It may not stay that way forever though. Borderline Personality Disorder renamed? For some time now clinicians have been calling for the label of Borderline Personality Disorder to undergo official change. There are a number of different names used around the world and under consideration for the same disorder:
Borderline Personality Disorder (BPD) – Current
Emotional Regulation Disorder (ERD)
Emotional Dysregulation Disorder
Emotional Intensity Disorder (EID)
Emotionally Unstable Personality Disorder (EUPD)
Emotion-Impulse Regulation Disorder (EIRD)
Impulsive Personality Disorder (IPD)
Impulse Disorder
Post Traumatic Personality Disorganization (PTPD)
Complex Post Traumatic Stress Disorder
The most commonly used name today is Borderline Personality Disorder – or BPD – as defined in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV-TR).
The term “Borderline” is a historic term coined to describe people who were diagnosed to be on the borderline between a neurotic and psychotic disorder. It is commonly felt that the “Borderline” label is misleading and stigmatizes the disorder. From the beginning the term Borderline Personality Disorder has been stigmatized and this has only been compounded by decades of misunderstanding. It implies that the entire person is flawed instead of looking at BPD as a medical problem. By renaming Borderline Personality Disorder it will be easier to move away from those stigmas that are automatically associated with the label. Originally it was termed Borderline Personality Disorder because it was thought to be on the ‘borderline’ of multiple diagnoses but not falling into any one category. However this is no longer believed to be the case. It isn’t on the border of anything. It is its own distinct problem; a disorder characterized by intense emotional experiences and instability in relationships, behavior, and emotions. Some clinicians don’t even want it labeled as a Personality Disorder because it implies that there is no hope for a cure when in FACT it has been proven that with psychotherapy and the aid of medication there is the ability to heal and live a life free from the symptoms that categorize BPD. They want it renamed and removed from Axis-II designation and placed firmly in the Axis-I category because of the high rate of comorbitity with other Axis-I disorders (as previously mentioned here).
Rumor has it that the fifth version of the Diagnostic & Statistical Manual (DSM-V) is likely to rename Borderline Personality Disorder (BPD) as Emotional Regulation Disorder (ERD) or Emotional Dysregulation Disorder (EDD). Indeed, Emotional Dys/Regulation Disorder is the most popular alternative for Borderline Personality Disorder. It’s felt that this more accurately describes the expression of the symptoms encompassed by BPD as it is just that, a disorder of regulating emotions.
Another term is post traumatic personality disorganization (PTPD) or complex post traumatic stress disorder, reflecting the condition’s status as (often) both a form of chronic post-traumatic stress disorder (PTSD) and a personality disorder in the belief that it is a common outcome of developmental or attachment trauma. I’m not sure I entirely agree with this because there are many people with BPD that don’t report any kind of traumatic event.  Personally, maybe, MAYBE, some arguable attachment traumas when I was a toddler, but even I don’t think this was so much environmental trauma as a predisposition to reacting the way I did. As I’ve mentioned in a previous post, I don’t agree that PTSD is an accurate diagnosis for me at all. I’ve had plenty of traumatic events to speak of but not until after my BPD began to present at a young age.  
Emotionally Unstable Personality Disorder…. Really? REALLY? Yeah, I see that diminishing the stigma that Borderline already has. Why don’t they just name it I-Am-Insane-And- Potentially-Violent-It-Is-In-Your-Best-Interest-To-Remove-Your-Children-From-My-Presence-Duck-And-Cover Disorder. IAIAPVISIYBITRYCFMPDAC Disorder is rather a mouthful though.  How about simply, BitchPleaseI’mCrazy Disorder. Seriously.
I’m against renaming Borderline Personality Disorder.  Renaming it doesn’t actually change a thing. Anyone with half a brain is going to know that ERD/etc is the same thing as BPD just with a new name, IF they even knew what BPD was to begin with. The symptoms are The. Same. Damn. Things. I mean, yeah it’ll take away the general stigma of BPD but then again, it may work to perpetuate others. BPD is already stigmatized as a female disorder. “Emotional this/that Disorder, Post Traumatic Something Disorder, those will all only perpetuate if not increase that particular stigma. It’ll make it more difficult for men to be diagnosed and make women an even easier target for ridicule. I can just imagine anytime a woman speaks her mind or has a strong opinion because she has an actual voice and isn’t a doormat, some douchebag guy is going to replace “is it that time of the month?” with “Emotional Disorders are treatable, get help for that shit”. It’s all ridiculous. In that way, Borderline is safer because a good majority of people don’t even know what it is so they can’t jump to asinine conclusions. So while, yes, ERD, encapsulates the fact that it is a disorder of emotional regulation, at the same time it almost trivializes the severity of what this disorder is. That is not okay.
Personally? I’m not sure I want it to be renamed. I like the term Borderline Personality Disorder. I like the idea that something can overcome the stigma and be understood for what it is; kind of civil rights activation for personality disorders, haha (for that matter I don’t like that there will be a full re-categorization of PDs from 10 to 5 in the new DSM V). I still don’t like admitting that I have a disorder of emotions because I was lead to believe that I needed to repress them for so long. At least Borderline doesn’t directly state a disorder of emotional problems (though obviously it is) since it doesn’t have Emotion in the title. It doesn’t stamp CRAZY BITCH on my forehead right away. Someone hears Borderline Personality Disorder and they may cock their head and ask, ‘what’s that?’. Someone hears Emotional Dysregulation Disorder and they’re going to start creeping backwards because this person is OBVIOUSLY emotionally unstable.
Idk, maybe I have no logical reason for it. Mostly it’s probably due to my attachment issues. I have a hard time giving anything up that I’ve become accustomed to and this label is one more example of that. I like the name, I don’t want it to change. I’m familiar with it. I mean… BPD is a disorder characterized by abandonment! Don’t make us abandon our label! It’s mine. I’ve embraced it. Don’t take it away from me! (Jokes. Sort of). And quite frankly, all the other names for it are kind of lame.
While I’m on the topic of continued designation of things; please return Pluto to its previous planetary status; “Dwarf planet“ is just insensitive.  

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.

Post Traumatic Stress Disorder – Stats and Facts Part 3

Approximately 25% of those with BPD/ERD also meet the criteria for post traumatic stress disorder.
So let me tell you a story. I had to go to a counseling session because I made a very poor decision concerning alcohol and driving. I had to have a psychological evaluation and talk to a social worker about my past and stuff. First off, let me tell you that I hate, HATE, talking to shrinks that are not of my choosing. I don’t believe it’s any of anyone’s business to ask me such personal questions, intimate, details of my life. Especially when they inevitably make snap decisions and diagnosis because one session is not enough time to understand anyone. So anyways, I had this session. The guy (the only male counselor other than my psych I’ve ever talked to) started asking me questions off of a list of psych questions. It was clear that he cared precisely zero about me as a person. He just needed to get through his checklist. Throughout the interview he ask me questions, then instead of letting me talk, cuts me off and proposes his own theories and tangents. So he’s asking me these questions when he gets to the section on pysical/mental/emotional abuse. It’s at this point I’m debating whether or not I want to tell him the truth or just get him to skim past this. I decided that the truth would work to my benefit as it was part of why I landed there in the first place. So as soon as I start saying yes to some of his questions his eyes light up and he proclaims that I have Post Traumatic Stress Disorder. WTF? He didn’t even ask me to elaborate on the situations he was asking about. He just went on and on about PTSD, cutting me off when I tried to elaborate, and got way to excited about my potential mental disorder. It was clear that PTSD was his pet subject. So while I have technically had a diagnosis of PTSD, I don’t believe it. It makes me wonder how accurate some diagnoses are too. People are human and therefore subject to their own biases.
And while I might fit the technical criteria for PTSD, the incidents that made him jump to this conclusion had less lasting traumatic effect on me than did a really bad car accident I was in while I was at university (years after my BPD emerged).
So let’s take a look at what PTSD is (and how I potentially fit the criteria):
Causes – Psychological trauma:
“PTSD is believed to be caused by either physical trauma or psychological trauma, or more frequently a combination of both. PTSD is more likely to be caused by physical or psychological trauma caused by humans such as rape, war, or terrorist attack than trauma caused by natural disasters. Possible sources of trauma include experiencing or witnessing childhood or adult physical, emotional or sexual abuse. In addition, experiencing or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency service workers).  Traumatic events that may cause PTSD symptoms to develop include violent assault, kidnapping, sexual assault, torture, being a hostage, prisoner of war or concentration camp victim, experiencing a disaster, violent automobile accidents or getting a diagnosis of a life-threatening illness. Children or adults may develop PTSD symptoms by experiencing bullying or mobbing. Preliminary research suggests that child abuse may interact with mutations in a stress-related gene to increase the risk of PTSD in adults.”
Criteria:
The diagnostic criteria for PTSD, stipulated in the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), may be summarized as.
A: Exposure to a traumatic event
– This must have involved both (a) loss of “physical integrity”, or risk of serious injury or death, to self or others, and (b) a response to the event that involved intense fear, horror or helplessness (an event was “outside the range of usual human experience.”).
Yep. Definitely had a few such instances involving abuse and a particularly bad car accident.
B: Persistent re-experiencing
– One or more of these must be present in the victim: flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event(s).
You be the judge. I often have distressing dreams but they’re no longer terrorizing. Intense negative responses: If you consider an inability to let most guys touch me without utter revulsion, freaking out and regretting any instance where it occurs outside of my comfort zone, constantly disavowing any intimate male companionship (this never sticks) and quickly second guessing, overanalyzing their motives… or… when I’m a passenger in someone else’s vehicle I often have knee jerk reactions with braking too hard, or getting to close to other vehicles. This causes me to pull back, hard knees to chest, my heart rate to speed up, grabbing onto the ‘oh shit’ handle and my breath catching in my throat. I prefer to drive.
C: Persistent avoidance and emotional numbing
This involves a sufficient level of:
– avoidance of stimuli associated with the trauma, such as certain thoughts or feelings, or talking about the event(s);
– avoidance of behaviors, places, or people that might lead to distressing memories;
inability to recall major parts of the trauma(s), or decreased involvement in significant life activities;
– decreased capacity (down to complete inability) to feel certain feelings;
– an expectation that one’s future will be somehow constrained in ways not normal to other people.
Heh. After some such events I severed contact with certain people, wanting nothing to do with them or those that are involved with them. Avoiding situations where I might even have the possibility of running into them. Not places that I was sure they would be (though of course I won’t go there) but places they might be, where there is even a small chance of it. After one incident in my early 20’s I completely repressed events, only recalling it years later after I found a journal that I had written immediately after and then completely forgot about. I still only have flashes of this, not a full recollection. Decreased capacity to feel certain feelings. ::smirk:: I often have a complete inability to feel feelings at all. This problem is what lead to the diagnosis of my Dissociative Disorder. When I have extreme stress, loss, and/or conflict I depersonalize and derealize from my life and even my own body. I do absolutely expect that my future will be constrained. My present is currently constrained in ways not normal to other people. I have a Borderline Personality Disorder. I’m pretty sure, by definition, this qualifies for ways not normal to other people.  I believe this has more to do with my depression than any traumatic experience that I suffered after this problem began.
D: Persistent symptoms of increased arousal not present before
-These are all physiological response issues, such as difficulty falling or staying asleep, or problems with anger, concentration, or hyper vigilance.
Long posts need more pictures
I think they need a better phrase than ‘increased arousal’. This did not immediately inspire thoughts of heightened awareness if you know what I mean. I have always had extreme difficulty with sleep. I had insomnia for years that still occasionally creeps back (last night for example – so freaking tired). Even with the prescribed medication that I’m on specifically to help me sleep I have a hard time falling asleep, staying asleep, and once I wake up, calming my brain down enough to return to sleep.  Anger, hah, see this post. My therapist just brought up my sense of hyper vigilance yesterday as a form of self protection. All of these things, however, were a problem well before any real trauma that I suffered and were not the result of bad experiences that I can recall. I imagine that some of the experiences I’ve had since the onset of this most likely exacerbated the problem.  
E: Duration of symptoms for more than 1 month
– If all other criteria are present, but 30 days have not elapsed, the individual is diagnosed with Acute stress disorder.
How about years? Does years count? Acute stress disorder seems more accurate to me though.  Don’t ask me why. Maybe I just don’t want to have PTSD too.
F: Significant impairment
– The symptoms reported must lead to “clinically significant distress or impairment” of major domains of life activity, such as social relations, occupational activities, or other “important areas of functioning”.
– I’ve had significant distress and impairment in social relations since I was 12 years old. This was at the onset of my clinical depression and anxiety disorder. Both precursors to my BPD. By this point my abandonment issues were also in full swing. But, again, not due to an experiences that could be considered very traumatic. I think it has more do to with a predisposition to feel things in a way that is not normal to most – BPD.
So yeah, after this very long personal assessment, I am still not a psychologist or psychiatrist and am therefore not qualified to diagnosis myself. Thoughts?
Abuse is very common in the lives of people with BPD. It is often one of the root environmental contributors to the emergence of the borderline disorder. I do not have any doubt that many people with BPD also suffer from PTSD. Recognizing this is very important for treatment because it helps understand some of the underlying factors that need to be worked through and healed.
I do wonder if PTSD leads to BPD, or if being predisposed to BPD leads to an increased sensitivity to situations that feel traumatic but would not normally be considered a traumatic event required to define PTSD.  Then again, if something feels a certain way, a situation is perceived a certain way, doesn’t that make it reality for the person experiencing it? Therefore the event occurring is in fact something very traumatic.
I don’t know.  Most likely it is a co-morbid issue building and feeding off of each other.