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Why a stigma surrounding BPD?


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I don't currently have a BPD diagnosis - but I did once, long ago (I have no idea if it was accurate.)

I am really curous about this issue -

I was thinking about the whole "stigma" thing associated with BPD - and I honestly, truly don't get it.

Why would a professional have a hard time dealing constructively - with people who are in such tremendous emotional pain? Or worse, refuse to do it?

I once read an article comparing BPD to having no skin on your body. That seems pretty raw & clear, to me - as far as describing it.

If "professionals" can muster up sympathy & therapy, for people with SZ, BP1 and OCD etc., etc. - what's the problem w'dealing w/BPD patients?

Other patients can be manipulative, angry, etc. - this kind of behavior clearly isn''t limited to BPD patients - not as far as I can see.

People with BPD can also be kind & loving, as far as I can tell.

Is a BPD person in the throes of a negative episode of their MI - really any worse to deal with - than angry mania in someone with BP? (Bipolar disorder)

Or someone with OCD, who is constantly obsessing on something to the people around them? Etc.

This is NOT a rhetorical question - I am actually kind of amazed that I read about this BPD stigma at all.

This BPD diagnosis has been around for several decades by now -

I would think that therapists would at least have some idea - or "game -plan" re: How to deal with it - as far as de-stigmatizing it.

What seems to be the problem? It's not like they haven't had time to deal, or research it better - and to realize these are people in pure emotional pain.

I've been pretty difficult with my P-doc as an OCD patient. In fact, I've been a real pain in the ass, at times. He's told me that. But he never shamed me for it.

I can honestly think of several other diagnoses that would be potentially very difficult for P-doctors & therapists to deal with -

So why the stigma particularly surrounding this diagnosis of BPD? Especially among "professionals?"

Any thoughts? Theories?

Just thought I'd ask people who have it, before I google any articles speculating on why - from people who don't have it - (if any exist.)

Not meaning to be intrusive or a "downer" - I'm just plain curious,

-suzie

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Hell, I have a Dx of a PD and feel ashamed... I think that because it is tied up with our personality, it is tied up with who we are as people. So somehow it is our fault, because we should be able to "get a hold" of ourselves, stop being so "dramatic", and the like. Whereas a Dx of a mood disorder or Sz is thought of as a physical problem, even though it manifests mainly as a behavioral problem...

Maybe this is it?

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In the days before DBT the biggest reason was that therapy just seemed to intensify BPD rather than ameliorate it. DBT really nails it when it comes to identifying and targeting Therapy Defeating Behaviors. I've got no hardened prejudices against treating BPD, so long as the person is ready for treatment. It can be a helluva ride even then.

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Before DBT the kahunas in the Borderline realm were Gunderson and a smattering of psychoanalytic/object relations theorists (Winnicott, Fairburn, Kernberg and others). If you are so inclined to read these folks opt for Gunderson. Kernberg is a particularly difficult read. Margret Mahler wrote well and Althea Horner had a pretty readable book (Object Relations and the Developing Ego in Therapy). Theodore Millon gives a really good summary in his magnum opus (Disorders of Personality).

Empathy-based approaches were just too much for a lot of therapists to handle. So hot, so cold, so often. And flipping back and forth between being over-idealized and demonized was an ongoing stressor/distraction. DBT takes treatment to a much more objective level. This is a great boon to therapists. And the chief complaint of participants. But it is great for teaching survival skills and assuring the survival of the therapist(s). Never mind the big burnout rate among therapists, though. I witnessed a lot of really bad outcomes with psychodynamic approaches. They seemed to cultivate too much dependency and that led to some ugly fireworks. While I'm not a DBT practitioner in the orthodox sense, my work is decidedly DBT-informed.

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I've always liked most of my BPD patients, and have gotten so good at dealing with them I have a harder time dx them now, they blow up less. Heh. I was the 'go to" BPD person on my unit at my last job when some folks were having a hard time.

I think due to the intenisty of my BP mood states I do have some more empathy than some providers might.

It's the self defeating behaviors that bring out the agony in providers, and the countertranfernce, I think. it's no fun to watch someone you care about hurting themselves.

DBT is really lessening the stigma, I think, now that there is a therapy that can work quite well.

Anna

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I think I've read something, though I'm too lazy to look for it right now, about pre-DBT therapies being ineffective, or sometimes counterproductive, because what people with BPD usually need is not so much an empathetic, introspective approach, as the kind of skills based, relearning how to live in the world, approach DBT offers.

I also think one of the things that can make people with BPD so difficult to deal with, in any context, is that, unlike, say, bipolar, it's chronic, rather than episodic. So they have no internal point of comparison, as far as their own behaviors and responses go, and there's no respite from dealing with their issues for others in their lives.

I don't think any of that is anyone's fault, or makes anyone a bad person, or anything like that. It just is.

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...it's chronic, rather than episodic. So they have no internal point of comparison, as far as their own behaviors and responses go, and there's no respite from dealing with their issues for others in their lives.

Which makes having the dual Dx of bipolar disorder and a personality disorder (NOS) such a challenge-- for me and the people I live with. An ex-employer of mine said once, "It's always something with you." (god, she's a snarky bitch) and it's true. I feel as if I spend almost every day battling something-- my mood, my response to stressors, trying to figure out what is a symptom of my mood disorder, what is being driven by my self hatred, etc. Add in that I physically can't tolerate most meds (clinically proven, not just whining), and emotionally can't tolerate most side effects, and it's not a wonder I go off the deep end sometimes.

/tangent

As for DBT-- I had a therapist trained in DBT, and we used it loosely in our weekly sessions, and it helped tremendously. I lost her, and after months of the wrong therapist, have another DBT therapist and I will be going to a DBT group (GAH- HATE GROUPS) weekly for six months. Maybe I can finally get sorted out enough that I can move forward. I had never heard that personality disorders could be temporary-- I thought that it was pretty much a lifelong affliction...

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Upate: Vanderk - I read a 20-page synopsis by Dr. Gunderson about BPD (online) I am so glad you recommended his writings -

Wow - there has been somecvhanges in how BPD is viewed, since I was diagnosed w/it years ago - maybe I should have checked Google, before I moaned on about it. Ah well - I live & learn!

The most surprising to me - is that it seems to have, in very many people, a relatively short duration? Like a few years, between the ages of young adult-hood to a few (5-8) years later? I mean yeah, people still need treatment for it, but still, I used to think it was considered "in-cureable" - and definitely life-long, which seems absolutely not true.

It was a very enjoyable and enlightening read. Yay for Dr. Gunderson!

I"ve (so far) briefhly glanced at Million's intergrated evolutionary theory on BPD - am delving into that further as soon as I can. Looks like interesting stuff. And the rest, too - thanks again for the enlightening reading recommendations.

-suzie

You're welcome. I'm glad to be of service to this community.

The duration of the condition is a big topic of debate. One of the big voices in the mood disorders realm, Akiskal, believes that BPD is not a personality disoder because it can be cured. Not so sure ot the 'cured' bit. And I believe he's a bit of a pharma whore. But I digress. I have seen more than a few folks "age out." Whether it's an exhaustion phenomenon or something else I dunno. I'm too old to quibble about it any more.

I'm a big fan of Millon. I really like the historical overview he presents. And, like him, I look forward to the day when the term "Borderline" is dismissed. It's not the slightest bit descriptive and it's become so bloody pejorative. I was disappointed not to see him included in the Personality Disorders workgroup for the DSM V. After his bad stint with the DSM III committee he probably steered clear.

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And, like him, I look forward to the day when the term "Borderline" is dismissed. It's not the slightest bit descriptive and it's become so bloody pejorative.

Exactly! On the borderline of what, exactly? Borderline of having a personality disorder? Borderline between human and animal? A personality disorder that is like Madonna's song "Borderline"? Gah! As I said earlier in this thread, I absolutely should know better, and yet I feel shame that I have a personality disorder, and relief that I wasn't pegged solely as having "borderline" personality disorder.

One of the worst parts of my recent hospitalization was the way the main pdoc kept referring to me in really insulting ways, such as, "a person like you" (ie. he insisted my main problem is BPD and that because of that, nothing I said could be taken seriously).

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Borderline between neurosis and psychosis. Blech. I'm not a fan of the name, personally.

There are a lot of therapists, at least in my area, that won't take people who have dx's beyond anxiety disorders. A lot seem to deal with "change of life issues" and "spiritual crises" and all sorts of other vague things. It's not just BPD, though BPD probably has the most stigma attached to it.

As someone who has worked with PD's, I think one of the hardest things to deal with is a lack of mutuality. You give a lot. And sometimes it doesn't feel like you get anything back. There's no interest in your life, it's all about the current crisis. I don't let it get to me, but I see a lot of folks get burned out that way. It's human nature to want some level of give-and-take, even in therapeutic relationships. Whether or not that's OK...I don't know. It's the job of the mental health professional to be "the rock," but at the same time, it's human nature to expect the other party to give on some emotional level.

Not sure if I'm making sense.

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If it makes you feel any better I don't read you as BPD at all. You seem very kind and capable, and a good addition to the boards. In the end, stigma's don't help, treatment does.. and I think we can agree that everybody here need treatment of one kind or another.

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  • 3 weeks later...

As someone who has worked with PD's, I think one of the hardest things to deal with is a lack of mutuality. You give a lot. And sometimes it doesn't feel like you get anything back. There's no interest in your life, it's all about the current crisis. I don't let it get to me, but I see a lot of folks get burned out that way. It's human nature to want some level of give-and-take, even in therapeutic relationships. Whether or not that's OK...I don't know. It's the job of the mental health professional to be "the rock," but at the same time, it's human nature to expect the other party to give on some emotional level.

Not sure if I'm making sense.

Makes a lot of sense to me - and has played a large part in my recovery. My treatment team refers to themselves as "my other family" and there is definitely give and take in the relationship. I refer to one of my GP's as my second mum, and my psychiastrist calls her patients her kids - and I'm expected to behave because if I don't I'm hurting my family and we've been together too long for that to be acceptable.

It has some great benefits. One of the reasons I won't overdose is solely because of the reaction I will get from one of my doctors - she's made it quite clear that emotionally she wouldn't be able to handle it if I did that again.

I actually think that it's unavoidable for those who suffer from severe abandonment fears. The normal line in doctor/patient relationships leaves me too scared that they are going to abandon me when I need them. They have to allow me closer, and to do that they have to open up to me as well, and I have to take responsibility for the fact that I need that close relationship and what it costs them to give it.

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I have BPD. My six year professional relationship with my psychiatrist is formal, I couldn't even call him by his first name. I couldn't imagine being thought of as his kid. He has remained genuine, thoughtful and constant in his treatment of me, despite my borderline tendencies, and for that I am grateful. I have got a lot from our time together despite not having that sort of closeness with him.

I worry about the emotional fallout and lines crossed of a therapist feeling they are there in a familial or friendship capacity, when it must be quite hard to make sound judgements and accept the patient for who they are in that sort of set up. Therapy to me, is a period where you form a kind of relationship built on trust and acceptance that allows you to move on and build real relationships in life. If I had been able to think of my last tdoc as a mother, I'd never have finished working with her, she may not have been as detached and able to see my issues.

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I guess what works for some, doesn't work for others. I have a more detached relationship with some of my therapists than I do my doctors... I find those relationships help me a lot less than the relationships I have with my doctors. Being "family" means I am accepted for who I am unconditionally - despite my borderline tendancies. My DBT therapist is definitely outside of that 'family' and I find she isn't nearly as helpful because I find it difficult to trust someone who keeps the distance she does.

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Borderline between neurosis and psychosis. Blech. I'm not a fan of the name, personally.

There are a lot of therapists, at least in my area, that won't take people who have dx's beyond anxiety disorders. A lot seem to deal with "change of life issues" and "spiritual crises" and all sorts of other vague things. It's not just BPD, though BPD probably has the most stigma attached to it.

As someone who has worked with PD's, I think one of the hardest things to deal with is a lack of mutuality. You give a lot. And sometimes it doesn't feel like you get anything back. There's no interest in your life, it's all about the current crisis. I don't let it get to me, but I see a lot of folks get burned out that way. It's human nature to want some level of give-and-take, even in therapeutic relationships. Whether or not that's OK...I don't know. It's the job of the mental health professional to be "the rock," but at the same time, it's human nature to expect the other party to give on some emotional level.

Not sure if I'm making sense.

You are making sense, but I have to disagree. By definition, the therapeutic relationship is not mutual. It's about the patient, not about the therapist. The therapist isn't going to be getting anything back. It's supposed to be about whatever's going on with the patient, because it's not a friendship, it's therapy.

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I have BPD. My six year professional relationship with my psychiatrist is formal, I couldn't even call him by his first name. I couldn't imagine being thought of as his kid. He has remained genuine, thoughtful and constant in his treatment of me, despite my borderline tendencies, and for that I am grateful. I have got a lot from our time together despite not having that sort of closeness with him.

I worry about the emotional fallout and lines crossed of a therapist feeling they are there in a familial or friendship capacity, when it must be quite hard to make sound judgements and accept the patient for who they are in that sort of set up. Therapy to me, is a period where you form a kind of relationship built on trust and acceptance that allows you to move on and build real relationships in life. If I had been able to think of my last tdoc as a mother, I'd never have finished working with her, she may not have been as detached and able to see my issues.

Yep. I could go on, ad nauseum, about this issue. But I won't. Titania simply nailed it. Two small paragraphs that bear continual re-reading.

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I'm not Bpd but I have to say, there's a difference between feeling affection towards and love towards ones providers and actually considering them family.... I'd say I fall somewhere in the middle.

My therapist has been my therapist since I was 13 and I'm 36 now, I definitely consider her my 'spiritual mom" on some levels, but I say that kind of tongue in cheek. She's never been anything other than professional and supportive towards me in every way, and we don't do motherly things, she's just taught me so much about how to be a functining memeber of society.

My favorite psychiatrist ever I felt kind of a fatherly affection towards, but again, we really never crossed that boundary line in the slightest, he just was adorable and kind towards me and never anything other than solicitous and kind, and really one of the best psychiatrists I've ever met. The feelings were more on my side, while he admired me and liked me a lot, I'm sure he never considered me in the status of one of his 'kids".

My current pdoc is professional and kind and while nothing will ever replace the affection I felt towards THAT particualar pdoc (some people you just click with) he's great at his job, knows his meds shit, and manages me very well.

I think being in a different place with my disorders helps. I don't need the kind of support and assistance I did and while I get the sense that my pdoc gives a shit, he's not at all the fatherly, nurturing type in any way, just sort of a good person to bounce ideas off of.

I think I'd feel uncomfortable and burdened if my PROVIDERS actually felt that I was somehow a member of their family and like professional lines were being crossed, I'd much prefer to keep the transference on my side of the street, as it were.

Anna

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I worry about the emotional fallout and lines crossed of a therapist feeling they are there in a familial or friendship capacity, when it must be quite hard to make sound judgements and accept the patient for who they are in that sort of set up.

I think I'd feel uncomfortable and burdened if my PROVIDERS actually felt that I was somehow a member of their family and like professional lines were being crossed, I'd much prefer to keep the transference on my side of the street, as it were.

Totally agree with both of you. I have gigantic "attachment issues," don't fit criteria for BPD but have been dx'd that way in the past. I've gone on and on before here about how attached I am to my pdoc, I have a ton of absurdly heavy transference stuff going on, huge overwhelming longing, desire for "more closeness," impossible fantasies, constantly obsessing about what she thinks of me, etc. (sigh)

My pdoc maintains perfect professional boundaries. She's warm and funny and human, but would never take on the role of a family member or friend. I won't deny it, of course part of me wants her to cross those boundaries, to be my friend and mom and sweetheart and everything else. But I know she never will step into any of those roles in any way, and I've finally understood how important that is.

All that "stuff" is on my side to deal with. I do have the freedom to drop the stuff and move on from it, if I ever can. I don't have the slightest bit of responsibility or burden of keeping up a role for her sake. It's okay for me to have all these huge feelings about her... AND it's okay for them to go away or change, too. She will accept me either way. This is unbelievably liberating for me.

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Borderline between neurosis and psychosis. Blech. I'm not a fan of the name, personally.

There are a lot of therapists, at least in my area, that won't take people who have dx's beyond anxiety disorders. A lot seem to deal with "change of life issues" and "spiritual crises" and all sorts of other vague things. It's not just BPD, though BPD probably has the most stigma attached to it.

As someone who has worked with PD's, I think one of the hardest things to deal with is a lack of mutuality. You give a lot. And sometimes it doesn't feel like you get anything back. There's no interest in your life, it's all about the current crisis. I don't let it get to me, but I see a lot of folks get burned out that way. It's human nature to want some level of give-and-take, even in therapeutic relationships. Whether or not that's OK...I don't know. It's the job of the mental health professional to be "the rock," but at the same time, it's human nature to expect the other party to give on some emotional level.

Not sure if I'm making sense.

You are making sense, but I have to disagree. By definition, the therapeutic relationship is not mutual. It's about the patient, not about the therapist. The therapist isn't going to be getting anything back. It's supposed to be about whatever's going on with the patient, because it's not a friendship, it's therapy.

Mutuality in terms of a professional relationship is a little different than a friendship. By it I meant the recognition that both parties are human beings, with real feelings. As a professional, you do get something back from your clients - respect, empathy, understanding of boundaries. Whether or not that's right, I don't know. I just know it's hard for people to shut the part of themselves that wants that understanding off.

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