Personality Disorders Largely Being Treated Inappropriately by Psychiatrists

Rob Wipond
34
426

Psychiatrists are giving drugs to most people with emotionally unstable personality disorders outside of the best-practice clinical guidelines, according to a study in the Journal of Clinical Psychiatry. And an accompanying editorial stated that the reason is because “therapy takes time.”

The researchers performed a cross-sectional survey of self-selected psychiatric services, and found that of 2,600 patients with a diagnosis of personality disorder, more than two-thirds (68%) had a diagnosis of emotionally unstable personality disorder (EUPD). Nearly all of these (92%) were being treated with antidepressants or antipsychotics. “The use of psychotropic medication in EUPD in the United Kingdom is largely outside the licensed indications,” concluded the researchers. This was a particular concern, they added, because the practices aren’t often systematically reviewed and monitored, “so opportunities for learning may be lost. Treatment may be continued long term by default.”

“(I)t is now known that specialized treatments such as dialectical behavior therapy and mentalization-based treatment can be helpful for most cases,” stated the accompanying editorial. “Although these more specific psychological treatments are known to be efficacious, they are not readily available. The reason is that therapy takes time and is expensive in human resources. This leaves harried clinicians with an inadequate set of options. The easiest choice is to focus on pharmacologic therapy for target symptoms rather than the personality disorder as a whole.”

The editorial argued that the problem may be even more widespread than found in the study, and stated, “Clearly, psychiatrists need to receive better education about evidence-based treatments for severe personality disorders. However, much of what they think they know is filtered through a climate of opinion shaped by neurobiological models and psychopharmacologic options.”

Paton, Carol, Michael J. Crawford, Sumera F. Bhatti, Maxine X. Patel, and Thomas R. E. Barnes. “The Use of Psychotropic Medication in Patients With Emotionally Unstable Personality Disorder Under the Care of UK Mental Health Services.” The Journal of Clinical Psychiatry, April 22, 2015, e512–18. doi:10.4088/JCP.14m09228. (Abstract)

Paris, Joel. “Why Patients With Severe Personality Disorders Are Overmedicated: (Commentary).” The Journal of Clinical Psychiatry, April 22, 2015, e521–e521. doi:10.4088/JCP.14com09441. (Full text)

34 COMMENTS

  1. “EUPD”, lol never even heard of it.

    I wouldn’t have thought they’d go with something so nebulous. Though if there’s a way to fix all the political correctness craziness going on in the Western world i’d be all for something that works and I agree clearly drugs aren’t working on these people.

  2. Part of the problem (and there are many here) is in the notion of “co-morbidity”. How psychiatry as a profession can pretend that one can take such faulty constructs as psychiatric diagnostic categories and them combine more than one to get something that has meaning and drives clinical decision making has always been beyond my own limited comprehension. But when you ask the prescribing psychiatrist why she is giving 5 drugs to this person who she has labeled with the term “borderline personality disorder’, she will most likely say that it is because she also has the diagnosis of “major depressive disorder” and/or “bipolar disorder, type II,” and/or, in a recent worrisome expansionist trend, “attention deficit disorder” etc., etc. The growth of each of these diagnoses typically directly follows the introduction of a newly patented drug or drugs that is reported to be effective for that particular “co-morbid” condition. This way of thinking has been widely promoted by the field -and exported to our primary care colleagues – for the past 30 years.

    • “Part of the problem (and there are many here) is in the notion of “co-morbidity”. How psychiatry as a profession can pretend that one can take such faulty constructs as psychiatric diagnostic categories and then combine more than one to get something that has meaning and drives clinical decision making has always been beyond my own limited comprehension.”

      You don’t have “limited comprehension,” the psychiatric industry’s current approach is completely unscientific and nonsensical – it’s the absolute opposite of what actual “care” is.

      The functional goal of today’s psychiatric system is to defame and tranquilize patients for profit, after promising to first and foremost do no harm. In other words, behave as complete hypocrites while torturing and stealing from other human beings. You actually want to help people, Sandra, which is why what’s going on in your industry doesn’t make sense to you.

      As my husband’s old boss used to say, “Get the f-ckin’ money,” at any expense to human life, is the only logical purpose behind today’s DSM based psycho / pharmaceutical industries. “The growth of each of these diagnoses typically directly follows the introduction of a newly patented drug or drugs that is reported to be effective for that particular “co-morbid” condition.”

      “This way of thinking has been widely promoted by the field – and exported to our primary care colleagues – for the past 30 years.” And the psycho / pharmaceutical industries have completely corrupted the entire mainstream medical community now. It’s really a shame.

      Medicine for profit doesn’t work, at least in a non-competitive corporatocracy. But at least we can psychoanalyze the corporations, who have been making a mockery of the medical literature for the past several decades, and garner insight into whether they are credible “people.”

      https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CB8QtwIwAA&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DZ4ou9rOssPg&ei=pQZKVc_GB_iCsQSo_YBw&usg=AFQjCNGEvG-Sj_UnbjQ8rCvMcB0kj2a0SA&bvm=bv.92765956,d.cWc

    • If you get 3 categories of lists with overlapping elements and you only need a small subset of them to fall into the category then you’ll end up with multiple diagnosis based on the same symptoms. It’s another point why DSM is ridiculous.

      In real medicine if you poison your patient with something that is not indented for a given illness there is some small chance you can sue and win. In psychiatry there is no chance since one can’t prove he/she is not “mentally ill” It’s practically impossible.

    • Smarter Than Your Psychiatrist Disorder is a real thing. I got diagnosed by a guy who was personally offended by my intelligence (I guess because he felt stupid). These people are allowed to judge others’ personalities – what a joke.

      • I received my wonderful “diagnosis” at the hands of a psychiatrists who thought that it was “interesting” that I’d just been told the day before about my sister’s murder. Then, when I told him that it felt like the world was coming down all around and upon me he jumped at me and screamed, “That’s stupid!”. I guess I was supposed to be as emotionless and cold and unfeeling about life as he was. He never knew how close he came to getting my fist between his eyes! These people can be emotionally and psychologically abusive to people and it’s supposed to be fine. I’ve had my fill of them up to my eyeballs.

  3. Psychiatrists are giving drugs to most people with emotionally unstable personality disorders outside of the best-practice clinical guidelines
    Pharmaceutical companies are giving away money to psychiatrists. Perhaps their is a method to their madness.

  4. “Emotionally unstable personality disorder?” I hadn’t previously heard of this UK version of borderline PD. It reminds me of the old school DSM personality disorder diagnoses. I checked my old lecture notes and found this list I compiled of personality disorders in each edition of the DSM that were subsequently eliminated from the next one.

    -DSM-I (1952): Emotionally Unstable PD, Passive-Aggressive PD, Inadequate PD, Cyclothymic PD

    -DSM-II (1968): Explosive PD, Asthenic PD

    -DSM-III (1980): Affective PD

    -DSM-III-R (1987): The following 3 examples of Personality Disorder Not Otherwise Specified: Immature PD, Sadistic PD, and Self-Defeating PD

    -DSM-IV (1994): Personality disorders “under study”: Depressive PD, Negativistic PD

    -DSM-5 (2013): After rejecting a radical new trait-specific method and a compromise hybrid model, the criteria remained unchanged from DSM-IV. Section III lists the hybrid proposal’s six personality disorder types; four of the DSM-IV’s 10 personality disorders are not listed among them. Two of the DSM-5 PD task force members resigned in protest and accused the task force of “display[ing] a truly stunning disregard for evidence.” (http://www.straight.com/life/ubc-prof-emeritus-john-livesley-and-dutch-expert-quit-dsm-v-committee-defining-personality-disorders)

    It’s hard to avoid the impression that the DSM personality disorder task force members are just making this stuff up.

  5. “emotionally unstable personality disorder (EUPD)”
    Also known as borderline. Or as sophisticated insult against victims of abuse.
    Stop drugging abuse victims and sop blaming them for it. The drugs are an absolute crime but the therapy is in some ways more insidious – it tells people they are wrong for who they are and their emotions are wrong and not adequate and so on. Personality is not an illness.

    Seriously, can we please abolish psychiatry already? I’m so fed up with this nonsense.

    • Just answered my own question: I believe this would be a textbook example of ‘intolerance.’

      I believe psychiatry is intolerant of personal differences and uniqueness in processes. That’s nothing but trouble. Intolerance leads to oppression and violence, which is what occurs within the culture of psychiatry.

      We want a tolerant society, not such rampant and dehumanizing personal judgments, thinly veiled as something ‘medical’ related. That’s a terrible example in society. Now everyone goes running around saying “you have a ‘personality disorder'” when they want to insult or demean someone. No thanks.

  6. While reading this I am wondering why MIA is reporting on a pseudo-label that has zero reliability and validity, the supposed symptoms of which are no more related to each other in nature than are the stars comprising the constellations which astronomers invent.
    The title of this article should be, “Human beings with varying degrees of serious but unique and unrelated emotional problems largely being treated inappropriately by psychiatrists.”
    That has a nice ring to it.

  7. Rob, thanks for your response. I actually think you are doing a great job given that you have difficult choices to make. I understand that the intent of this posting was education and useful information can be gleaned even if one doesn’t totally agree with the point of view of the source. In this case I should have directed my comment more toward the authors/viewpoint of the article, not against the one who chose to post it (you/MIA). Sorry!

  8. From Steven Goldsmith, MD:
    My profession’s wholesale medication of people diagnosed with personality disorders reflects fundamental errors in its models of illness, health, treatment, and what it means to be human. These errors have fostered the clinical and philosophical bankruptcy of contemporary Western mainstream psychiatry. The list of these errors is lengthy, so I will cite but a few:
    1) DSM labels and equivalent diagnostic epithets are abstract nouns and not reality. Instead, the reality that confronts psychiatrists consists of whole, unique individuals with their particular symptoms, strengths, histories, and quirks. No treatment can help people get well by targeting their diagnostic labels or the symptoms these reflect. Rather, treatment can help people get well only by strengthening the individual self-healing resources of the whole person. In other words, you cannot help someone get well by suppressing perceived sickness, only by utilizing strengths.
    2) This is a corollary to 1). Psychiatry views symptoms as the bad guys that must be eradicated or at least lessened. However, in most instances, psychiatric symptoms reflect actual or potential strengths, which must be respected and utilized to enable healing. As a result, those whose symptoms psychotropic meds suppress are often weaker, not stronger. And I haven’t even mentioned side effects yet.
    3) Psychiatry is wedded nowadays to a biologic reductionist model in which most symptoms supposedly reflect biological derangements that must be suppressed. Though obviously all human experience is associated with inner physiological/biochemical changes of some sort, there has never been any evidence–none!, zero, nada–that any of the major mental illnesses have a specific biochemical cause. Big Pharma has perpetrated this myth of “chemical imbalance” and psychiatry has swallowed it. (By the way, this is not a controversial assertion.) But we are more than our neurotransmitter molecules.
    4) For the above reasons and others, pharma-psychiatry is unable to cure almost anyone of anything (cure meaning the complete and lasting resolution of problems without the need for further treatment). If you doubt me, check the statistics. For instance, no more than 15% and perhaps as few as 3% of depressed people treated with antidepressants get well and remain well. (From the NIMH-sponsored Star*D study.)
    5) There are many non-pharmaceutical forms of treatment that can help people with psychological problems get well–CBT, EFT (Emotional Freedom Techniques), orthomolecular psychiatric treatment, chronotherapy (light and sleep therapies), Open Dialogue, EMDR, strategic and systemic psychotherapies, homeopathy, etc. (Over the years, for example, I have seen a number of people diagnosed with bipolar disorder, schizophrenia, OCD, etc. get well with homeopathy so they were able to get off their meds and remain well.) And DBT, while not curative, can be enormously helpful in teaching coping skills to some diagnosed with personality disorders as well as others.
    6) Unfortunately, most psychiatrists are not well-trained in any of these non-pharmaceutical methods and don’t utilize them. According to statistics, most psychiatrists no longer even provide competent psychotherapy worthy of the term.
    These grim tidings notwithstanding, the good news (as indicated in point 5) is that if you are suffering from a psychological disorder, it is quite possible for you to get well.
    Be well.
    http://www.greenpsychiatrist.com

  9. What’s strange is the idea that there is this distinct differentiation between Axis I (mood disorders) and axis II (personality disorders). The belief has been that axis I disorders such as depression, bipolar and schizophrenia can be “treated” while disorders such as narcissism, borderline tendencies and sociopathy are inherent, ego-syntonic and cannot be treated. So it used to be that folks with axis II disorders were not given drugs- because they can’t treat underlying personality traits.

    But now pretty much everyone is given axis I diagnoses- because you can bill insurance for them. So everyone labelled with a personality disorder also has a co-occurring mood disorder (as Sandra said). That way everyone gets paid. And that means people who are “borderline” and have experienced abuse, and trauma- are not only accused of having this awful borderline personality disorder but they are also pushed to take psych drugs to manage the severe emotional distress associated with trauma.

  10. The standard way to present the terms critically is to write ‘with a diagnosis of…’ and to use scare quotes – ‘schizophrenia’, ‘personality disorder’, ‘bi-polar disorder’ when the label is used in a news item heading.
    It’s not overly complicated and simply implies the validity of the term is being called into question.