This is the Truth About Personality Disorders

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From The Independent: Armchair diagnoses of personality disorders are a rising trend, from speculations that President Trump has narcissistic personality disorder to viral articles about discerning whether a friend, supervisor, or partner is a psychopath. In reality, the notion of personality disorders is often based on gender roles and conformity, and discounts consistent evidence that personalities change over time.

“In recent years, there has been increasing interest in the idea of narcissism and ‘narcissistic personality disorder’. BPD is a diagnostic category populated overwhelmingly by women, narcissism more with masculinity. Just as women with a diagnosis of BPD are characterised as having a reckless relationship with emotions they could or should be able to control, men with narcissistic traits are seen both in the public imagination and psychiatric nosology as too self-centred, too lacking in empathy, too obsessed with conquer at all costs. These character sketches, so influenced by the mores and gendered norms of what is acceptable at any given time, are not backed up by any scientific evidence. They seem immune to our newfound capacity to celebrate difference, and look to the back-story behind any given personality. They derive from a time when personalities were more stable because people’s lives were more closely tied to the social bonds of a given local community, and when conformity was privileged.

Modern ideas of the ‘protean’ self who can explore, play and self-create are absent from the discourse of personality disorders, despite consistent evidence that all our personalities are a work in progress, shifting form across adulthood. Enter most personality disorder services as a patient today and one would think one has an affliction for life, despite robust evidence that more than 50 per cent of people diagnosed with BPD, for example, no longer meet the criteria after five years. Being super messed up and at times destructive for a few years is a passing stage for many of us in early adulthood. To have this stage rubber-stamped with the words ‘personality disorder’ can be incredibly traumatising, keeping one entombed in the worse period of one’s life.”

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13 COMMENTS

  3. I’m sorry, but just because a diagnosis isn’t pleasant doesn’t mean it’s not valid. It doesn’t stop people from being themselves and all that. People who receive diagnoses have come for HELP. People who don’t want help are free to “self-create” and all that. But there is actually a TON of evidence surrounding personality disorders, particularly borderline. Women tend to have it more often, yes, but I know a man with it, and it’s textbook. That’s the point: IT’S TEXTBOOK. It’s always textbook. That’s what a diagnosis IS. And the symptoms bother people and hurt them and ruin their lives, which is why they seek help for them. To say that they the disorders don’t exist is to deny the massive amount of evidence that they do, most of which is RIGHT IN FRONT OF PEOPLE WHO HAVE THESE DISORDERS.

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    • Hi sggriff!

      I was going to welcome you to this website, but see you have made a few comments in the past. Most of these ‘disorders’ really aren’t. They are simply descriptions of people’s behaviors. Now my wife has d.i.d. and I’ll stand by that and say it’s a disorder because of how the ‘hard-wired’ dissociation affects the person’s ability to function and integrate all aspects of one’s self into something semi-functional. And what I have learned as I helped her heal (and undo that ‘hard-wired’ dissociation) is that more than likely, most other ‘disorders’ really are just varying degrees of dissociation that may not rise to the level of those with full-blown d.i.d. but I see the hallmark markers of her issues in the other ‘disorders’ just to a lesser degree.

      Anyway, I understand you will probably disagree based on your past comments, but I wish you well, and maybe there’s a tiny kernel of our experience that might help you to reconsider your position.
      Sam

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    • No one is suggesting that people don’t act the way BPD and others are described in the DSM. We’re only saying that it’s a DESCRIPTION, not a DIAGNOSIS. The “diagnosis” (though I don’t think that’s the right word at all) for most BPD people should really be childhood abuse and neglect, because it’s present in almost all cases. This way, we’re looking at actual causes instead of blaming victims. Saying someone “has BPD” places the problem within the person who was abused, and lets the parents and/or cultural institutions and/or other perpetrators off the hook for their destructive behavior.

      You say that people with these “disorders” come for help. So I guess there are two questions: one, is it really OK to “diagnose” a person with a “disorder” that is simply an observation of how someone acts and has no connection to any kind of objective physical cause or measurement, just because it allows them to get insurance reimbursement? And two, is “diagnosing” someone with BPD actually helpful TO THE PERSON who is diagnosed?

      I think on the latter, the concerns are pretty obvious. As a person who has worked in the field, I can tell you that people with a BPD diagnosis are commonly feared and even reviled by mental health “professionals” in the system. People find their behavior frustrating, and the label BPD allows them to blame the client for his/her frustrating behavior and allows clinicians to act out their anger punitively with the support of their fellow professionals while denying any kind of real connection or empathy with the client. It also often disqualifies a person for therapeutic support, since “BPD” is considered by some to be “untreatable.” So I think the answer to the second question is a resounding NO in most cases.

      As to the first, I again ask you if it makes sense to “diagnose” someone with a description? To get more concrete, would it make sense to diagnose someone with “a rash” and leave it at that? A rash is an indication that something might be wrong and that further investigation into causes is needed. If we diagnosed a rash like we do BPD, we’d give everyone topical steroids. It would work for some cases, would do nothing in others, and make it worse in yet other cases. Some cases would really be caused by poison ivy, others by measles, others by syphilis. The ones with poison ivy would resolve better with the steroids, the measles would be unaffected. The syphilis rash would go away, too, but the person would later die an excruciating death as the bacteria ate up his/her brain. We’d say that the syphilitic person was “treatment resistant,” and no one would ever suspect that the problem was with the diagnosis itself, or rather the pretension of diagnosis that prevents actual diagnosis from ever happening.

      It would be a lot easier for people to be “diagnosed” with “Badly mistreated by parents and learned coping measures that are ineffective in current life” than “BPD.” They could still get help without someone blaming and denigrating them for having what is a very common reaction to very poor conditions in early life.

      Hope that clears things up a bit!

      —- Steve

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      • A lot of things in the DSM manuals might have some validity if they were not considered lifelong brain diseases. (None out of three is bad!) Rather they could be viewed as clusters of negative, counter-productive thoughts and behaviors that the person can change–with or without counseling.

        In that sense you could say I had BPD years ago and cured myself by changing the way I viewed myself and those around me. Including the men I dated. I have chosen not to date the past three years. That has helped me immensely. If I were truly BPD wouldn’t I be swinging from one relationship to another like monkey bars in a jungle gym?

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        • Oh, and if TF wants to rant about how he doesn’t need to change, I’m assuming folks who seek out counseling want to change. No sense making TF and others go to sessions against their wills since they’re happy with the way things are and involuntary counseling is unethical/abusive.

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  4. Just popping on my pedantic hat here but… BPD is not a description. It’s a diagnostic category. It’s a noun. An improper noun!

    Are we permitted to diagnose things for which there are no tests, numerous conflicting aeteologies, and broad variance of symptoms?

    Short answer: yes.

    Conventional medicine does it all the time.

    That is why I can tell people I have tinnitus and no-one blinks an eyelid. It’s similar to hearing voices, except the voice, as such, is mono-tonal, high-pitched, and continual, without pause. All that changes is its loudness. And the louder it is, the more it affects me, yet no-one else can hear it or test for it, or tell me where it’s coming from.

    The noun BPD is qualified by the descriptors. I agree it’s acceptable to embrace the descriptors, but disagree in that it’s a little clumsy to reject having a noun. Although I accept we need better nouns, those in current use have replaced other, even worse nouns. Like “hysterical”, “witch”, “femme fatale”.

    Schizophrenia too is a cock-up of a noun, but it replaced other nouns such as “demon possessed” and “heretical”.

    Not sure anyone has come up with substantially better nouns. Lots of defeatists though… “The nouns don’t matter!” and “Abandon all nouns!”…

    When really, all we need is a bit of imagination, a little bit of freedom to be creative…

    Of course, a person with BPD will be called a whole gamut of nouns, by professionals and non-professionals… mostly by non-professionals, if truth be told. Of the ;beep! variety. People that meet the descriptors of so-called BPD will be called by others throughout their lives every name under the sun. And, if truth be told, its not as if these terms would be improperly applied, in context. They’d beused for what they were intended for.

    Which really falls back into maybe this neurosis over psychiatric terms being a bit of a waste of time and energy. Given that the preferred (in real life terms) alternatives are always going to be way worse. They are way worse, certainly in polite company.

    Agreed with the thrust of the article though. And I have far more experience of people suffering with BPD than most professionals, due to having close relationships with a number of them. I’m over-qualified in this area. 😉

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    • These three diagnoses [somatization disorder, borderline personality disorder, and multiple personality disorder] are charged with pejorative meaning. The most notorious is the diagnosis of borderline personality disorder. This term is frequently used within the mental health professions as little more than a sophisticated insult.

      – Judith Herman, Trauma and Recovery

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      • It may be a “sophisticated insult”, and there may be reasons why insults are not allowed, even sophisticated ones, but it is at least not a death-sentence, as some other conditions are interpreted as — even sophisticated death-sentences — given that BPD is something eminently recoverable from, particularly for the significant minority who can attest to childhood trauma.

        For many sufferers the pseudo-medical name-calling is the first time in their lives that someone with the power to help them has taken them seriously. They are used to being name-called — because their behaviour can be extremely challenging — so no wonder the hypersensitivity.

        A very vocal few despise the term. But then the majority that wecome the term have no real motivation to defend it as vociferously as others wish to rip it to shreds.

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  6. Something to consider. If someone gets a diagnosis of BPD by one psychiatrists, but the next psychiatrist tells this person that they have nothing that is diagnosable, what should we go with? The BPD, or the nothing. Perhaps we should keep going to new doctors until the majority tells the person they have nothing? and will that make it a fact.

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