In this blog I am going to write about just some of the issues within the NHS to do with the various Personality Disorder diagnoses, that affect how these illnesses and the people with them are viewed both by professionals and themselves. If you have any other experiences of problems like these that I haven’t mentioned please do comment below as this is a hugely important topic. Within the psychiatric body I believe there are many contradictory, incorrect and ultimately harmful opinions surrounding Personality Disorders and as a person diagnosed with one I have found the process of navigating my way through the bias and misunderstanding towards a solid, evidence-based understanding of what my and other PD diagnoses mean very difficult…Let alone how I’d managed to end up with a label that seems to suggest my very character was flawed enough to be ‘disordered.’ For more information about the different diagnostic cluster and Personality Disorder diagnoses click this link
And that introduction brings me to my first point, the name they are given:
What first strikes you about that label? Is it not, at very least, mildly offensive? This key concern has the potential to be severely damaging considering many people being diagnosed with PDs, particularly clusters B and C- Borderline, Histrionic, Aviodant and Dependant, may already see themselves as weak, valueless and without identity. Part of these disorders is to feel these things and feel the need for the approval of others also, so then being told by an authoritative figure, what could be understood as, your personality/character is the reason behind the immense suffering you’re going through….surely that is a recipe for disaster? What could make a person feel any more hopeless than that? ‘Essentially, Miss X you’re character is the issue, sorry about that.’ I believe an alternative name would be more appropriate and would reduce the chance of self-stigma and despair upon diagnosis. I have come across terms such as ‘Complex Needs’ and ‘Persisting Symptoms’ being used instead but, really, one needs to be developed by professionals.
Then to expand on this further ‘Borderline Personality Disorder’ is a label many have flagged as being utterly misleading. Is it almost a PD, what is it on the borderline of exactly? Originally, the answer to this was neurosis and psychosis, however, this has now been disregarded. Personally, I prefer the British term Emotionally Unstable Personality Disorder, as harsh as it sounds- it ‘does what is says on the tin’ (unfortunately.) I’ve also heard Emotional Dysregulation/Intensity Disorder being used- these clearly explain much of the issue, however, within the mental health world the Borderline still rules the day and very few would recognise those alternatives. The thing to stress at this point is that these diagnoses are just, like any other illness, a label- a ticked box for those who describe themselves as having the majority of these symptoms. That doesn’t mean they are all alike nor does it mean they are different from who they were pre-diagnosis and, as always, the person should be treated not the diagnosis and the person should be treated with respect.
My second point is that many still regard personality issues as solely ‘behavioural.’ This is, again, misleading and leads to untrained (or badly trained) professionals seeing those diagnosed with PDs as ‘causing problems for no reason’ and just ‘needing to take more responsibility,'(both of these are from personal experience.) This is torturous to listen to, imagine hearing this whilst hopeless and in so much emotional pain you feel the need to self harm and/or take your own life- plus, from the studies I’ve seen, this view is factually incorrect. According to Dr Marsha Linehan’s widely accepted BPD bio-social theory, there is a biological disposition, a genetic factor, to developing BPD and since then studies have shown brain differences in those with PDs, with various areas underdeveloped.
Furthermore, regarding Cluster A Personality Disorders, symptoms can be longstanding magical thinking, delusions, paranoia and disorganisation/catatonia, all also regarded as common signs of schizophrenia. Schizophrenia is seen by most as ‘a disease of the brain likely relating to levels of dopamine,’ so why then are the same symptoms, when given a different label that represents how they effect every area of that person’s life, seen as purely behavioural? Psychiatrists and psychologists need to come together to address this issue. And this is not an individual case. Concerning Borderline or Emotionally Unstable Personality Disorder, many don’t even see the Disorder as an illness. Moreover, aids to recovery are extremely set in stone.You go to a doctor with a diagnosis of BPD and the first thing they are likely to say is ‘according to NICE Guidelines (whenever you here this start to a statement cover your ears: my hatred for NICE is deep-seated) medications will be useless to you,’ despite this many, myself included, are given mood-stabilisers, antidepressants and anti-psychotics. ‘Only therapy can help you’ (which is often not even offered but that’s a blog for another time.) Now go to a doctor with Bipolar Affective Disorder Rapid Cycling or Mixed State on your medical notes, and this time, ‘medications will be the only solution for you- trust me, I’m a doctor.’ These illnesses are on a similar spectrum, mood instability-wise, as this psychotherapist tweeted:
Every case is unique but most with either disorder will need a complex combination of both therapy and medications but it is so much easier for health professionals to resort to black and white ways of thinking (those with any of knowledge of BPD will see the irony in this.) And that brings me onto my final point- like Bipolar Disorder and Schizophrenia, Personality Disorders are serious mental disorders. This can be seen, simply, in the figures. About 60% of those with PD diagnoses will have a comorbid psychiatric disorder. 1 in 10 people with BPD die by suicide- giving it one of the highest suicide rates of all mental illnesses. BPD alone accounts for an estimated 20% of all hospitalisations worldwide and unfortunately there aren’t statistics for other PDs but it is considered to be high. Furthermore, up to 90% of all prisoners in a recent global study had some variant of PD. These disorders, by definition, have to be persistent and debilitating. And as a result of this, problematic and costly to society- taking them as a joke or with any less severity than is the truth will not be helpful to anyone. This does not mean recovery is not possible, by any means, but it does mean recovery by learning to manage and treat the symptoms is very hard work both for the individual and the professionals working with them. Therefore, the UK needs to catch up with Europe, North America and much of Africa in recognising it for what it is, a ‘Serious Mental Illness,’ both in literature and on the frontline among policing, nursing, social care, psychiatric and psychological professionals. And all these issues affecting people living with a PD, and their carers, must be addressed if the country, as the government said in 2003, is truly treating Personality Disorder as ‘No Longer a Diagnosis of Exclusion.’