Thread by @Keirwales

For #BPDawarenessMonth let's put a different answer out there to the question:

"What is BPD?"

There's some other threads on this subject on twitter today, but this one is a bit different...

These are the criteria. To get a diagnosis you need to tick 5/9

But you're probably thinking "if someone has criteria 1-5 and another person 5-9 they have the same diagnosis while only sharing 1 characteristic!"

You might also think "who gets to decide if my anger is appropriate?"

Most people who meet the criteria for 1 personality disorder meet the criteria for another. We could then think "excellent, we have fit these problems into 2 discreet diagnoses".

We might also think this way of classifying things is an absolute mess.

I'm going to suggest that if you've been given the diagnosis of BPD you probably meet 3 criteria

1 - You cope with things in ways that can hurt yourself.

2 - You've felt that life isn't worth living and either acted as if that's true or told people how you feel...

3 - You're female.

BPD is diagnosed 3:1 female to male and while I see that statistic a lot, it's closer to 10:1 in my experience.

Up to 80% of people who are given this diagnosis have lived though some form of abuse.

I've worked in mental health for 20 years and have never met 1 person with this diagnosis whose difficulties didn't make sense in terms of their life experiences.

"But 20% don't have trauma. Ha!"

Marsha linehan, the creator of DBT spoke of her life always being criticised for who she was, having no recognition for what she was good at and constantly getting the message she was wrong/bad. No one hit her or physically hurt her.

She went on to break the record for being kept in isolation at her local hospital due to her recurrent self harm and suicide attempts.

Let's think less disordered personalities and more "Why does this make sense?" 🤔

We might think about the criteria too...

Frantic efforts to avoid abandonment

You were probably abandoned and suffered as a result

Unstable/intense relationships

You probably had some role models who taught you people are not to be trusted and that relationships can cause harm

Unstable sense of self

You might have had to spend a lot of time pretending you were someone you weren't. You might have had to act in ways that pleased others, regardless of how it impacted on you

Impulsively

You might find that what you feel is intolerable and that you need to do something immediately to manage how you feel

Feeling Suicidal

You might have had to put up much that has made you feel life isn't worth living.

Reactivity of mood

If you've lived a life with lots of threats in it, you might need to look out for threats all the time. That will change a mood pretty quickly

Chronic emptiness

I always find this too vague but... some experiences might have been so bad you just had to totally cut off from them. You might spend a lot of time feeling numb.

Inappropriate anger

You probably have a lot to be anger about. You might have had role models who taught you that huge displays of emotion were how to communicate with people.

Paranoia/dissociation

Again, if you've been hurt a lot it makes sense to be on the look out for that. If reality has been unbearable it makes sense that slipping out of it became a way to cope.

Now all the above could be seen as a personality disorder, but they could also be seen as understandable adaptions to adversity that have helped people survive. I prefer to help people understand themselves as the latter.

Emergence used the definition "the term used within services to describe longstanding difficulties in how an individual thinks about themselves and others and consequently how they behave in relation to people". Thats better than the criteria for me too.

There's a lot of stigma around this diagnosis and sadly it's strongest in mental health professionals (although maybe the Depp/Heard trial might change that 😬)

Because they don't get prepared to work with people with these difficulties, they might treat you like you have a disordered personality.

I think a lot of "personality disorder" comes from staff who get their self esteem from caring for others meeting people who have learned those who are supposed to care can't be trusted.

There's a big market out there that's interested in helping people treat people with this diagnosis like dirt. You'll find plenty of blogs and books telling people to to avoid them or be very wary in their relationships.

Given that our relationships are the only things we can use to help, setting the scene with the idea that this method is already toxic is really unhelpful.

There are a load of therapies with an evidence base for helping people who get this diagnosis and people can be helped. I've worked with people who couldn't hurt themselves enough who now work as professionals in mh services. Change can come.

You can advocate for people who have this diagnosis by using the NICE guidelines for BPD. They describe what services should provide (you may notice services bear little resemblance to these) and it's what you can fight for.

Finally...no one goes into a caring profession thinking "what I really want to do is make the lives of people who have lived through abuse just a little bit worse" but that can happen.

If people pathologise less and understand more they can keep the empathy they need and be the practitioners they want to be. Those who get this diagnosis have suffered enough. They can be helped and we are the people who are supposed to do that.

*other opinions are available.