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The Borderline Personality Disorder or BPD

The term BPD is a catch-all term for hard to deal with patients that do not belong in the classification of other Personality Disorders. The use of the label BPD is used so frequently by the psychiatric communities that the term could probably be used as a whole category of mental illness.

patient in hospital.jpg (60304 bytes)The odds are that sometime in your life you have known someone who thought that you were the greatest, smartest, best looking person on earth and in the course of 10 minutes changed their belief to thinking you were the most depraved scum of the earth that they ever new. And they left you wondering ,"what did I say"?

Now you’re probably be thinking, "you must be talking about my ex girlfriend" Actually I’m talking about a mental illness that is called Borderline Personality Disorder.

Sometimes they’re the nicest most conscientious person you know, but with a moments notice, they are ready to explode, self-destruct or kill you for the smallest of perceived wounds.

BPD patients have had a pretty messed up childhood. You could  say that they’re not responsible for their behavior, almost. When you’re growing up and you’re taught to hate yourself, that experience will indefinitely show up to sabotage your relationships during your adulthood. It is a matter of degree to how much psychological damage occurred during the patients childhood and whether this damage would cause severe enough personality dis-integration to warrant the diagnosis of BPD.

To be diagnosed as having BPD the patient must meet the "diagnostic criteria" to warrant the label. The following is the diagnostic criteria for BPD. This criteria is taken from the DSM-3:

     A: At least five of the following are required:

1) impulsivity or unpredictability in at least two areas that are potentially self-damaging, e.g., spending, sex, substance use, shoplifting, overeating, or physically self damaging acts
2) a pattern of intense unstable interpersonal relationships, e.g., marked shifts of attitude, idealization, devaluation, manipulation (constantly using another for one’s own ends)
3) inappropriate intense anger or lack of control of anger, e.g., frequent displays of anger, constant anger.
4) identity disturbance manifested by uncertainty about several issues relating to identity, such as, self image, gender identity, long term goals or career choice, friendship patterns, values and loyalties, e.g., "who am I", "I feel like my sister when I am good"
5) affective instability: marked shifts from a normal mood to depression, irritability or anxiety, usually lasting a few hours and rarely more than a few days, with a return to normal mood
6) intolerance of being alone, e.g., frantic efforts to avoid being alone, depressed when alone
7) physically self damaging acts, e.g., suicidal gestures, self mutilation, recurrent accidents or physical fights chronic feelings of emptiness or boredom
B: If under 18, does not meet the criteria for Identity Disorder.

Is a Psychiatric Label in the Patients Best Interests?

I would guess that over half of the people that read this description would say that it describes themselves. I would also make an educated observation that most psychiatrists and psychologists that label a patient BPD do so because it's just the best fit. The patient could go to a completely different therapist and be labeled a totally different personality disorder e.g. Narcissistic, Avoidant or possibly even  as having an Antisocial Personality Disorder. It  is not uncommon be labeled in a different classification ( A different DSM IV Axis)   like Schizophrenic or Bipolar Disorder. Different therapists come to totally different conclusions.... regularly. It is also quite common for a patient to have multiple psychiatric labels.

The point is, that there is no truly accurate way to diagnose a mental illness. (Most) Mental Illnesses do not have a biological origin, so it is not possible to take a blood sample to diagnose the illness. Instead the therapist just observes the patient's behavior and decides what psychiatric label he or she thinks fits the best. Another problem with this that the insurance company won't pay the patients hospital, Doctor, medical or prescription bills until there is a psychiatric label. This is a very powerful incentive for a therapist to label the patient. The therapist then tells the patient that it is in the patients best interest to have this label because after it is assigned the patient can be directed toward the correct type of therapy and treatment. Unfortunately, for the patient, who now has to walk around with this new label of being mentally ill, these types of therapy are completely determined by the whims of the therapist. When a patient is diagnosed with a bacterial infection the patient is usually prescribed a specific antibiotic to clear up the infection. When a patient is diagnosed with BPD, the therapy may or may not include psychotropic medicines such as antipsychotics or antidepressants and sometimes it will only include verbal therapy. To make my point very clear, there is no specific treatment nor or is there a cure for BPD or any other mental illness for that matter.

At the very best the patient is provided with enlightening insights and possibly prescribed an antidepressant that actually increases the patients quality of life instead of just dulling his or her spontaneity and emotions. Again, unfortunately for the patient, psychotropic medicines such as antidepressants, more often than not, create a feeling of "unreality" and remove the patients vitality and feelings of aliveness. In addition to the fact that the label does not warrant a specific treatment, there are much worse consequences to being
labeled mentally ill.

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