The diagnosis of Borderline Personality Disorder (or as some prefer, Emotionally Unstable Personality Disorder’) appears to be a much debated issue at current. The diagnosis of personality disorder has been a topical issue for a long time, but with the upcoming ICD-11, this has increased
The idea that changing the title of the disorder would change the treatment of those labelled with this illness is questionable to myself; how can the ‘new’ diagnosis not then become stigmatised itself? It seems likely that the public, and more to the point professionals, would see any move to another diagnosis as “oh that is now basically people that had BPD” and the same narratives would develop.
As someone diagnosed with BPD I do not struggle that much with the title. The use of the word ‘personality’ is what I believe is the biggest issue that people have; that to deem a persons personality as disordered is not a true reflection of the issue, and being frank, insultive. I think that is a fair comment, and many believe your personality is something that does not change. The problem here lies in that. If your personality cannot change, does that mean someone with BPD cannot get better?
But here are my issues with that: Personality can change, surely, at least to some extent. And why is there this fixation on being able to get “better”, to be able to “recover?” Personality disorders used to be seen as pretty untreatable, and therefore why should the NHS plug money into treating something that cannot be cured? Well, actually, they should. Some people have problems that do not get better, but that does not mean that they should not be supported in managing their condition.
The fact is though, contrary to that point, that people with BPD can and do get better. There is plenty of research to back this up, particularly in the area of DBT. It just so happens that the NHS often does not provide this therapy.
Back to the use of the word ‘personality’. I have to go against what I said to some extent; it does affect me. When I have been in A&E for self-harm, or even somewhere entirely unrelated and I am asked what my diagnosis is, or why I am on the medication I am on, I used to pretend I did not have a diagnosis. These days I say it, but the words come out of my mouth painfully, and I feel sick to my stomach. In my head I am concerned about what the person in front of me is thinking when they hear those words. They probably do not know very much, and it is quite likely that they know the stigmatising beliefs that exist surrounding the disorder.
Is my personality disordered? If you asked me to describe my personality I would use words such as ‘caring’, ‘sarcastic’, ‘humorous’ and ‘weird’. I would not for one second think of my mental health. I would not say ‘unstable’, ‘destructive’ or ‘mentally ill’. It would not cross my mind. My issues are less to do with my personality and much more to do with my mood and emotions. In some senses that makes the label ‘Emotionally Unstable’ seem more fitting, but that also makes you sound like you are overly hormonal and a mess (being honest). I once read about the use of the term ‘Emotional Dysregulation Disorder’. I genuinely believe that is more fitting. Living with BPD looks and feels a lot like someone who experiences Bipolar, except your mood changes unbelievably fast, medication is much less useful and you are more likely to have a history of trauma.
I do believe that ‘Borderline Personality Disorder’ and ‘Emotionally Unstable Personality Disorder’ carry a heavy amount of stigma. I do believe that there are better names, and I do believe that issues with personality are not at the core of this illness. But is the name the issue? No, not really. I can get over the name. I just cannot get over the responses it invites. The issue here is the way in which people living with these types of issues are almost blamed for the way they are. Not by all, but by many.
There are many problems within this; far too many to discuss here and now, but they lay in the belief that people with BPD, particularly those who self-harm, are attention seekers. That they just need to sort themselves out, like acting the way they do is a choice. I think to some extent, because it can be difficult to treat, it scares professionals, and it becomes easier to blame the patient, again because of this fixation on getting better.
What we need is a better understanding of the illness, irrespective of the name it is given. I personally feel as though the fixation on the name takes away from the real problem. Label me however you want. If BPD is how professionals can understand and group together my symptoms, so be it. But please try to begin to understand that this set of symptoms comes in many different forms and combinations, that each person is an individual, and that often people with BPD have found themselves where they are after years of trauma and/or abuse. Trauma and abuse that they suffered as children; children who never got the help that they needed. Yes, we need a lot of help. Yes, it takes a lot of time. But that is because of how ingrained our problems have become, for no fault of our own.
We know you struggle to understand, and heck most of the time we struggle to understand ourselves. But slowly, in time, you can help us find our way. No matter how we are presenting, we do not want this at all. However hard to manage we can be for you, it is no way near as hard as it is for us.