Posted by alexandra_k on January 19, 2005, at 18:27:41
In reply to for those with borderline diagnosis, posted by CareBear04 on January 19, 2005, at 17:59:06
Validity of the diagnostic categories tends to be a function of (a) whether there are a certain percentage of the population who meet diagnostic criteria (b) whether these people typically share a common etiology (c) whether a common form of treatment tends to help this clinical population.
If you are interested in validity in the sense of whether DSM criteria 'carve nature at the joints' in the way that biological classifcation of species is supposed to, or medical classification of diseases etc then maybe this is a bit of a different question... In this sense considering whether a diagnostic category picks out a 'natural kind' of disorder would be greatly assisted if we could find something like a common neurological abnormality, a gene, a virus or whatever.
Some of the DSM disorders seem to hit apon something close to a medical category. Others seem to have more to do with social / cultural norms so that what may be considered pathological in one era may be acceptable in another.
BPD has a history... The history of the term 'hysteria' is instructive. This 'phenomena' has been noted all the way back since the ancient greeks. It was thought that the 'womb had wandered' and had become lodged somewhere it wasn't supposed to. As such, hysteria could only happen to females as males didn't have a womb! The prescription for 'hysteria' was to get married and have children. To fix the womb :-)
Then hysteria became fashionable with Freud etc. Lots of 'diagnoses' try to claim Freud's patients as 'their own' but it has been thought that some of the hysterics (e.g., Anna O) were most likely BPD.
BPD became something of a judgemental term. As did 'hysteria'. 'Hysteria' is no longer part of official DSM nosology, though in many peoples minds this has simply been replaced by Histrionic and Borderline Personality Disorders. They are not supposed to be judgements (they are supposed to be descriptions of people who display certain behaviours) but they are used as judgements nonetheless.
When you think of someone as being 'hysterical' you think of someone screaming or crying or whatever and carrying on in spite of logic or whatever. Some people think that when people do this they need a good slap.
The judgements come in when people try to explain WHY borderlines exhibit the symptoms exhibited in the crieria. E.g., repeated suicide attempts. When theorists say this is done for 'attention' or with the intention to 'manipulate others' then they are JUDGING rather than assessing.
The DSM is supposed to be fairly behaviourist, and as such fairly descriptive raher than interpretive / theorietical. But judgement creeps in when their theory influences the way in which they describe the phenomena as well.
The DSM is judgemental. As are the majority of clinicians regarding that diagnosis.
For many clinicians BPD is what you diagnose 'difficult' or 'emotionally labile' or anyone who SI's with. Marsha Linehan goes on about how wrong this is. But it is true that BPD has become a diagnoistic 'dumping ground' for 'difficult' clients.
That is starting to change now. Mostly thanks to Linehan.
When I was first diagnosed I read everything I could get my hands on. If I took that (especially the psychodynamic theory and judgements and assumptions) to heart then I really would just kill myself now. To protect the world from me. To stop me 'manipulating' others etc.
But it is judgemental BS.
My behaviour can be interpreted in such a way so that I meet criteria.
But it can also be interpreted differently.
Being diagnosed with that was harmful to me.
People didn't take me seriously unless I acted out and so I quickly learned to act out so as to be taken seriously. They thought I'd act out - by definition if I was serious. They elicited from me the very behaviours they expected as a matter of self fulfilling prophecy. I never SI'd until I was diagnosed with this. I tried suicide - but it was planned and genuine.Sorry to go on...
I think about this a lot too...
poster:alexandra_k
thread:444362
URL: http://www.dr-bob.org/babble/psycho/20050117/msgs/444367.html