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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by CareBear04 on January 19, 2005, at 17:59:06
for those of you who have been diagnosed with borderline personality disorder-- do you believe your diagnosis? do you think it fits your qualities accurately? where were you diagnosed? in the hospital or in an outpatient setting after being observed and in therapy or with a pdoc for a substantial amount of time?
i'm just curious about this. in two out of three psychiatric hospitalizations, i'd been stuck with the borderline diagnosis. in the outpatient setting, no T or pdoc, including the DBT therapist, diagnosed me with BPD. my current pdoc has said more than once that she learned in training and believes that you can't diagnose Axis II like BPD in the hospital; that everyone looks borderline or otherwise personality-disordered under that much scrutiny and under the pressures and stresses of hospital living. in a recent hospitalization, every young woman who came on the ward was given a book about BPD. that's why i think young women who are admitted to psych are borderline unless proved otherwise, and no one in the hospital really cares about proving otherwise. it bothers me that something like a serious suicide attempt is interpreted differently for a man and a woman. when i took a month's worth of lithium, they told me i was impulsive and hysterical and such when neither were really true; i had the OD planned to the smallest details and i did it calmly not to manipulate anyone but just because i'd exhausted all the ways to get help and couldn't see a future or hope.
for those of you who are diagnosed borderline, how do you feel about that? do you consider the dx derogative or find that the dx limits your treatment or keeps other Ts or pdocs from helping you? once you're diagnosed, do you ever shake the dx or are considered successfully recovered? do you find that you come to fit the profile of a borderline once the dx is made?
i'm just recently been considering the validity of DSM diagnoses and this is the one i'm most curious about. please answer if you can! thanks!
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...
Posted by Shortelise on January 19, 2005, at 20:14:46
In reply to for those with borderline diagnosis, posted by CareBear04 on January 19, 2005, at 17:59:06
I have not been diagnosed as BPD but when I fugured out that diagnosis fit me pretty well, and I asked my psychiatrist, he did not say that it was not the correct diagnosis for me.
He did say that no one fits the DSM profiles exactly. He said basically that people are too diverse, that those narrow defininitions are way too narrow.
Hope that helps. It did make me feel better.
ShortE
Posted by Racer on January 23, 2005, at 20:49:09
In reply to for those with borderline diagnosis, posted by CareBear04 on January 19, 2005, at 17:59:06
Something I think a lot of us have thought about, and I certainly have.
Answering specific questions you asked:
nope, never been given this as a dx. A therapist did try, though, to convince me it fit. It doesn't fit me, but even I could see that, the more pressure she put on me to admit that it fit, the more I tried to MAKE her listen to me (about anything, really, not just telling her it didn't fit me), the more I LOOKED hysterical, emotionally labile, etc. As our marriage counselor has pointed out, anyone will look Borderline at some point, if that's what you're looking for. (Especially an angry woman, of course, which is where the stigma comes in.)
As for the stigma, yeah, definitely there. That damned therapist with her "Everyone has a personality, dear, so of course you're Borderline..." led to me receiving a lot of abusive behavior from others at that agency, rather than anything that could be construed as "treatment". (Long story, everyone else here has heard it, so I won't bore them again.)
Anyway, I do think there's a stigma, and I do think that the stigma comes of BPD being a "woman's" disorder. If men got it, they'd probably call it something like "Executive Disorder" and say it's adaptive unless found in middle management or below. But I'm cynical when it comes to gender issues.
Posted by terrics on January 25, 2005, at 18:44:54
In reply to Re: for those with borderline diagnosis » CareBear04, posted by alexandra_k on January 19, 2005, at 18:27:41
Hi, I have the BPD diagnosis. It fits. I have 7 to 8 criteria. I was dxd by a psychologist.
My current pdoc told me she throws all borderlines out of her practice eventually. They wake her up in the middle of the night, drunk and saying they are going to commit suicide. I asked her why she kept me. She said I am a 'soft'(her term) borderline and only bother her for a good reason and and in the daytime. Can a pdoc be one's threapist? I really trust her. P.S. I hate the dx. terrics
Posted by CareBear04 on January 31, 2005, at 22:37:00
In reply to Re: for those with borderline diagnosis » alexandra_k, posted by terrics on January 25, 2005, at 18:44:54
dear terrics,
thanks for answering my questions about borderline dx. i think it's so sad that your pdoc and many many others throw up borderlines. who helps them then? i just know that in the hospital, where every young woman seems to be borderline until proven otherwise, i get treated like the biggest and most manipulative loser in the world, and it feels horrible. i can understand that pdocs want to preserve their sleep and their free time, but if they know that they're going to dump their borderline patients eventually, why bother taking them on? since borderlines seem really sensitive to rejection, i would think that the termination would be much more hurtful than an outright rejection at first. just my thoughts... i'm glad your pdoc is helping you. my pdoc is my T, too, so maybe yours will be willing.
Posted by CareBear04 on January 31, 2005, at 22:41:14
In reply to Re: for those with borderline diagnosis » CareBear04, posted by Racer on January 23, 2005, at 20:49:09
hi racer,
i totally agree about people looking more and more borderline the more the T looks for those qualities. my pdoc threw out the bordeline dx they gave me in the hospital because she said you can't diagnose Axis II disorders in a hospital setting-- who doesn't look borderline under that kind of scrutiny? and like you, the more i tried to make them listen, the more ammunition i gave to put me down as hysterical and manipulative. in a recent hospital stay, every young woman on the unit received a book right off on borderline personality disorder. i don't know why they didn't give it to me, but i guess it's because they were set on my being anorexic instead. i hate, too, that it's a woman's disorder and especially that of young women. my primary diagnosis is BP with no borderline, but all the medical drs i go to see a young woman and fear hysteria, fictitious disorder, and borderline, and they regret taking me on. i hate it. maybe someday when i'm an old lady, i'll finally escape the clutches that borderline has on almost every young woman with any DSM dx.
Posted by terrics on February 2, 2005, at 20:25:18
In reply to Re: for those with borderline diagnosis » Racer, posted by CareBear04 on January 31, 2005, at 22:41:14
Hi Carebear, I most certainly am not young and only got the DX at age 49. I am now 54 and feel silly with this dx, but once it is pasted on to you it seems to stick. My pdoc (who I think is smart and has alot of common sense) called my T. today. I did not even know that she had her number. I do not like them speaking with each other about me without my presence. They never asked me and I feel betrayed. I have always told my pdoc that my T. makes me angry,...Pdoc told me she(T.) could help me even if I do not like her. Pdoc told T. today that I have transference issues with her.(T.) Perhaps I am overreacting, but I do not want them talking about me period...Unless I am included. I still would like to keep Pdoc if she can do therapy and dump T. Any comments? Any suggestions? How would any of you feel if you were in this position? Perhaps there is nothing wrong with me after all and I should just dump both of them. terrics
Posted by Dinah on February 3, 2005, at 9:12:07
In reply to Re: for those with borderline diagnosis T/Pdoc » CareBear04, posted by terrics on February 2, 2005, at 20:25:18
Did you sign a release for them to talk about you? If not, they've violated their professional ethics.
I haven't, and won't, sign a release for my my pdoc and therapist to discuss me for just that reason. If either think it's necessary, I might consent to a conference call with me as part of it.
If you did sign a consent, I suppose they've done nothing wrong. Did they tell you in advance they'd be doing it? Did your pdoc tell you in advance that she thought your reactions to your therapist were transference?
Sorry, more questions than answers. It just brings up some old anger from when my pdoc and therapist worked at the same clinic and discussed me (in unfavorable terms to my mind) behind my back.
Posted by terrics on February 3, 2005, at 15:14:10
In reply to Re: for those with borderline diagnosis T/Pdoc » terrics, posted by Dinah on February 3, 2005, at 9:12:07
Hi Dinah, Consent was signed in retrospect. Stupid me signed one for T. after the conversation she had with pdoc, Which by the way was initiated by pdoc. No, pdoc did not tell me that she was going to tell T. about transference. I am very upset. Even more now because you reinforced my fears. I am going to pdoc tonight. I am draughting a letter now that they may not speak about me without my knowledge and presence. What do you think about that??? thank you. Helen
Posted by Dinah on February 3, 2005, at 16:59:46
In reply to Re: for those with borderline diagnosis T/Pdoc » Dinah, posted by terrics on February 3, 2005, at 15:14:10
I didn't mean to reinforce your fears. :(
I've got some serious issues of my own on this subject. The pdoc from Hades nearly destroyed my relationship with my therapist through his lack of discretion. He pretty much passed things on to me, supposedly from my therapist, that I hope were stated more bluntly than my therapist stated them. It took years to repair the damage caused.
Sigh. At the very least I hope my therapist no longer thinks those things about me.
I think you're able to revoke a consent form. If it makes you feel uncomfortable, why don't you ask to revoke it? If you think you can come to terms with it, perhaps you can discuss it with both of them before deciding.
From what you've said, I'm not sure if transference is the right way to categorize your feelings about your therapist. Did your pdoc give any explanation of why he thought your feelings were based in transference rather than in reality? Is the explanation worth considering?
A consulting psychiatrist once wrote off all my feelings toward the pdoc from Hades and my therapist as tranference. I've since found out that many people dislike that pdoc, so if it's transference it must be a group phenomenon (among a group who have never met). And as I told my therapist, it's awfully convenient to him if my feelings about him can be considered transference. That if I get mad because he's late, falls asleep, forgets what I say, or returns phone calls poorly, maybe it's just him I'm mad at.
To his credit, my therapist thought the whole thing was hilarious, and "transference" is now a shared joke between us. Brought up gingerly and with lots of humor on his part.
This is the end of the thread.
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