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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Shy_Girl on April 23, 2005, at 14:44:46
Hello
I was just wondering why there is so much written about borderline personality disorder stigma. It's not very encouraging to me. I don't think of myself as a difficult person to be around, yet articles I've read suggest that BPD is one of the most stigmatized of mental illnesses.
Even here at babble, I don't find much mention of BPD. Most are much more likely to acknowledge bipolar disorder.
It's upsetting to me that it is seen that it is my "personality" which is disordered. I KNOW that I'm a good person, yet this label of BPD suggests that my whole being, which is ME is somehow very flawed and undesirable.
I'm wondering if it is a good idea or not to mention my diagnosis of BPD to future Ts, pdocs, or GPs. Will they automatically assume I'll be difficult and most likely reject me???
I want to hear some success stories of people with BPD. How did you overcome it? Was stigma a problem? Do you think it helped you or hurt you to know your diagnosis?
At first I was ok with it, but I read through the many articles written about BPD over again and it seems like such a serious illness. I don't consider myself as having such a serious illness. I hate to think that people will dislike me because of this label. Any thoughts on this?
Shy_Girl
Posted by Shy_Girl on April 23, 2005, at 15:42:25
In reply to Borderline stigma, posted by Shy_Girl on April 23, 2005, at 14:44:46
I'm sad. :-( I think my pdoc giving me this label of BPD means she is fed up with me. My worst fears are confirmed. She hates me!
I don't even cut anymore and I've never actually attempted suicide (hurt myself with the INTENT of dying). People don't even find it difficult to be around me, probably because I avoid most people.
Perhaps I've been too open with my pdoc, aways telling her of my suicidal ideations. I'm probably stressing her out and now she really hates me.
I hate this. I don't want to be a drain on the health system. It's probably easier if I don't exist. I hate this. I'm flawed and might never get better. Drugs won't even work because it's my personality that's flawed. I've grown up wrong and may never become normal. I'm doomed. I'm an outsider even to the mental health system...no sympathy for me because it's my personality that's flawed. This is horrible. My life is a waste.
Shy Girl
Posted by alexandra_k on April 23, 2005, at 18:10:55
In reply to Borderline stigma, posted by Shy_Girl on April 23, 2005, at 14:44:46
(((Shy_girl)))
I have to admit that I read your post on your dx and I wondered how long it would be before you were posting something like this...
I was diagnosed with BPD in 1998. I didn't have any idea what on earth that meant so I did a lot of reading - and I mean a lot. I read everything I could get my hands on from psychology text books to journal articles to treatment manuels.
I do think that it is fair to say that there is a lot of stigma attached to the BPD label. And the worst stigma - unfortunately - comes from clinicians rather than from the general public who typically have no idea what the diagnosis means.
I struggled for a long time with the same questions that are occurring to you:
-Is my whole personality (my whole being) f*cked up?
-Am I attention seeking / manipulative?
-Am I just a drain on the system?
-Am I never going to get any better / feel any better?
-Wouldn't I just be better off dead?In answer to these - NO NO NO.
> I'm wondering if it is a good idea or not to mention my diagnosis of BPD to future Ts, pdocs, or GPs. Will they automatically assume I'll be difficult and most likely reject me???I think it is better not to mention it. Let them get to know you as a person rather than knowing your diagnosis first. I found that clinicians who met ME first typically were good to me - whereas ones who knew my diagnosis first made all these initial judgements that took many sessions for them to backpeddle from.
> I want to hear some success stories of people with BPD. How did you overcome it? Was stigma a problem? Do you think it helped you or hurt you to know your diagnosis?It both helped and hurt. Really. It was a mixed blessing. Apparantly I no longer meet criteria for BPD. I am 26. It is possible. Don't get me wrong - I still struggle. Life is hard at times.
>I'm sad. :-( I think my pdoc giving me this label of BPD means she is fed up with me. My worst fears are confirmed. She hates me!
Sometimes the diagnosis of BPD is given innapropriately to patients who seem 'difficult'. But not so much as it used to be. They were reluctant to tell you your diagnosis - isn't that right? To me that signifies that they were attempting to spare you of what you are going through right now.
>People don't even find it difficult to be around me, probably because I avoid most people.
I am avoidant too. If it is any consolation a fair few people with BPD are avoidant as well. My avoidance actually got worse with my getting the BPD dx. I started to believe (even more so) that I wasn't fit to be around people.
Your life is not a waste.
I struggled a lot with the idea that my whole personality - my whole being was flawed. Try to remember that the DSM diagnosis is DESCRIPTIVE. The symptoms that you must meet to be given a diagnosis are fairly much descriptions of BEHAVIOURS. Not your whole being - just some of the behaviours that you exhibit. As you learn other ways to cope - you won't exhibit those behaviours anymore.I really would suggest you have a read of the treatment manuel that was written my Marsha Linehan. That was a real godsend to me. She is a really terrific advocate for reducing the stigma around BPD. She argues (convincingly I think) that most of the stigma is due to counter-transference issues on the part of clinicians.
"I hate you - don't leave me" was also quite good.
If you ever get the chance to do DBT (Dialectical Cognitive Behaviour Therapy) then I highly reccomend it. I did it for a year and it helped me immensely.
Smokeymadison has a dx of BPD as well. (I hope she won't mind me mentioning it). I have started threads over on social asking who was BPD and there were many many responses by posters saying they had been diagnosed with / told they had BPD traits.
There is hope.
Hang in there.
Posted by Shy_Girl on April 23, 2005, at 20:27:51
In reply to Re: Borderline stigma » Shy_Girl, posted by alexandra_k on April 23, 2005, at 18:10:55
Thanks so much for the support :-)
I feel so alone, even though I know intellectually that I'm not.
> I do think that it is fair to say that there is a lot of stigma attached to the BPD label. And the worst stigma - unfortunately - comes from clinicians rather than from the general public who typically have no idea what the diagnosis means.
I'm curious, how did you manage to overcome the hurt from ill-informed clinicians? I think it would be a good thing to dimiss them and find more understanding clinician...but to be rejected really really hurts.
The pdoc my GP recommended a couple of years ago (when I first started to have problems) refused to even see me. I was devastated. The pdoc I see now works mostly with uni students since she works at the health services centre there. I've been seeing her for I think 2 years now, on and off...maybe she's kept the diagnosis from me that long.
> I struggled for a long time with the same questions that are occurring to you:
>
> -Is my whole personality (my whole being) f*cked up?I question everything I've thought now. I don't know if what I believed to be true, IS true. Are the memories of events I've experienced accurate? ...or tainted by irrational throughs brought on buy my explosive emotions??
> Apparantly I no longer meet criteria for BPD. I am 26. It is possible. Don't get me wrong - I still struggle. Life is hard at times.
That is a ray of hope for me. I've read that many people with a BPD get much better as they reach their 30s and 40s. I'm hoping that life experience will help me change. It also helps me to know that people's personalities are not static...they change over a lifetime.
Knowing my dx is hurtful for me, but I cannot deny that I have some very maladaptive coping mechanisms. I should change them because changing them will make me feel better, and I do want to feel better. Facing this is going to be difficult. Destructive as my coping mechanisms are, they do work...to a degree, but I really want to LIVE life, not avoid it.
>They were reluctant to tell you your diagnosis - isn't that right? To me that signifies that they were attempting to spare you of what you are going through right now.
Yes, maybe for the first couple of months my pdoc really wasn't sure, but she must have come to the conclusion a while ago. I think she was preparing me these couple of weeks. She starting using words like "dramatic," and "provacative" to describe my behaviour.
> I am avoidant too. If it is any consolation a fair few people with BPD are avoidant as well.
I thought it was odd that I could have a BPD and be so shy around people. I thought (mistakenly) that all people with a BPD get themselves tangled up in all sorts of relationships. I think to a certain degree my avoidance has shielded me from that aspect of myself. I never get close enough for people to see the "real" me...who is very unpredictable.
Posting here, I begin to see bits of my BPD coming out. I'm uninhibited...not sure if that's a good thing. It was probably a good thing I got blocked for a week, I was raging for quite a bit.
>The symptoms that you must meet to be given a diagnosis are fairly much descriptions of BEHAVIOURS. Not your whole being - just some of the behaviours that you exhibit.
I just don't like the word "personality disorder." I think that in of itself creates some stigma. I know you are correct though. I'm slowly finding out who I am, the bits I've found are positive for the most part. I need a major overhaul of my coping mechanisms though.
> I really would suggest you have a read of the treatment manuel that was written my Marsha Linehan.Thank for the info, I'll check it out.
> If you ever get the chance to do DBT (Dialectical Cognitive Behaviour Therapy) then I highly reccomend it. I did it for a year and it helped me immensely.
I'll look into that, thanx. :-)
Thanks for all the help. Congrats on not meeting the BPD criteria anymore! Hopefully with a lot of hard work and introspection I can get out of this before my 30s like you did!
Shy_Girl
Posted by Dinah on April 23, 2005, at 21:05:57
In reply to Re: Borderline stigma » alexandra_k, posted by Shy_Girl on April 23, 2005, at 20:27:51
I echo the suggestion of Linehan's works. I think more and more clinicians are accepting the view she puts forth, that there are biological factors that predispose people to be easily aroused emotionally, with a slow return to baseline. The research would indicate the truth behind this. Have you read about BPD and the pysostigmine challenge? Perhaps as the biological basis of this, and most if not all Axis II disorders, becomes more widely understood they will develop some more effective medications.
In the meantime, treatments such as DBT that concentrate on modulating response to emotional stimuli and facilitating a quicker return to baseline can be helpful. There may be drugs that can help with that too. And if you concentrate on the physical factors of emotional lability, you'll realize there's no reason to feel any differently about it than someone with Bipolar.
People with Borderline Personality Disorder are just trying to cope the best they can with the tools they have.
Posted by alexandra_k on April 23, 2005, at 21:27:09
In reply to Re: Borderline stigma » alexandra_k, posted by Shy_Girl on April 23, 2005, at 20:27:51
> I'm curious, how did you manage to overcome the hurt from ill-informed clinicians? I think it would be a good thing to dimiss them and find more understanding clinician...but to be rejected really really hurts.
Yeah. Rejection does really hurt. Hmm. 'Intense fears or real or imagined abandonment' - I've never gotten over that one. How to overcome the hurt... I guess that either they get to know me as a person in time (in which case I manage to forgive them their initial judgement), or else they terminate me. Which hurts like hell, but is probably best in the long run because they can't help me if they judge me. They just HURT me.
> The pdoc my GP recommended a couple of years ago (when I first started to have problems) refused to even see me. I was devastated.Thats gotta hurt. You don't know why though. Maybe they had too many clients on their caseload. I was reccomended to see a p-doc who is supposed to specialise in personality disorders - especially avoidant and BPD but he wouldn't see me. I don't know why.
>The pdoc I see now works mostly with uni students since she works at the health services centre there. I've been seeing her for I think 2 years now, on and off...maybe she's kept the diagnosis from me that long.
What is that person like? It sounds promising that they have worked with you for that long and that she was worried about letting you in on the dx.
> I question everything I've thought now. I don't know if what I believed to be true, IS true. Are the memories of events I've experienced accurate? ...or tainted by irrational throughs brought on buy my explosive emotions??
Thats a problem for everyone - and not just for you in particular. The thing I struggled with the most was hearing all about my supposed cognitive distortions and faulty logic. How can a philosopher have faulty logic??? I mustn't be able to be a philosopher after all... Everyones thinking gets distorted to a degree with emotional stress. It is just that we get more stressed more often. Linehan emphasises that the errors in cognition are secondary to the disorder in emotional regulation. She developed DBT. If you do get the chance to do it...
> That is a ray of hope for me.More than a ray, sweetie :-)
>I've read that many people with a BPD get much better as they reach their 30s and 40s. I'm hoping that life experience will help me change. It also helps me to know that people's personalities are not static...they change over a lifetime.
Yeah.
> Knowing my dx is hurtful for me, but I cannot deny that I have some very maladaptive coping mechanisms. I should change them because changing them will make me feel better, and I do want to feel better. Facing this is going to be difficult. Destructive as my coping mechanisms are, they do work...to a degree, but I really want to LIVE life, not avoid it.Yeah. They do work. Thats why we do them - because they do work to a degree. But there are other coping mechanisms that work even better - though it is really really really hard to switch to them.
> I thought it was odd that I could have a BPD and be so shy around people. I thought (mistakenly) that all people with a BPD get themselves tangled up in all sorts of relationships. I think to a certain degree my avoidance has shielded me from that aspect of myself. I never get close enough for people to see the "real" me...who is very unpredictable.Not everyone meets all the symptoms on the criteria. Also a lot of people with BPD are afraid of anger and avoid that while the DSM presents borderlines as having difficulty inhibiting anger. I used to believe that I never got angry. It took me a while to discover that one.
> Posting here, I begin to see bits of my BPD coming out. I'm uninhibited...not sure if that's a good thing. It was probably a good thing I got blocked for a week, I was raging for quite a bit.Linehan talks a bit about changing a personality 'disorder' into a personality 'style'. She says borderlines will 'always be the 'colourful' people of this world'. Just because you meet DSM criteria for BPD doesn't mean that you don't have a FABULOUS PERSONALITY with heaps of REALLY GREAT AND POSITIVE TRAITS. Really.
> I just don't like the word "personality disorder." I think that in of itself creates some stigma.Yeah. I struggled with that too.
Hang in there. You will get better. Really.
Posted by Shy_Girl on April 24, 2005, at 17:16:53
In reply to Re: Borderline stigma » Shy_Girl, posted by alexandra_k on April 23, 2005, at 21:27:09
> What is that person like? It sounds promising that they have worked with you for that long and that she was worried about letting you in on the dx.
She's a comfortable person to be around. I can pretty much say anything and she won't over-react like other people. I find it amazing how she can maintain her cool and be calm and relaxed with me even when I'm so out of control. It's nice to know she trusts that I am capable of doing the things I want in life. She's so stable! Geez, I wish I could be like her. She doesn't push meds on me either. She's pretty cautious with meds. I've never been given anymore other than an SSRI. I was a little surprised that she was willing to give me a beta blocker a few days ago...she only prescribed 5 pills though, smart I guess, considering my history.
> Linehan emphasises that the errors in cognition are secondary to the disorder in emotional regulation. She developed DBT. If you do get the chance to do it...
I don't know whether DBT is available here in Canada. I think it is only available in one or two places here. I highly doubt there are any DBT programs where I live. :-( I'll ask my p-doc about DBT. I don't know if she's familiar with it. I'm not even sure what type of therapy she uses with me. We mostly talk about the thoughts I have and then dicuss whether or not there's evidence for my thoughts to be true or not.
I'm curious about Marsha M. Linehan's two main books:
"Cognitive-Behavioral Treatment of Borderline Personality Disorder"
and
"Skills Training Manual for Treating Borderline Personality Disorder"
I've read some good reviews on these two books. I'm wondering whether or not I need to read both books to be able to learn to apply DBT techniques on myself? Can I just get the training manual, or do I need to read the theories behind it all first? Also, I'm not too well versed in psychological theories and therapies, would I be able to understand what she writes about?
thanks so much for caring :-)
Shy_Girl
Posted by Shy_Girl on April 24, 2005, at 17:56:31
In reply to Re: Borderline stigma » Shy_Girl, posted by Dinah on April 23, 2005, at 21:05:57
>Have you read about BPD and the pysostigmine challenge?
Nope, I'll have to look it up.
> And if you concentrate on the physical factors of emotional lability, you'll realize there's no reason to feel any differently about it than someone with Bipolar.
Hmmm...I can somewhat control my emotions, the enironment controls it. They are exogenous?? is that the word? Is that the same as in bipolar mood swings? I don't think I've ever really "switched" on SSRIs before. I've been maybe hypomanic, and agitated before, but they don't cause me problems. Anyways, my pdocs doesn't feel the need to give me mood stabilizers. She agrees that I'm not bipolar. I haven't asked her about what she thinks of the bipolar spectrum though. I trust her decision to not give me a mood stabilzer or anti-psychotic.
Posted by alexandra_k on April 24, 2005, at 19:05:43
In reply to Re: Borderline stigma, posted by Shy_Girl on April 24, 2005, at 17:16:53
It sounds like you have a really good p-doc! Really. You don't need to go looking anywhere else.
> I don't know whether DBT is available here in Canada. I think it is only available in one or two places here. I highly doubt there are any DBT programs where I live. :-( I'll ask my p-doc about DBT.
There might not be any. It is only offered in a few places in NZ too, and it is hard to get into. Worth a shot though.
>I don't know if she's familiar with it.
I'm sure she will have heard of it.
>I'm not even sure what type of therapy she uses with me. We mostly talk about the thoughts I have and then dicuss whether or not there's evidence for my thoughts to be true or not.
That sounds like cognitive therapy (cognitive restructuring). She may well be modifying that slightly in a DBTish way. DBT outperformed alternative treatments for BPD - it is currently the best treatment for BPD that there is. IMO that is because it is non-judgemental. Your p-doc may well be using ideas from DBT to inform her practice even though you aren't formally doing DBT.
> "Cognitive-Behavioral Treatment of Borderline Personality Disorder"That one is the treatment manuel for individual therapy. It starts with looking at the history of the BPD dx and how the criteria have evolved through time. Then the conceptual underpinnings of DBT and into specific techniques etc to be used in individual therapy and the rationale behind them. It is useful because instead of the usual judgemental explanation that is typically offered for borderline behaviours she offers non-judgemental explanations. I was able to take those on board to a certain extent and it helped me feel a lot better about myself and the reasons why I act out sometimes. It can be a little hard going. But you don't have to understand everything. I would reccomend that you give it a go and take what you can from it.
> "Skills Training Manual for Treating Borderline Personality Disorder"
One of the ideas behind DBT is that borderlines do the best they can with coping strategies - but quite often at least some of the coping strategies they use are maladaptive (in the sense that there are better ones out there). Thats not our fault - we were never taught these better coping strategies and skills. In DBT you work with an individual therapist for therapy and you also go to skills training which is typically in a group therapy environment. There are (from memory) three sections to the skills that are taught in skills training: Mindfulness skills; interpersonal skills; emotion regulation skills. It takes about 6 months of weekly skills training to go through learning all the skills. Individual therapy is supposed to help you apply those skills to problems in your daily life. It is helpful to go to 1 year of skills training to go through all the skills twice (they make much more sense on the second time around). Basically we were given handouts that are in the skills training manuel. They pretty much photocopied the whole book and gave it to us. We just worked through that over the course of a year. It is worth having a look at as well.
> I've read some good reviews on these two books. I'm wondering whether or not I need to read both books to be able to learn to apply DBT techniques on myself?Hmm. It is helpful to read them. I thought that if I read them I could be my own therapist - but it doesn't work like that. Knowing something rationally and knowing something emotionally or through experience are two different things. You can be told 'you are worthy of being loved' but that doesn't compare to someone SHOWING you that you are worthy of being loved - by loving you if you get what I mean.
>
Posted by B2chica on April 25, 2005, at 13:24:25
In reply to Borderline stigma, posted by Shy_Girl on April 23, 2005, at 14:44:46
there is a stigma in the psych. community at times as well with BPD. the one thing you mentioned is typically what puts people 'automatically' in this category and that's your SI. at least for me that was the kicker.
there are several ways to view BPD.
most websites i've read and many people view it as people (mostly women) that are 'uncontrollable', have volitile emotions, are suicidal or attention seeking.
i don't like or agree with this. my T who put me in this actually said there are a couple types of BPD, i am BPD-depressive type. which means i am currently having difficulty controlling or monitoring the emotions that i have mainly the depressive ones. (i laughed and said so what's the difference between BPD-dt and just being a pessimest!)
anyway, he explained that there is this elevator we all have that takes us from ground floor(everyday life) and down deep (deep contemplation etc.) and people with BPD cannot control the elevator. my problem is i go down but i can't make the elevator come back up when i need it to.ok, long schpeal, sorry.
know you are NOT alone.
hth
b2c.
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