Understanding PD without using the term ‘personality disorder’
Understanding different types of emotional distress: an important area of mental health that is getting increasingly recognised is the way people express various forms of emotional distress. It can cause various behaviours:
People harm themselves, for example by cutting their arms
Drinking unsafe amounts of alcohol
Taking illegal drugs regularly, excessively or irresponsibly
Misusing prescribed medications (or those available over-the-counter at pharmacies)
By impulsive and reckless actions that could have have serious consequences, like driving too fast or having unsafe sex
Chaotic eating patterns – such as bingeing, vomiting, abusing laxatives or continuously eating too much.
In addition, people with these problems often have repeated difficulties in relationships in ways like this:
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Never keep friends very long
Cannot hold down a job
Isolated and lonely
Violence in intimate relationships
Over-sensitivity to criticism
Argumentative with people in authority
Feeling very abandoned when left alone or people leave
Unable to cope with making any decisions without help
Often switching between loving and hating family members.
Many people will experience these things at some time during their lives, perhaps in response to stress, but some are severely troubled by many of them for most of their lives. These could be called ‘long-standing emotional problems’, and they often go right back to childhood. In mental health services they are sometimes known by diagnoses like ‘complex needs’, ‘personality disorder’, ‘borderline’ or ‘severe and enduring non-psychotic disorder’.
Although it is not always the case, people with these types of difficulties have usually had difficult childhoods, with adversities like repeated trauma, or physical, emotional or sexual abuse, or neglect and deprivation, or several severe losses and bereavements. On the other hand, some people who suffer very harsh childhoods seem to be somehow ‘protected’ from the long-term psychological damage it can do. Unfortunately, there is no easy way of finding out who will have more problems and who will have less – although research is always being done to help us understand these matters better.
People who suffer in these ways often do so silently, without getting any help and often feeling guilty or ashamed of how they ‘are’. They often do not even know that they have a problem that others have too – and can become very isolated and lonely with it. In fact, these problems are very common, and increasingly recognised. The reason people behave the way they do, and have the difficult relationships they do, is usually to deal with their feelings, and to try and cope with them. But their actions often do not help enough, and they can make matters worse.
Very commonly, the behaviours can be confusing and upsetting, and this is as true for the people themselves as for those around them. This is because there is a lack of information and understanding about how these things arise, unwillingness to think and talk about them, and little knowledge about what can be done to support someone in this sort of emotional turmoil.
Although it is often the easiest route, there is recent research and NICE guidelines which suggest that medication is not usually the best way to deal with these problems. In the NHS, psychological treatment often helps, and this may take different forms. However, short-term ‘quick fix’ treatments and therapies are rarely very much help. Some psychiatric services are good at helping people with these problems, but because the number of people affected has only recently been recognised, many mental health staff do not yet have good training to deal with it.
In this situation, one of the things that can be very helpful is to help people to feel less alone and ‘odd’ – and for this, other people who have suffered similar feelings are usually better than professionals at understanding what it is like.
Arts & Social Network
Also, many people with these difficulties are particularly talented in other areas – and this is often in creative and artistic activities. Instead of expressing their emotions in destructive or self-defeating ways, the feelings can be channelled into art, music, drama, writing, or other creative activities. There are several local projects, called ‘Arts and Social Networks’, that provide the opportunity for this – and there are regular national events, where people can come together and give each other good ideas for creative and imaginative projects.
I have felt, for a long time, that the term ‘personality disorder’ is quite unacceptable; and it seems, to me to be a perjorative expression, ‘devised by professionals’ who, as a group (ie not as individuals) appear to lack empathy. I’m not sure I saw what I am saying reflected in this article, however; and that puzzled me somewhat – given it had the title: ‘Understanding PD without using the term Personality Disorder’. Unfortunately, in my professional work (where I frequently have to write ‘reports’) there is no other terminology. Perhaps DSM-V will help?
from
Ian Patterson, Chartered and HPC Registered Psychologist, Aberdeen,
Thank you for your comment – I pass it on. Ann Grain (website editor)
I have been suffering with BPD and other things for many years from childhood and am now in my early 60′s. I was only diagnosed about 10 years ago and so have had to live with my problem and manage it somehow all this time. I was being treated by a Psychiatrist and was attending Mental Health Services, but was soon discharged, I think mainly because of my attitude or behaviour, so you can say I was dumped, like many other people with BPD by the Care Services and NHS Trusts. But what gets me is the amount of reports pushed under people’s noses, who suffer BPD, telling of these wonderful services that we are able to access, and yet I have yet to see any of these services happen. Is this another government fiasco telling people of the new updated fantastic mental health services provision that will soon be on offer, another lip service, another report, words on paper. And if this is an American updated programme to help people with BPD, by the time it gets popular in England, I will probably be pushing up daisies in my grave.
I am not persuaded that we should avoid using the
term ‘Personality Disorder’. Repeated name changes in other
areas of mental health have already shown that stigma soon
catches up with such approaches.
As Shakepeare said; ‘A rose by any other name would smell
as sweet’.
What we should be tackling is stigma and unhelpful
attitudes towards those with personality disorder. Avoiding
or changing, the term, does not tackle real problem.
I think the name needs to be changed. The words ‘personality’ and ‘borderline’ should be avoided. They immediately conjure up the impression that someone is ‘odd’ which just compounds a person’s problems and isolation. Emotional distress is easier to identify with. If there does have to be a name, any name change which improves understanding, and promotes the availability of effective treatment, would be a move in the right direction.
I’m in my mid-forties and I too have been ‘dumped’by every medical health professional I’ve ever met,mental hospital staff,social services,g.p’s,consultant psychiatrists,cpn’s,crisis teams,1 2 1 therapists and comples needs group therapists,even police and ambulance services.There’s NOTHING available to help chronic bpd’s.You have to just whatever YOU want and have to do simply survive each day and keep well away from people who judge you and condemn you for what you do.
im kind of ambivalent over all the comments as well as the article.. ho hum welcome to the diverse world of living in a chaotic head, chaos and calm rule as equal measures, usually at the inappropriate times. for me the overall sadness is how as i have difficulties understanding, motive, intent, in relating, relationships etc i am denied family ties purely as i cant deal with the emotional turmoil euphoria and distress that follows and my life is now solitary. i would so want to take part and do and be but feel unless i get specialist support that understands i am doomed to be eternally frustrated, on the move, or denied. and i dont see why i should be
I suffer from BPD and cannot get a psychiatrist in my area (Wolverhampton) and keep getting sent to psychotherapy services such a Healthy Minds, which ive been sent to before for 6 weeks which just doesn’t work as i relapse almost straight away. Ive been told i need long term treatment but the UK government have cut all funds to these services.
I feel as i am not taken seriously bye anyone as i am able to talk about how I feel and the therapist who i see label me as ‘ok’ but they do not know me as they have not seen me when im in a bad state.
I can totally understand what Caroline Matthews was saying in her post. i feel as if i’ve been left to rot and being sent to WCA assessment by the DSS has not helped matters as i’ve been made to feel disbelieved
I have been diagnosed with BPD for quite some time now!
I have been in treatment with a therapist for two years and i can safely say that without this therapist i do not know where i would be.
i believe for individuals suffering with PD that the only way forward is therapy. I do have a long way to go yet.
I do not believe in any other multi disciplinary team other than a (excellent pyschologist) to get you through your difficulties.
The argument about the name of Personality disorder doesnt matter to me, call it anything you want, it will not change what am going through. I’ve been with numerous mental health practitoners i.e. frensic pyscharists, cpn, counsellors, Pyscharists, Gps, but to name a few and everyone one of them pushed me from pillar to post as they didnt no what to do with me or they just didnt have the tools/umderstanding/knowledge to help me.
so therefore i am very thankful that i found a pyschologist who doesnt judge me, who is consistent and very reliable and to top all that off knows what she talking about and as a sense of direction of my treatment.
I’m in my forties and have never been formally diagnosed, like some previous replies having been treated pretty badly i.m.o. whenever I sought help from the NHS.
A few years ago a sought a CBT therapist (at my own cost) who in so many words guided me towards the realisation that I have Schizoid Personality Disorder. It changed my life to know that I’m not the only person like me and I’d rather be known as having SPD than be known as “an inadequate person” as written on my medical notes by a “helpful” physchologist 20 years ago.
I dont feel “labelled” and know that I can change myself for the better to the best of my ability. However, this was after 20 years of not having a clue why I was different to most people and not knowing where to start in trying to change myself. I cant help but feel bitter at what I experienced as pretty much complete indiference from the NHS to my plight.
I hope things would be different know but I’m not sure that the less “exciting” PDs still elicit much interest from the health services.
Just a couple of things, although yes PD can be Hell, you can recover and learn to manage your emotions. Someone said it is actually a good prognosis diagnosis….. If you get the right therapy and support. Unfortunately not all people in the UK have access to the right therapies. Personally I want DBT and I am working towards getting this to happen in my trust.
I think peer support groups are brilliant. Let me know how I can set one up please : )