QUESTION:

Dear Dr. Heller,

I was diagnosed with BPD about five years ago, about 2 years after suicidal behavior first manifested.  My first symptoms began in my early 30′s within a few months of becoming a lawyer and starting to practice law at a large national firm, where the stress was very high.  My history seemed to match the diagnostic criteria: I grew up with severe physical and sexual abuse, and with what could be classified as an absent parent – a mother who had MS, was quite mentally ill and incapable of acting as a parent (the limited resources available in my home were utilized by her).

The more I read about BPD, the more offended I became that the label had been attached to me.  They seemed to be the modern-day equivalent to Freud’s hysterics.  I then read Judith Herman’s Trauma And Recovery, and came to the conclusion that there is no such thing as BPD – only hard-to-treat PTSD.  I concluded that BPD was a misogynist label attached to women (I never met a male BPD in treatment) in a victim-blaming manner, and it seemed to give treaters an easy out when treatment failed (which it usually did).  It seemed a catch-all, almost “garbage can diagnosis” for women with trauma histories who were not responding well to treatment.

I just wanted to know your thoughts about this.

 

ANSWER:

While there are some areas where I agree with you, I totally disagree “that there is no such thing as BPD”.  I view the BPD as a medical problem, and recent studies showing areas of the brain that are smaller tend to confirm this concept.  So does the response to medications.  My ratio of females to males is 3:2.  I suspect the ratio is even, but more males wind up in prison and don’t get the medical attention they need. While many individuals with BPD also have PTSD, it’s not consistent. The BPD diagnostic criteria are not established by one’s childhood, in fact the diagnosis is independent of cause. I believe the BPD is a form of epilepsy (brain cells firing inappropriately and out of control) in the “trapped, wounded, cornered animal” part of our brain.  It causes enormous psychological damage.  It has profound genetic influences – likely close to 50/50.  It can be caused by emotional trauma, head injuries, brain infections and abuse. The BPD is not a label, it’s a diagnosis.  I agree totally the name of the diagnosis has to change.  I like “Dyslimbia” – which means malfunction of the limbic system.  Dyslimbia doesn’t carry the connotation a “personality disorder” diagnosis has.  The BPD is no more a label than being a diabetic, epileptic, or hypertensive. I agree there are some misogynists out there, but the BPD is not a diagnosis manufactured by misogynists who wish to label women with something horrible. Another area I agree with you about: Blaming the victim is extremely common and wrong.  No one with the BPD asked for it or caused it.  I believe strongly that the right daily medication combined with the right “as needed” medication gives the individual with BPD the opportunity to become the person he/she wishes to be.  I try to acknowledge to my BPD patients that they are indeed suffering.  I explain that they deserve to get that suffering under control, that it’s not their fault, and that they can have a terrific life.

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