I think something needs to be said here about the perpetuation of some of the myths about Borderline Personality Disorder (known as Emotionally Unstable Personality Disorder in ICD-10) in particular the quesions of manipulation, violence and treatability.
First, manipulation. People with BPD/EUPD struggle to regulate emotions. So, if a person communicates intense pain, or engages in self-harming or suicidal behaviour, this causes an intense reaction in significant others. It is then assumed that the intense reaction was the intention when the behaviours were undertaken.
This is not a safe assumption. This is tricky for many Aspies to understand, because we tend to look at outcomes (intense reaction) rather than intentions, which may simply to have been to communicate or to release pain. As Marsha Linehan points out, were you to withhold pain medication from a burn victim or cancer patient, they would quickly engage in "attention-seeking" or self-destructive behaviour in order to cope.
I do not recognise the description of a prior poster's co-worker, booking out all the overtime. I suspect something else was going on here. My suspicion is that the logic runs "This person had BPD; this person behaved in this way; therefore this person's behaviour was caused by the BPD". This is not a logical syllogism. Someone can have BPD and be a jerk, just as someone can be a jerk and not have BPD. Having BPD does not make you a jerk.
I'm going to quote Wikipedia verbatim here: "The features of BPD include emotional instability, intense unstable interpersonal relationships, a need for intimacy, and a fear of rejection. As a result, people with BPD often evoke intense emotions in those around them. Pejorative terms to describe people with BPD, such as "difficult," "treatment resistant," "manipulative," "demanding" and "attention seeking," are often used, and may become a self-fulfilling prophecy as the negative treatment of these individuals triggers further self-destructive behavior."
I've faced this. I know there is a problem. I've asked for help. I've been turned away. This worsens symptoms.
On the subject of violence, the research does not support the stereotype of people with BPD being violent. BPD does come with emotional instability and intense anger, but this tends to be directed inwards - into self hatred, self harm and suicidal ideation. This is not the case in ASPD, which is something else entirely. Again, the research suggests that many people with BPD have experienced violence, and have a low tolerance for violent behaviour (I know I do - it's one reason why, when I hit a meltdown, it's so freaky). I now stay out of situations where I might get angry.
BPD/EUPD is not untreatable. The available research suggests that the most effective interventions rely on long-term psychotherapy. Mentalization-based treatment (MBT), transference-focused psychotherapy, and dialectical behavior therapy (DBT) have all been shown to be effective, but require a long-term commitment, which makes them expensive. Refusal to treat says more about healthcare budgets and stigma than it does about the clinical evidence.
This leads me to prognosis. One longitudinal study found that 73.5% of patients were in remission by the end of the study. This required treatment, not stigmatisation.
So, I would like to ask that, before people make any more generalised stigmatising remarks on here, they check their facts before they start to type! Much of what has been written by other posters has been wrong at best and libellous at worst.
20 Jun 2013, 8:09 am
