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So after being slapped with the charming label of “Borderline Personality traits”, I’ve decided to go all out and get myself the whole shebang diagnonsense of a personality disorder. I’m not one for half measures, and can’t be fannying around with this “Traits” business
Me neither, Marine Snow. Me neither. So, what does it mean to say that you have “traits” of a personality disorder?
Well, basically it means that you have some of the features, but not enough of them to warrant a diagnosis.
Much in the same way that a headache could be called “brain tumour traits”.
Telling a patient they have “traits” of a personality disorder is something that annoys the hell out of me, and often doesn’t strike me as particularly useful. After all, anyone who’s spent time involved in mental health services will know that “personality disorder” often seems to be a synonym for “cunt”. “Personality disorder” means, “Discharge this fucker as quickly as possible from the acute ward”. It means, “For God’s sake, don’t actually offer this person a service with the CMHT”.
I don’t want to cause half the Mental Nurse readership to immediately collapse to the floor laughing, but a personality disorder diagnosis is also supposed to be there in order to identify treatment options and enable access to services. So, if you’re not actually giving the diagnosis (and therefore not offering access to those barely-existent services) why give them the stigma of a personality disorder?
Worse still, in my opinionated-bastard opinion, is telling someone not that they have “borderline personality traits” but “traits of a borderline personaility disorder”. If you’re not actually suggesting that they have a full-blown personality disorder, why use the word “disorder” to describe their personality?
Overall though, wouldn’t it be better just to say, “You seem to have some difficulty regulating your emotions and some problems around your sense of personal identity. Perhaps we can explore that in your CBT sessions”, rather than, “You have borderline personality traits”?
That’s a very undiplomatic thing to say to someone who already has “uncertainty about self-image” (ICD10).
You’re starting to appear hypomanic Z, but just in a few traits.
There was an interestingly similar in as much as it was different post on ShrinkRap reviewing the DSM IV -
The DSM-IV is the standard for diagnosing psychiatric disorders. It lists the disorders and what symptoms a patient needs to have to ‘meet criteria’ for that disorder. It reads a little like a Chinese Menu– if you have one/two/however many symptoms from column A and a certain number of symptoms from column B…you get the idea. What’s interesting is that it’s the Diagnostic and Statistical Manual of Mental Disorders, but there’s nothing Statistical about it. The criteria are decided by committees, not by experiments or long-term studies that follow prognosis, not by response to medications, not by the presence or absence of a gene or chemical or abnormal brain structure.
http://psychiatrist-blog.blogs.....-book.html
Personally I have a few traits of everything – but I enjoy my psychopathy the most.
Hmmm perhaps it wasn’t just me being all emotionally unstable in my interpretation of the letter then? I would have been perfectly content if they had just written “Very stubborn, Has attitude problem” Would not have been new information….
It is beginning to be possible to find consistent, non-pathological signs of autistic spectrum conditions, i.e. hyper visual acuity, increased ability on the block design test, to mention only two.
However, these relatively recent findings, don’t even get mention in the DSM V’s PDD committee meetings. There is nothing other than a search for pathology – which, being a manual of disorders, one would expect, but it seems a little short-sighted.
As for the current criteria for PDD’s, apparently strict adherence to the guidelines would mean it is impossible to diagnose Asperger Syndrome – they would have to be dx’d as Autistic Disorder.
Personally, a system based on categories like, Bonkers (A Bit, Raving, Stark Raving), Looney Tooney, Weird, Weird but Harmless,
Mad As A Tree and Mad As A Box of Frogs would suffice in general day-to-day work.
All others should first be sent for a soapy rub-down from Nurse Bunniekins/Bert depending on inclinations and proclivities.
Amen.
Signed,
Alex Kelly, Aspergers Traits, dictated but not read
Poo, I was composing a post about almost the very same issue. Great minds think alike eh?
We have a few people within our service with an actual proper diagnosis of BPD – and it is a useful to have a diagnosis. Wouldn’t change the way we work with them if they didn’t have that diagnosis, but at least it gives us a framework.
We also have some with that ‘traits’ diagnosis. I don’t particularly like it either, but it can sometimes be useful i.e. the person doesn’t have all the diagnostic criteria but it helps to work with them in such a way as if they did. That’s the only real use for it – but more as a tool for clinicians than a ‘valid’ diagnosis for service users, if that makes sense.
Wouldn’t change the way we work with them if they didn’t have that diagnosis, but at least it gives us a framework.
This is true. And really ‘traits’ would not be a problem if it wasn’t for the framework the parent diagnosis of the traits creates.
The treatment pathway for PD, as Z said – “Get them out ASAP”.
I wonder if there’s an RCT on that mode of treatment?
‘Traits’ could be useful if it was used in any therapeutic sense (symptomatic treatment) rather than the pejorative and dustbin-diagnoses sense.
If it was then we could get away with the shorthand of ”traits’ and not need the clarification of “You seem to have some difficulty regulating your emotions and some problems around your sense of personal identity.”
The treatment pathway for PD, as Z said – “Get them out ASAP”.
Not in our service. We try to work with people ‘as are’. The ‘diagnosis’ of PD or personality traits at least gives us some idea of what we are working with.
Might I hijack matters a tad here, and ask if it has ever been standard practice in the UK to not inform the patient when they have been diagnosed with a personality disorder?
This happened to me in Ireland in 1997. I was, I discovered afterwards, diagnosed with “paranoid personality disorder” and “mild depression” (when I couldn’t watch tv or read a newspaper headline and remember it) but – here’s the important bit – not told about the PD.
Then proceeded to be baffled some months later after moving to the UK when my GP and the SHO for my postcode acting so weird (all there there, have a cuppa, but we can’t help you) when what I wanted was treatment for depression.
Not knowing what the fuckwas going on, I couldn’t argue. I actually found out by accident, some years later I asked my GP for a copy of all my records and of course she gave them to me. It never occurred to her that I didn’t know what was in my notes from Ireland (as then, you didn’t have the right to see your notes there). If I had stayed in Ireland, perhaps I’d still be trying to access services and baffled as to why I wasn’t getting anywhere…
(Incidentally, I have since had any mention of a PD officially refuted in my record, yes I was paranoid but that was the mood disorder, duh).
“We also have some with that ‘traits’ diagnosis. I don’t particularly like it either, but it can sometimes be useful i.e. the person doesn’t have all the diagnostic criteria but it helps to work with them in such a way as if they did. That’s the only real use for it – but more as a tool for clinicians than a ‘valid’ diagnosis for service users, if that makes sense.”
I do have to disagree with that. I know many people who have been told they have BPD purely because they self harm, and it certainly does not help to be treated as if you have BPD when you clearly do not. Apart from professionals using the wrong approaches with people, it can also lead to the service user being unable to trust people working with them. To give someone such a stigmatising label is bad enough, but to treat them as if they have a condition simply because they meet one or two criteria is a complete insult and could not only be ineffective but actually damaging.
Bearing in mind how difficult it is to refute the label once it’s been given (for indeed any attempt to challenge a professional once those three little letters have been placed in the notes is simply seen as a symptom of BPD itself and the service user is either accused of histrionics or discharged altogether because they are obviously unhelpable), I think prattling about with the vague “traits” idea is completely unacceptable. It’s effectively labelling someone but not actually labelling them, thereby saving the professional in question the inconvenient burden of responsibility and accountability whilst still having the maximum negative impact on the service user.
Amen to that. Nothing destroys the therapeutic alliance quicker than someone trying to put words in your mouth every session. Or not accepting your opinion on any medication side effect, because you alledgedly cannot handle your emotions, rather than that the pills are known to cause aggitation in high doses. Apparently this “traits” diagnosis is the reason no one has taken my opinion seriously for the past year.
If I hear the phrase “Fear of abandonment” once more, It is possible that my head may explode like that bloke out of “Scanners”
I know many people who have been told they have BPD purely because they self harm, and it certainly does not help to be treated as if you have BPD when you clearly do not.
I would never say that someone should be diagnosed with BPD purely on the basis of self-harm. I would say that if someone has most of the criteria of a PD, but for whatever reason does not get given that diagnosis it *can* (emphasis) be helpful to work with them in a way that is similar to how one would work with someone who had a diagnosis of PD. It is, however, entirely individual.
But as self harm is in the criteria, surely it’s the same thing?! You’re still talking about giving someone a diagnosis based on not-quite-enough things crossed off the list.
The problem is also that when a professional sees self harm and thinks along the lines of “ooh I wonder if that’s part of a PD in this case?”, they are likely to go on to take the rest of that person’s life and find things in it which can be skewed to fit the rest of the criteria. It’s like a compulsion amongst professionals, once they get the idea in their heads they can’t un-think it, they *need* to act on it.
Once a professional has the slightest inkling of “BPD” in their mind, there is never an escape. Everything that person does from that point on is down to their BPD, whether they’ve got the five-star deluxe diagnosis or the diluted cop-out of “traits”.
It’s like eating Pringles, once you pop, you can’t stop…
ACT: Agreed. But I don’t think it’s just a professional thing, though.
But as self harm is in the criteria, surely it’s the same thing?! You’re still talking about giving someone a diagnosis based on not-quite-enough things crossed off the list.
But not just self-harm on it’s own, if a person has more than one criteria then that lends itself more to working with them in a certain way. I certainly wouldn’t look at someone who *just* self-harms and think ‘BPD’. I can’t speak for others of course.
Once a professional has the slightest inkling of “BPD” in their mind, there is never an escape. Everything that person does from that point on is down to their BPD, whether they’ve got the five-star deluxe diagnosis or the diluted cop-out of “traits”.
Well, I don’t think like that. Even my service users who have a diagnosis of BPD can have other issues that aren’t related to that.
I’m glad you don’t think like that uselesscpn; unfortunately many people do (including using just the one issue of self harm in making a diagnosis).
There’s a post on this coming from me as soon as Christmas is over and I get back to normality.
I agree with a lot that is said here though.
“Might I hijack matters a tad here, and ask if it has ever been standard practice in the UK to not inform the patient when they have been diagnosed with a personality disorder?”
DeeDee; I’m pretty sure they’re not allowed to, but in my case – YES IT HAPPENS IN THE UK
Let me digress: I spent five weeks as a ‘voluntary; in-pt on a mental health ward in the summer of 06. Every tmie I said I was leaving (a couple of times a week) they said they would section me if I tried; so then I would back down.
When I was admitted (having spent 2 weeks on a medical ward, one being stabilised and one waiting for a bed) I was on citalopram and insulin. They stopped the citalopram and started amitriptylline. Then they stopped that and started flupentoxol. Somewhere along the line they threw in chlorpromaznie for insomnia. All in just 5 weeks!
I was sectioned on a 5(2) after I kicked off about something. That’s correct, it was so wholly insignificant I have actually now forgotton what the initial incident was. Anyway, a doctor came to review me after 24 hrs and he was like ‘why are you here? your problems are psychological, not psychiatric’ and I was discharged. I was awaiting an assessment for suitability for admission to a private EDU (NHS funded) There was to be no follow up whatsoever from the ward.
I was was so elated to be free that I didn’t even look at the discharge sheet until I had been home a couple of days. Under diagnosis, they had written ‘Borderline Personality Disorder’ . The term had never been mentioned in my presence. I consulted Dr Google, and have spend the past 2 yrs trying to get it removed from my medical notes.
[...] had yet another entertaining post about Personality Disorder with Traits – All of the Stigma! None of the Diagnosis! Over on Marine Snow’s blog, she’s been informed by her psychiatrist that she has “borderline [...]
QUOTE zarathustra:”
Much in the same way that a headache could be called “brain tumour traits”….
After all, anyone who’s spent time involved in mental health services will know that “personality disorder” often seems to be a synonym for “cunt”. “Personality disorder” means, “Discharge this fucker as quickly as possible from the acute ward”…
Overall though, wouldn’t it be better just to say, “You seem to have some difficulty regulating your emotions and some problems around your sense of personal identity. Perhaps we can explore that in your CBT sessions”, rather than, “You have borderline personality traits”?…
END QUOTE zarathustra”
CORRECT!
“Traits” is vague, professional’s using the term informaly in conversation could be valid ..but only with examples. Say like.. “I think he displays traits of personality disorder because he has extreme mood swings. Yesterday on shift he was really interacting well with me the next second hes shouting because I told him nicely that he would have to wait for five minutes so he could make a phone call!”.
Vague words and sentences need Terminating.