Who the Frag Am I?

February 19, 2010

On Borderline Personality Disorder

Filed under: Autism, Bipolar Disorder — wtfmi @ 8:02 pm

Yesterday I mentioned that I don’t always agree with my psychiatrist that I have (sub-clinical) bipolar disorder. The criteria don’t quite fit right. There is another disorder with criteria that fit me much better … Truth is, I am afraid that I have borderline personality disorder (BPD).

And I do mean afraid. I’ve been terrified of a BPD diagnosis since I was an adolescent. Being labeled with BPD can be the equivalent of being labeled as a difficult, lying, manipulative bitch. Get branded with BPD and your chances of anyone in the mental health professions believing you ever again go way down. And as it happens, being disbelieved or dismissed is a major sore point for me, perhaps because it happens so often.

(Be aware that I am not saying anything about people with BPD here, only about the attitude of many mental health professionals.)

So yesterday, after posting, I decided to learn more about the underlying intricacies of BPD. I mean, I’d read the DSM-IV criteria before, but I know that the DSM is rather far off when it comes to autism and I assume the same is true for BPD as well.

I spent the next 8 hours reading up on everything I could find online. (The internet contains a lot of iffy information, but by starting with sources you already trust (if available), keeping an eye on your source’s sources, and cross-referencing the information you find, you can at least distinguish patterns in the available information. I also find the net to be a valuable source for the personal experiences of affected people.)

When my husband eventually pried me away from my computer and forced me to eat something, I was awash with new information and new thoughts about patterns of behavior — and I wanted to share it with him. Poor man. I basically brain-dumped everything I’d read on him in a fast-paced thirty-minute lecture, in no particular order, frequently punctuated with the exclamation, “Isn’t this fascinating?!”

But one thing that stood out to me while I was researching — besides the fact that the criteria for BPD are so broad as to be useless, that the shorthand concepts that we often use to describe BPD are not the incontrovertible outcome of those criteria, and that there is precious little actual research on BPD — what struck me was how many of the criteria could just as easily be the outward signs of undiagnosed autism, especially for women on the end of the autism spectrum that appears less challenged with social interaction … well, once you stripped away the whole “difficult, lying, manipulative bitch” thing.

So after dinner I went looking for research on that notion. I didn’t find any (suggestions welcome) but I found a decent number of opinions on it flying around the autism-sphere.

One of the common opinions is that autism and BPD are two entirely separate things that cannot possibly be related, largely because BPD is all about being too sensitive to feelings, too lonely, and too socially manipulative, while autism is all about being insensible to feelings, unable or unwilling to be with other people, and unable to lie or manipulate. Of course, both of these are simplistic to the point of being untrue.

Another opinion I found is that BPD probably contains a number of disorders which are currently all mashed together because we haven’t done enough research to separate out the threads. One of those may be ‘classical’ BPD (although I think we should still take a careful look at the sexist aspects of that definition), while another may be co-morbid with autism or even an outward manifestation of undiagnosed autism.

But the most valuable of the opinions I read was this one: it doesn’t matter. Diagnostic labels are only useful insomuch as they are … well … useful. The BPD label isn’t useful to me while bipolar label is — primarily because it comes with medications which I have personally found to be useful in smoothing out some of my nastier moods.

And the most useful label of all — for me, from my own strictly limited point of view — is the autism label. Because autism has helped me understand myself and my life enormously.

So I’m going to calm down about BPD and stop treating my bipolar disorder as a separate and terrible disease. These are just labels for patterns of behaviors I display, and my behaviors ultimately come from who I am. Sometimes I need help with those behaviors, and sometimes I am happy with them, but in either case what you call them is only useful if it helps me.

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