about the diagnosis
Borderline Personality Disorder (BPD) is also known as emotional dysregulation disorder or emotionally unstable personality disorder. Despite being referred to as a ‘personality disorder’ in the diagnostic manual, many have proposed that the term 'personality disorder' is best understood as a limitation in the capacity to self-regulate. This means that a person can have feelings that are overwhelming, spiralling out of control, and rapidly changing. These symptoms often go hand-in-hand a sense of emptiness.
‘ I think the diagnosis says ‘trouble maker’. You are ignored, you are not taken seriously.. '
‘Everything seems to be your fault when you have a personality disorder.’
‘They say it is not a mental illness but something I should be able to control.’
‘I feel like the black sheep of the community, that I don’t belong anywhere’.
Given the stigma and negative associations that are potentially attached to a personality disorder diagnosis, can getting a diagnosis ever be a good thing?
The answer is yes.
In fact, many people are relieved to get a diagnosis. The value of a diagnosis is in getting the right treatment. Although it sometimes come with the terror of being associated with a ‘personality’ defect, stigma and shame, it can help people make sense of their experience. Being able to put a name to experiences that are intangible and often misunderstood and be hugely validating. After getting a diagnosis, you may decide to tell family, friends and colleagues (if you want to) about it. Sometimes, when the people close to you understand that there is a reason for your difficulties, it's easier for them to empathise with you and offer the right kind of support. You may also then be able to identify and find others who share the same difficulties, and realise that you are not alone. Ultimately, you are the only person who can decide if this is the best choice for you.
‘For a long time describing my life was a train wreck , and I could not make sense of it. This was all before I was diagnosed '
How do I support someone I care about through this process of getting a diagnosis?
If you feel that your friends or family members have personality disorder traits, here are some bullet points that may help you to support someone through the process of getting a diagnosis:
- Remember that a diagnosis is not a brush stroke statement. It is important to allow the person you are supporting to speak about their individualised, subjective experiences.
- Knowing that being attached to a label can bring up a mixed bag of emotions, please respect your loved one’s ambivalence towards getting a diagnosis.
- Even when a person is given the diagnosis of personality disorder, he or she has the right to disagree with it. Your job as a supportive friend, family member or partner is simply to be there for him, and be a kind witness to any emotions that arise.
- Though you may want to encourage treatment or provide guidepost to it, do not ‘force it’. Treatment would not be effective if the person is not motivated.
- Remember that being given a diagnosis does not dilute a person’s heart and soul, and certainly does not take away the positive traits, creativity, passion and other virtues there is in him/her.
Do you offer clinical assessment?
If you would like to be clinically assessed to see if you fit the diagnostic criteria for Borderline Personality Disorder, I would be able to run a clinical interview, based on The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), for this purpose. Although I would not be able to prescribe medication or provide medical advice, I will try my best to communicate with your medical provider to make sure that we are on the same page.
The SCID Interview
The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) is a semi-structured interview for making DSM-IV Axis II: Personality Disorder diagnoses. The instrument was designed to be administered by a mental health professional who has relevant professional training and has had experience performing unstructured, open-ended questions, diagnostic evaluations.
What happens during and after the assessment?
The interview time varies, from 20 minutes to more than an hour, depending on the presentation and complexity of your difficulties. Typically, it will take 30-45 minutes.
You will be asked a set of open ended questions based on your past and current experience. there is no need to prepare anything and I will guide you through the process. Afterwards, I will write up a one-page report stating the results and my impressions. All information will remain confidential and will only be revealed to you (except in circumstances where I believe that you are in serious risk of harming yourself or others, or when required by law).
Are there reliability and validity data on the SCID?
The range in reliability for SCID is enormous, depending on the nature of the sample and research methodology (i.e., joint vs. test-retest, multi-site vs. single site with raters who have worked together, etc.). Please click here for information regarding SCID-II reliability (including tables summarising reliability results). Determining the validity is a more difficult question because of the lack of established gold standards for psychiatric diagnoses. In lieu of such a gold standard, "best estimate" diagnoses are often used as the clinical standard. You may click here for information regarding SCID-II validity.
‘ It’s not the label that matters but what happens afterwards’