I have done posts before about diagnosis and how this can be difficult.
This post is a bit more narrow as it will deal with one disorder.
Tis a newer one in the grand scope of things, of course I am talking of BPD, Borderline Personality Disorder.
So is it hard to diagnose? Yes and no.
Is it misdiagnosed often? Unfortunately this is often the case.
Why? ahhh, now this is the question. There are answers too.
To clarify the title, I am not saying that a diagnosis is a label. In this case though, it often is.This is the stigma associated with this diagnosis. This is something we must strive to remove from our thinking.
So, first things first, is it misdiagnosed or something else? hmmm again. Yes sometimes it is something else. There is a huge stigma attached to BPD, so many are unwilling to give that label to someone. Is this fair? I will not answer that, it may be fair if the treatment is one that is effective. Are labels always the best thing for someone? Unfortunately I feel they are. The trouble is with the label comes the stigma. Without the correct label, how can the patient receive the correct treatment? well they can’t.
Without the label, the treatment may not be the best. It may help the patient, many meds can treat symptoms. Therapy can identify issues that need to be treated, but this is band-aids, firefighting treatment.
With the label, there may not be treatment. WHAT? tis true unfortunately. There are times, when the diagnosis is made, the label is given and the patient… is dropped.
In a profession where stigma inhibits care, it is sad that there is stigma attached to treating someone that has BPD. Once the diagnosis is made, patients often find it difficult to find therapists that are either capable of treating them, or willing to do so. DBT is often the treatment of choice, a form of CBT, which I have discussed in previous posts. This is not the only answer though, and it is not written in stone that this is the treatment that works best. Yes the success rate is high. Not every person will respond to it however. We are all different after all. Some may respond best with a mixture of therapies. Everyone deserves individual treatment, we weren’t stamped out with cookie cutters. (thank you Joyce for that)
Treatment can be more difficult, more challenging, yes. but.. again the but, this disorder responds to treatment with therapy and medication. This is to say, with treatment someone with BPD can become stable with few or no symptoms, but managed. A grand goal is it not?
Again, as I have previously mentioned, many disorders co exist. This is to say, someone may suffer from anxiety and depression, this is common, However quite often an anxiety disorder may accompany BPD, or bipolar, or many more. So diagnosis may catch one of the other disorders and miss BPD. This happens at times when there is comorbidity, more than one disorder existing. PTSD often accompanies BPD, and is often felt to be a possible cause or relation. When someone is more susceptible to PTSD it may be the same susceptibility that allows BPD to form.
So, this rambling is to show, that diagnosis can be difficult when there is a comorbidity. Symptoms cross and intermix. Some that may be more prevalent may be treated first. The BPD diagnosis may come out later. Tis hard. Rapid cycling Bipolar shares so many symptoms with BPD that they are often mixed in diagnosis. Bipolar and BPD often co exist.
The trouble is, treatment is different, whilst it is true the same meds will help stabilize moods and drugs like Abilify will help treat some BPD symptoms, treatment with therapy is needed also. If the diagnosis is for Bipolar only, or instead, therapy may not occur, though the meds may help. Because the treatment is not specific to BPD, the patient may feel lost and give up. Frustrated. Like their wrist is broken but they have a cast on their elbow, the cast may help, but the wrist is still broken.
Age. Many will not wish to provide a diagnoses of Bipoar or BPD at ages below 18, and this applies with other disorders. These are still developing years, though symptoms may be somewhat clear, the diagnosis may not be. This is sad as the teen then loses many years of potential treatment, the longer a disorder goes without treatment, the more difficult it is to treat.
There is a tremendous amount of stigma attached to BPD. Much of it because it is not understood, yes it can be difficult to understand. Like any disorder, untreated, the person suffering may be erratic. Lets put it in perspective though, if you had a broken leg.. and it went untreated, would you behave “normally”? Is it really different? Because there is no stigma attached to a person with a broken leg.
Because of the stigma attached to BPD, some are reluctant to attach this label to a patient. To further burden them with discrimination.
We only fear the unknown. We should take the time to learn, not fear, not judge. But support. To learn ways we can support. To remove the stigma.