Abbreviations: What's in a name?

What does BPD stand for?

BPD is the abbreviation for Borderline Personality Disorder. It is
sometimes confused when people use BP to mean either Borderline
Personality or Bi-polar Disorder (also known as Manic-Depression).

Why is it called that?

Historically, BPD got its name because psychiatrists found that
patients would often appear with symptoms that could not easily be
classified within the context of a single diagnosis. In Freudian
circles, psychoanalysts saw patients who had characteristics of both
neurosis and psychosis, which was puzzling. More confusion arose
when patients would present a multitude of mix-matched symptoms.
Sometimes traits resembled schizophrenia, other forms of psychosis,
and other personality disorders. This made it difficult for them to
diagnose their patients. Since it was shown that these
clients "bordered" on one or more of the distinct known illnesses,
they received the diagnosis of Borderline Personality Disorder.

Besides its historical origin, in what ways does the
term "Borderline" apply to the disorder?
BPD does look and feel like many other distinguishable mental
illnesses. The common experiences of depression, anxiety, eating
disorders and other symptoms are found in other psychiatric
disorders.

The defense mechanism of splitting commonly employed by those with
BPD produces black and white thinking and an all or nothing
attitude. Sometimes during intensely emotional situations, a person
with BPD may feel they are "on the border" of this or that feeling
or may be indecisive and feel anxiety. Being "on the border" without
a support -a healthy coping skill- the person with BPD may turn to
the familiar tactics, like splitting, to deal with their
circumstances.

Another example of how the word "borderline" may fit people carrying
the BPD diagnosis is in the tendency among clients to border on
achieving success but falling short of reaching a goal just before
it is about to be realized. It's the "almost but not quite" effect;
this is commonly seen in people with BPD who drop out of school
shortly before graduating or quitting a job prematurely or ending a
relationship that feels "too good".

How is the term "Borderline" understood in our contemporary time?

There is still a sense in which BPD is an alternative name for a
complex ailment that has many 'cross-overs' with other diagnoses.
The fact alone that BPD does resemble other illnesses creates
potential misunderstandings. The difficulties associated with the
title "Borderline" trouble professionals when trying to make the
most appropriate, correct diagnosis of a client. For instance, all
people can and usually do exhibit the symptoms of Borderline
Personality Disorder. There is potential for misdiagnosis because of
the prevalence of its symptoms' commonness, especially among
adolescents.

Keeping in mind that "Borderline" characteristics and traits are
common experiences among the general population, it is prudent to
consider the possibility of creating a self-fulfilling prophesy - or
even a loop of self-fulfilling prophesies. The person who has been
diagnosed with BPD may have first presented with some symptoms but
once hearing their diagnosis, they learn to anticipate certain
reactions and responses from themselves. Soon, the symptoms begin to
appear more. Because of this possibility, professionals must be very
careful about diagnosing a client with BPD and must also be cautious
about when to tell the patient of his or her diagnosis.

Unfortunately, a strong stigma has also developed with regards to
Borderline Personality Disorder. Difficulty with diagnosis is often
followed by difficulty in treating people with this illness as well.
It has been tagged as the most difficult of all personality
disorders to treat and has been named as incurable and impossible
for people to overcome. It is generally agreed upon that 2% of the
general population and 20% of all mental health consumers may suffer
from BPD. It is understood by some to be pervasive and all
encompassing and patients are sometimes seen as resistant to change,
antagonistic or rebellious.

Why are some researchers and professionals suggesting name changes?

BPD got its name from a certain amount of confusion and ignorance
about its true nature as psychiatric professionals first began to
recognize and distinguish the disorder in their patients. Many
people find the BPD label inaccurate and feel that the stigma
attached to it are decreasing proper awareness and understanding of
what this disorder is really like. Also, as more research is done
with regards to the biological connections to BPD, some researchers
feel other titles would better describe the condition.

What are some of the suggested name changes?

First, it is important to know that BPD is not the only label that
has been officially used to describe this illness. Prior to the
listing of BPD in the Diagnostic and Statistical Manual of Mental
Disorders, Otto Kernberg! named the condition Borderline Personality
Organization, not using the word disorder at all. Kernberg's
contribution to the development of an understanding of BPD is one of
the most important historical topics to be explored. For more
information on this sub-topic, please see the section titled What's
an Axis For?.

The International Statistical Classification of Diseases and Related
Health Problems (ICD-10), published by the World Health Organization
(WHO) in 1992, lists 'borderline' as a sub-type of Emotionally
Unstable Personality Disorder.

Recent suggested names to replace the BPD label are Emotional
Regulation Disorder (ERD), Dyslimbia, Emotional Intensity Disorder,
Emotion-Impulse Regulation Disorder and Complex Post-Traumatic
Stress Disorder. These alternative names reflect the current
approach to a further exploration into the etiology of BPD.

There is also some discussion of 'relocating' BPD in the next,
fifth, edition of the DSM. Those experts who disagree that it is a
personality disorder have suggested removing it from Axis II.
Alternative suggestions have included placing it under the heading
of trauma spectrum disorders or under dissociative disorders, which
are both on Axis I.

Copyright Lisa Marie Kuhn 2003
http://b4c.webs4christ.com/

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