This Life: Diagnosis only a start

Labels are great for food, but they fail to enlighten us on a condition termed BPD, says Anna C Young

I have been aware of borderline personality disorder (BPD) since I was 19 but it was only recently, while doing research into whether the condition exists, that I have come to understand its meaning.

There seems a lack of scientific evidence. What there is for eff ective treatment tends to be for specifi c psychological therapies rather than for mental health teams. Filling in a questionnaire for a BPD therapy programme, I found I could associate myself with all the points in the description of the condition, known as the DSM-1V score for each diagnostic criteria. But is it a useful term? Is it a diagnosis that is helpful in a clinical context or is it just a catch-all phrase, into which people with difficult mental health problems are dumped?

For me the term BPD is controversial. As someone with cerebral palsy and a wheelchair user who has been diagnosed with  BPD, my physical disabilities are seen as paramount by professionals and laypeople alike. My BPD gets overlooked, yet I have always maintained that my personal mental health difficulties are greater than my physical difficulties. In my experience, the greatest problems are always the attitudes of others.

I was assessed recently for treatment for my BPD condition and the experience was not a happy one. Any form of clinical contact for someone with mental health difficulties can be distressing for them, and this is particularly so for BPD suff erers. The process of assessment can be positive and enlightening but this is only when handled by a clinician with considerable experience and strong communication skills. In my case, I suspect my physical disabilities once again intervened. However, a dual diagnosis is only an issue if people make it one.

My unease with the term BPD is because it is all too easy to give people a label so they can be classified and this attitude can mean people’s individual requirements are overlooked and unmet. Now I’m part of a therapy group of BPD sufferers and we are a mixed bunch. Does group therapy work for such a diverse group? Some are trying to change their lives, some are not. For me, one-to-one therapy can deal more eff ectively with the lack of a secure base that is the central component of BPD. If developing a reflective capacity and functioning is necessary, as most clinicians believe, then having a label is less important than identifying individual therapeutic needs.

I am in favour of classification systems that can be used as a diagnostic aid by clinicians of integrity. The DSM-1V classification acts as a guide to shared systems and can point the way to effective treatment programmes. My unease with BPD is that it is too wide a definition  to be useful.

As a label BPD is more confusing than it is helpful – we should leave labels to food and jars. People need to be seen as individuals. A BPD diagnosis is a starting point; it is not an end point.

Anna C Young uses a wheelchair and has mental health problems