• Daniel

So what is Personality Disorder, PD, BPD, EUPD...?

Well for a start it's an atrocious name, and this label can lead to lots of stigma.

You may hear people saying "she's got pd", or "he's a pd". It's shorthand and a way of categorising people so that others nod their heads and say "Oh right, one of those. The difficult ones".

When I worked in secure services the first thing I was told was that "they" were the hardest to treat. It doesn't really set people off on the right foot does it?

Hopefully one day the powers that be will reach a consensus and change the name, but it's been around a long time and these things take ages. So unfortunately we're kinda stuck with it, but let's just get one thing straight. There's nothing wrong with your personality, and nobody has a right to tell you otherwise. There is no personality graph you are being measured against.

Now associated with this label is the thinking that it needs "treatment". Along with certain other specialists in the field I can't stand this approach in thinking.

For one thing, you're not ill. Secondly medication is contra-indicated for "treatment". It's like saying you must be ill if you don't know how to drive a car. It's daft.

I prefer to think of it as training; so if you don't know how to drive a car, you get lessons and then you learn. You don't get drugs or therapy! You may never be Lewis Hamilton, but you will get where you need to go, when you want to get there. Personality disorder diagnosis just means that perhaps your first driving lessons were via Grand Theft Auto. All we need to do is to work together to retrain those skills.

So in essence what is "PD"; what is this label, what does it mean?

Well in the simplest terms it's a collection of traits, that you may have all or some of, that cause you problems in everyday life; particularly around relationships or emotions.

There are a few variations under this umbrella term and you can read the definitions here:


So when we talk to people with a diagnosis of "PD" or we have a hypothesis that they could be diagnosed with "PD", we're looking for certain things that are predominant in their lives.

For example, if emotions were on a scale of 1 to 10, you could easily reach 10 in anger or a 1 in sadness and would do that a lot and often quite quickly. It might feel like a rollercoaster and friends or family might be wary of you. Another example would be you had a very poor relationship with stress and would perhaps retreat away from situations that you couldn't deal with. You may have a poor view of yourself, constantly criticising and berating yourself. You may be hurting yourself either to gain a sense of control, to bring yourself back to reality or to punish yourself. This self harm may take many forms, from not caring about what happens to you, to overdosing or cutting yourself. You may even see yourself constantly through the eyes of others, fearing their judgement or whether they would leave you. You may have had anxiety and depression treatment through CAMHS and it just never seemed to do any good or you may have had various types of medication over the years.

That's the negative side. but what about the positive side? Well there's the empathy--you may well be an extraordinarily giving person, to your own detriment in fact. You may attract other people who have their own problems and then you find yourself exhausted helping them. You are often very clever but lacking in self confidence, so can shy away. Your mind is often going a hundred miles an hour but you then struggle to sleep. when you are doing very well, you are with the right relationships, highly engaging.

Hopefully this small blog entry might start you reflecting on previous issues, or cause you to question what has gone before. What it may also do is give you an idea of how complex things are, and taking a reductionist approach to you as a human being is a very daft approach. You are complicated; your environment is complicated, your history is complicated. Thinking that you would be "fixed" with a little white pill or through a dose of NHS group therapy is a little incongruous. We need to explore your perceptions and thinking and understand these in relationship with the big wide world, then give you the tools and the mindset to deal with it on your terms.

It's often why standard cbt treatment for "anxiety and depression" doesn't work, or why many mental health practitioners, councillors, nurses or psychotherapists think "PDs" are too hard to deal with!

That's why Saluber exists; combining the best of dialectical behavioural therapy, occupational therapy and best practice approaches.

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