I've been receiving mental health(?) services since 1971, have had numerous psychiatric hospitalizations and been on all sorts of medications, but it was not until 1998 that I was suddenly considered to have a bipolar disorder. Prior to that I was primarily diagnosed with major depression and borderline personality disorder with eating disorder and PTSD manifesting in my forties. I have never fully accepted the bipolar diagnosis, nor have any of the new atypical medications offered any positive results, in fact, I am inclined to believe those medications have actually worsened my symptoms.

Primary care physicians + meds training by drug companies + faked studies + scripts for antidepressants = bipolar disorder!

I think the axis 2 diagnosis just as absurd as bipolar and no more valid. As for depression, it can be a very painful phase....the point being if, as Nasser Ghaemi writes in his blog, there's no valid distinct disease called bipolar disorder, when someone is so labeled it usually doesn't mean they have some other medical disease but instead that their emotional discomfort is not a medical problem.

There is only one true bipolar disorder -- Bipolar I. The rest is bullshit and spawned by Big Pharma to make money. In other words, there is no money in Lithium -- the gold standard for treatment of Bipolar I. It is a travesty that so many "labile" individuals are being jacked up on pharama cocktails that destroy their livers. As Vonnegut once said, "So it goes."

Well, for better or worse the acceptable number for the majority of neuroimaging studies is 20 per group! (Including the infamous studies trying to link the brain imaging data to psychiatric diagnoses.)

Eighty-two doesn't sound that bad in light of the numbers for brain imaging.

I think borderline personality disorder carries even more of a stigma than the bipolar tag. I'm not sure what's to be gained from replacing someone's bipolar label with the borderline label.

What's gained by telling them they are "Borderline" is a clear distinction that they do not have a disease to be cured by taking useless psychotropic drugs. Psychiatry mostly admits it is horrible at treating personality disorders. However if we call you "bipolar nos" we can prescribe you pills. I spend a lot of my day trying to explain to people regardless of what we call them, there is little support for meds as curative. Many do not like to hear this. They have been brainwashed by the "bipolar" label.

I am not a professional and not too familiar with psych disorders, but my understanding is that soem BPD behaviors are quite similar to bipolar (eg. mood swings, impulsive behaviors, possibly suicidality). I seem to remember there was a study a few months ago that said that BPD was often misdiagnosed/underdiagnosed. But then again, BiG Pharma seems to be getting its hands on BPD as well, so I'm not sure whether this will have any effect on drug use/misuse.

Astrid,

I would have to agree with Lisa that the borderline label has more stigma than bipolar and harms. After all, borderline is just a phsrink's way of saying that some people are born irredeemably bad. Disgusting really. But some folks who are aware they have the label like it because it's an easy, if fraudulent, way to get social security disablity here in the US.

But we see how in the 60's schizophrenia was the trendy label in the US. In the 70's add became hot, the 80's were the decade of depression and then all of the same people, not people that have similar symptoms but people with the bad luck to be in a position to get a label (i.e. diagnosis) got labeled as adhd for a lot of the 90's before bipolar became trendy.

Surely just the fact that the same people keep having their labels switched should go a long way towards have psychiatry exposed as nonsense, a scary thought error.

I've known a ton of people (almost all female, for what it's worth) sporting the BPD label. ALL were drugged to the gills. All. It was polypharmacy at its most extreme. I always figured it was to shut them up, since no one in the mental health profession wanted anything to do with them. After all, they were Borderline, don'cha know.

Sally, I have at least 15 diagnoses in my little mental health shopping bag here. None of them fit. Do you think I could return them for credit?

Sherry,

I think most pshrinks have a deal where if you go in and attempt to return your diagnoses, they'll give you two or more brand new ones, especially with the dsm 5 on the way out, but I get the feeling you might not like the new ones that much either;)

Sherry writes, "I've known a ton of people (almost all female, for what it's worth) sporting the BPD label. ALL were drugged to the gills. All. It was polypharmacy at its most extreme."

Yep.

For the record, the diagnosis of bipolar II has proven far more accurate for me than major depression.

And as for the charge that people with bipolar II are mismedicated (for the most part) -- I plead guilty at least for myself, given all the medication changes I have been through.

But the same problems (except for being prescribed atypicals, of course) happened during the original period I was diagnosed with major depression in the late 90s. In fact, one of the medications actually put me back in the hospital, which is more than ever happened to me with the atypicals, bad though they were.

I am now on a stable med regimen that is helping me, and have been for two years. So consider me a "Minority Report" in the spirit of the Tom Cruise movie :-)

Sally,
I would agree with your assertion that "borderline" is a misused label by some in our field for patients they don't like. But let's be clear, it is a distinctly different diagnosis, in terms of etiologic characteristics and treatments. I agree with jsmd that new well researched psychotherapies, such as DBT, offer hope to many suffering with borderline personality disorder who heretofore have experienced suboptimal responses to multiple trials of various psychotropic medications. The DBT staff at our clinic are patient, nonjudgmental and compassionate professionals who are very skilled and effective in redirecting their BPD patients to better therapeutic outcomes, some involving no medication whatsoever.
Please be careful about painting with a broad brush. The diagnosis of Borderline Personality Disorder is perhaps the best understood of any in the DSM, in terms of its developmental and psychological underpinnings, as well as its clinical manifestation regarding signs and symptoms and psychosocial functioning. Incidentally, comorbidity is quite common with this diagnosis, including a lifetime prevalence of at least 1 episode of Major Depressive Disorder in 84%, but only 10% having Bipolar Disorder (per Menninger/Baylor research). To the contrary, I think such patients have been done a great disservice by the false labeling of "Bipolar" based on superficial symptom checklists, or merely from subjective complaints of "mood swings".

Scott,

Obviously the cause of borderline personality disorder is being diagnosed with it. None of the dsm diagnostic criteria are unique to this condition or in any way unique to "mental illness." It's a classic blame the victim label.

I do however agree with you that bipolar disorder is over diagnosed.

Scott, while the staff in your clinic may be nothing but compassionate to those labeled with borderline personality disorder, the problem is the rest of the world doesn't see this diagnosis the way you do. I have never, not in all my years of working in health care, seen staff (including those who specialize in psych) upon hearing that the patient has this diagnosis do anything other than roll their eyes and groan. This is before they've ever met the patient.

The day I see the rest of the world treat those labeled with this diagnosis with respect and compassion, then I may agree with you and jsmd that the diagnosis is helpful to the patient. One thing is certain, however, by diagnosing someone with this you are insuring that the patient's concerns will never be taken seriously by health care staff outside of your clinic, thereby increasing the frustration of the patient and reinforcing the diagnosis they've been given.

Liza,

You are correct that the stigma of the label reinforces the diagnosis. It's a self fulfilling prophecy. Take the first 2 dsm criteria:

1. frantic efforts to avoid real or imagined abandonment.

2. a pattern of unstable and intense interpersonal relationships characterized by alternating
between extremes of idealization and devaluation

With 1, of course in the context of "Mental health treatment" obviously the diagnosis causes the the therapist to want to dump the "patient" on some other therapist, real abandonment. So you treat someone who is afraid of being abandoned by abandoning them. And they wonder why people with the label have a higher suicide rate than people without it.

2. Similar point in that therapist at first believes or pretends to believe that "patient's" concerns are valid then becomes disillusioned and gives the label. How would a sane person handle this? With conditions with such vague and nebulous "symptoms" of course once you get the label, everything you do or say is a symptom of it. Love your pet - symptom, didn't finish college - symptom, divorced - symptom. And yet there are lots of pet loving divorced people who didn't finish college who don't get labeled mentally ill. Why? Because they're not unfortunate enough to have been seen by a "mental health" professional.

The worst of course is the stat that borderlines are more likely to be in abusive relationships. The subtext here is that borderlines are so frustrating to live with that abusing them is somehow understandable. What the correlation really means is that when someone tells a therapist they were abused and the abuse is of a level or intensity the therapist is uncomfortable with, the therapist hauls out the borderline label.

Unnecessary side effects are a significant concern of over diagnosis. Because mood stabilizers are the treatment of choice for bipolar disorder, over diagnosing can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.Once thought of as a single mental illness, bipolar disorder is increasingly recognized as a spectrum disorder, with symptoms ranging from less severe to devastating.