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Struggling with personality disorder

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Mark Easton | 12:30 UK time, Thursday, 26 November 2009

We like to see the world in black and white: a landscape of villains and victims; good and evil; right and wrong.

These labels allow us to make easy moral judgements about others, to apportion blame and sympathy. It seems to be an involuntary human response. Who has suffered? Who is at fault?

Indeed, many of the stories in today's news are about the process of allocation: the Iraq War Inquiry; reports of crimes and the courts; response to the credit crunch.

We extract complexity and nuance until we have distilled events to the point where their human constituents can be placed in monochrome boxes marked "saints" and "sinners". Every narrative becomes a morality play.

Take the heart-rending story of Baby P. The toddler we now know as Peter was a tragic victim of abuse - torture which ultimately led to his death.

Those who carried out the abuse have been described as "evil". Blame was also heaped on some of the professionals involved in the case.

But what if Peter had been saved? What kind of person would he have grown up to be? We can never know, of course. But we do know that young children who suffer serious abuse are more likely to develop a personality disorder (PD) in later life.

In a recent academic paper, researchers studied 50 people with PD. Of those, 44 had experienced abuse and most of them blamed it for their problems.

The deviant and sometimes anti-social behaviour which defines PD may well result in such individuals ending up in the criminal justice system, at which point the victim becomes the villain.

Peter's mother was herself seriously abused as a child. At some point in her life, she was moved from the white box to the black.

The question about Baby P was raised by psychiatrists at a conference I attended last week. The first National Personality Disorder Congress brought together professionals, PD service users and their carers to "celebrate developments in the personality disorder field".

But for all its up-beat tone, the event forced me into uncomfortable territory, a place where moral and medical judgements are blurred and the idea of personal responsibility is tested. Where does fate end and fault begin?

Two hundred years ago, clinicians began to focus on criminals whose offences were so abhorrent that they appeared insane and yet didn't suffer from any recognised mental illness.

The term "moral insanity" was coined, a description of a condition where intellectual faculties are unimpaired but morals are deemed "depraved or perverted".

However, as early as 1874, the pioneer of psychiatry Henry Maudsley suggested that the phrase portrayed "a form of mental alienation which has so much the look of vice or crime that many people regard it as an unfounded medical invention".

We now use the term personality disorder, but the argument has not changed. Recent guidance from the National Institute of Health and Clinical Excellence (NICE) notes that: "there is considerable ambivalence among mental health professionals towards those with personality disorder.

"Some see this label as sanctioning self-indulgent and destructive behaviour, encouraging individuals to assume an 'invalid role' thereby further reducing whatever inclination they might have to take responsibility for their behaviour."

"The alternative view", NICE continues, is that people with PD "have complex health needs that ought to be identified and addressed, either within or alongside the criminal justice system".

I met dozens of people with personality disorder at last week's conference, many of whom had had dealings with the police and courts over the years. But none looked like Hannibal Lecter.

Kayla KavanaghThe woman pictured is Kayla Kavanagh, an Irish musician who is a regular on the festival circuit, has just completed a national tour, is working on an album and has just released her first single.

Performing at the conference she came across as charming, intelligent and talented. Kayla has also been diagnosed with Borderline Personality Disorder (BPD). She talks openly about her "destructive behaviours", the "state of mind that you just can't switch off" on a short video (which you can watch here).

BPD is described as "a disorder of emotion regulation" which "may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse".

Typically, people with BPD will have "highly unstable patterns of social relationships" in which attitudes towards family and friends may suddenly shift from deep love to intense hatred.

BPD and other personality disorders are classified by the World Health Organisation as "a severe disturbance in the character, logical condition and behavioural tendencies of the individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption".

So when Kayla lashes out or cuts herself is she a victim of her condition or a villain who should control her behaviour?

What about Andy Brooker, another delegate at the conference? Andy has been diagnosed with "severe personality disorder" and spoke about one incident in which he found himself throwing furniture out of the window of his mum's flat. The television, tables, ornaments all went flying - passers-by had to dive for cover.

When the riot police turned up with shields raised, the front-door opened to reveal a man naked to the waist with his chest dripping with blood from self-inflicted slash marks.
Victim or villain? Although he says he was at this stage entirely passive, officers put him in a strangle-hold and were verbally aggressive towards him.

Artwork by Andy BrookerAndy, incidentally, is also highly respected as an advisor to government and the NHS on personality disorder, a director of the charity Emergence and a practising artist having had exhibitions at the Tate Modern and other galleries.

Such people do not easily fit into black and white boxes. Instead, they present us with disconcerting questions about free will and self-determination. Should we pity them or punish them? Treat them or imprison them?

The rule of thumb for most people, I suspect, is whether such people are capable of controlling their behaviour. But what does capable mean? A woman whose drink problem causes her to neglect her child is likely to be regarded as a villain.

A woman whose depression has the same result might well be seen as a victim. And yet alcohol abuse and depression may be different sides of the same coin, both perhaps triggered by some historic trauma.

People with PD will say that when they behave in a deviant way, it is prompted by something inside them that they cannot control. We all "lose it" sometimes, a display of temper, unkindness, self-loathing or self-centredness which we bitterly regret later. "I wasn't myself", we might say.

It seems to me that personality disorder sufferers "lose it" more often and more intensely - sometimes with devastating consequences for themselves or others.

The head of the Department of Health's Personality Disorder Programme, Nick Benefield, produced this slide to give an idea of the range and scale of PD in England.

Chart showing range and scale of PD in England

Included in his definition are more than five million people. It is likely, therefore, that everyone reading this post will either be a sufferer of PD or will know someone who is.

One piece of UK research suggests that up to 13% of the general population, 25% of GP consultations in deprived urban areas, most people in prisons, at least half of homeless people and between a third and two thirds of inpatients in psychiatric hospitals have diagnosable PD.

Officials generally work on a figure of about 4% who would benefit from help - roughly two and a half million people in Britain.

If you want to see whether your own characteristics would potentially lead to a diagnosis for PD, there are online assessment tools here and here.

I sometimes wonder whether these very broad definitions help or hinder. There is such a difference between a violent psychopath and someone with mild obsessive-compulsive PD that there must be a risk that attitudes to the former may hinder help for the latter.

A useful primer on the subject - Ten things to know about Personality Disorder explains how many clinicians and service users dislike the term because of its pejorative sense.

They also find the 10 categories of PD (defined here) unhelpful as most people with severe problems have a mixture of them, and the exact diagnosis does not help in deciding on treatments.

One of the psychiatrists I met at the conference, Dr Ian Kerr from Lanarkshire, told me in an e-mail that "the term PD MUST BE SCRAPPED" (his capitals). He argues that there are many reasons why it is unhelpful:

"[S]tigmatising, historic baggage, implication that it is something about the core or essence of an individual that is somehow 'wrong', or the confusion and overlap in forensic circles about PD and 'murderous crazed psychopaths' which has nothing to do with the majority of so-called PD sufferers."

Dr Kerr thinks it would be better to describe it as "post-complex-trauma syndrome/disorder" which gives a clue to what some experts think triggers the disorder.

The trauma might be childhood abuse or, as in the case of one PD sufferer whose family talked movingly at the conference about her suicide, it resulted perhaps from nearly choking to death on a walnut shell as a toddler.

We don't know. Research is thin. And there are some who argue that doctors' attempts to find a therapeutic label for it are in danger of simply medicalising bad behaviour.

However, we have come a long way since the term "moral insanity" was coined in the early 1800s. In January this year NICE published its guidance on how to treat both borderline and anti-social PD, official recognition that people with a diagnosis for personality disorder deserve help and can benefit from treatment.

But the dilemma remains. Not every trauma victim goes on to abuse. Not every neglected child self-harms. Society cannot easily forgive or excuse those that commit appalling crimes on the basis that it is a consequence of a troubled past.

The question is still unanswered. Where does personality end and disorder begin?

Comments

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  • 1. At 1:48pm on 26 Nov 2009, Maria Ashot wrote:

    Thank you for drawing attention to this crucially important subject.

    As a non-professional, having huge respect for your field, I am enormously grateful to all who seriously commit to this field os essential study.

    My impression, from having thoughtfully brought up three young people and living in a marriage with a man who had very young, overworked parents in a village environment where not much thought was given to anything beyond forcing obedience from offspring -- almost an any price: the most important investment is of time early on in life, indeed even from gestation and infancy.

    The younger they are, the more they thrive from undivided attention. The more undivided, focused, unstinting and loving that attention is, early on, the healthier the personality.

    A child who is constantly waiting, constantly hungry, constantly being punished or held to account for things clearly beyond their capacity to comprehend will grow up mistrustful, unhappy, fearful of others & at times inevitably full of self-loathing (if introverted) and manipulation (if extroverted).

    Boys, in particular, whose parents believe they need to be "toughened up" so they are sufficiently "manly" are in fact profoundly vulnerable to signs of disapproval, rejection or venomous criticism.

    To have less BPD or PD in society, I think what you must have first are more enlightened, educated, thinking and resourceful parents -- and more social support for those parents, so that they have the necessary time to really focus on any child they bring forth or assume as a responsibility.

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  • 2. At 2:28pm on 26 Nov 2009, Tempus115 wrote:

    I tried the first of the online tools you mention. I'm not impressed. It said 'be honest', but a lot of the questions, taken literally, are ones everyone would answer yes to now and again, e.g. 'Do you get angry when your expectations aren't met?' So the builder promises to come next week, you take time off, he doesn't show; it happens again; you don't feel angry?

    Taking the assessment literally, it labels me with almost every personality disorder on offer! So I did it again, not literally, and came out 'very high' borderline. Why? Because I sometimes get angry and have suicidal thoughts -- even though I don't show any of the other borderline symptoms listed under 'more info' for BPD, like impulsivity or relationship conflict!

    What happened to differential diagnosis? I know the test doesn't claim to diagnose, but nuances like the difference between 'assessment' and 'diagnosis' tend to get ignored. I could have depression, be grieving, be a binge-drinker, have post-traumatic stress disorder or just be working for a lousy boss. That's five 'assessments' with very different implications for me and my treatment. Meanwhile, the worried well have yet another label to torment themselves with. Jerome K Jerome's remarks on housemaid's knee spring to mind as a cautionary tale.

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  • 3. At 2:54pm on 26 Nov 2009, John Airey wrote:

    Thank you for writing this post. I personally do not think that anyone is ever not responsible for their conscious actions no matter what abuse they have been subjected to. The abuse is important to take note of in any punishment that is given, but that does not absolve them of responsibility.

    Unfortunately in the area of mental health (which abuse almost inevitably leads to) the media often portrays sufferers in a stigmatising way, eg schizo kills with knife. This leads to more discrimination against those who suffer from these problems. Worse still it prevents people from seeking help in the first place.

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  • 4. At 3:14pm on 26 Nov 2009, General_Jack_Ripper wrote:

    I tried both of the on-line diagnostic tools and in all but one area I got widely varying results.
    I know they're not supposed to be definitive but I found the results varied so much that they ended up giving a contradicting diagnosis of my personality.

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  • 5. At 3:52pm on 26 Nov 2009, Robert Carnegie wrote:

    I once tried an online Asperger's syndrome screening test and I thought most of my answers were what everyone thinks, then my score was almost off the scale. Also about a third of the questions were irrelevant and didn't score at all, presumably to keep you from "guessing" the "right" answers. I assume this is similar.

    We had a "Dangerous Dogs Act" on the basis, admittedly rather shaky, that some dog breeds are just naturally dangerous and should always be restrained or simply killed. It isn't their fault how they were born or how they are, but they're the ones that cause trouble. Britain's population of personality disorder cases are probably more liable to cause trouble as well. What could we do about that? Maybe make everyone take an annual anger management test, and certain things you aren't allowed to do if you fail unless a carer supervises you - drive? drink? So in practice you'd make sure that you passed, unless you couldn't do it.

    We could also expect and require PDs to recognise difficult situations and avoid them. If things go badly wrong then this will come up at sentencing.

    I am not surprised that leading people in politics, business, and the arts are PDs, because often that's how you get ahead.

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  • 6. At 3:56pm on 26 Nov 2009, jon112dk wrote:

    Looking at the statistics/conceptual issues that you mention there's a common place game from the 'mental health' industry at work.

    On the one hand they define the concept very widely to give somewhat silly figures of 1 in X have a problem. It all sounds very common place and suggests you or I could be classified any day.

    Next they cite extreme and one sided anecdotes of riot police and strangle holds.

    Now we have the implication that (a) anyone of us could be so labelled (b) once labelled the riot police are on the way.

    Have a look at the informative diagrams. The actual reality is that large numbers of people exhibit features of some form of PD - and get on with their lives contributing to the community. Tiny numbers genuinely are the DSPD 'hanibal lecter' psychopaths and (quite rightly) get locked up.

    Don't let the 'mental health' industry mislead you. The evil government has neither the interest nor the resources to lock up (or strangle hold) everyone who gets distressed or angry. Frankly, they don't have the resources to deal fully with the tiny proportion who actually are a threat.

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  • 7. At 4:20pm on 26 Nov 2009, John North wrote:

    Where we must begin is to recognise and emphasise that PD is not an illness. It is behaviour. Whatever the disadvantages people have faced in their upbringing there seems to me to be no alternative but to regard them as being responsible for their own behaviour. PD is by no means tightly defined and there is no intervention which we can be confident will "address" the condition. In other words (and like the schizophrenias and other mental "illnesses") elements of PD can be found from time to time in all of us; it is part of the human condition and there is no "cure". It follows that the "victims" of one era may indeed become the "villains" of another as they pass into adulthood. Society will need protection. If there is t hope it lies in the fact that human beings can and do "mature" sometimes with the help and support of a wise counsellor. We get nowhere however if we regard PD, with its slippery and elastic definition, as if it were an illness. This excuses behaviour for which all individual in society must be regarded as being responsible. Johnnor

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  • 8. At 4:23pm on 26 Nov 2009, Matt wrote:

    Like "General_Jack_Ripper" I completed both test with absolute opposite results had high in one type, low in another & the other test had the high type as low & the previous low as high!!

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  • 9. At 4:33pm on 26 Nov 2009, Tim Watkins wrote:

    The term "Personality Disorder" was used by the Home Office solely as a means of locking up dangerous, antisocial and undesirable people under them Mental Health Act. Only a handful of psychiatrists (mostly those in the pay of the Home Office) ever recognised PD as a real illness - much of the Royal College of Psychiatrists' opposition to the Mental Health Act 2007 was around this issue, since they correctly argued that PD could not be properly diagnosed, let alone predicted (while the majority of people given the PD label have been abused, the majority of people who have experienced abuse DO NOT have PD), and they certainly couldn't be "treated" in any meaningful sense.

    I guess what we now have is a group of "bought" psychiatrists looking to justify their continuing existence (and large scale public funding) now that their purpose has been served, by trotting out the offensive lie that 5 million of us have PD or BDP (whatever that is supposed to mean). The Home Office estimates for the prevalence of PD (set out in the consultations around the Draft Mental Health Bills 2002 and 2004) were that no more than 600 people in the UK had PD.

    In short, this is classic "mission creep" pure and simple!

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  • 10. At 4:38pm on 26 Nov 2009, cping500 wrote:

    Actually the problem is not the what the disorder is... the syndrome is fuzzy but usable, but helping suffers, as with all chronic medical conditions, to take responsibility for the condition, as clearly those at the conference do. And for professionals and carers not to ignore their signals of distress, or even as the Met used to do... shoot them. Many of the enquiries into situations which have got out of hand demonstrate this latter a one of the proximate causes of disaster.

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  • 11. At 6:29pm on 26 Nov 2009, paul wrote:

    Hi Mark

    Thanks for doing a great post which covers the key issues. I'm a clinical psychologist who works with people who could be classified as having PD and it's good to see some coverage of this area.

    You rightly point out that the question "Where does personality end and disorder begin?" is unanswered. This is the case with many psychiatric concepts. No-one has yet been able to offer a satisfactory definition of 'delusion', for example.

    However I believe this type of question can lead us down the wrong path. Such questions can cause conceptual confusion, blind us to what really matters and attempts at answering them are often implicated in both paternalistic and neglectful behaviour by MH professionals.

    Rather than ask "does this person have disorder X?", I believe we should instead be asking "should we offer this person help?"

    In answering this last question we need to consider 6 things;

    1. Level of current subjective distress and suffering.
    2. Risk of future distress and suffering if not offered help.
    3. Whether their capacity to make consequential decisions is impaired.
    4. Whether they are at high risk of losing capacity to make consequential decisions if not offered help.
    5. Available resources.
    6. Whether we can help.

    These criteria allow us to do three things; reduce suffering, promote autonomy and abandon the controversial and alienating concepts of abnormality and disorder.

    A good resource on this is Professor Derek Bolton's book "What is Mental Disorder?". Another good resource is the online Stanford Encyclopedia of Philosophy's entry on mental disorder.

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  • 12. At 7:04pm on 26 Nov 2009, Randi Kreger wrote:

    I am seeing so much inaccurate information and bias in this article I don't know where to begin. I am the author of three books about borderline personality disorder and have a website about it as well.

    At first, the article bemoans the tendency we all have of splitting, or seeing things in black and white. It then goes on to examine personality disorders (PDs) in black and white (!): "are people with PDs to be innocent, a victim of a mental illness, or terrible nasty people who claim to have PD that doesn't exist--it's just an excuse and they deserve to be in prison?" (Quote from article: "Should we pity them or punish them? Treat them or imprison them?".)

    In reality, there is a middle ground: they have a disorder, AND they are responsible for their behavior. And anyone who doesn't think that PD's don't exist are incredibly far behind the times and ignorant of the latest research.

    The article contains a link to a PDF that states, "Personality disorder is not an illness you catch or are born with, but is a 'way of being' you develop while growing up." In reality, we have begun to identify the genes that contribute to traits common to BPD, including impulsivity and emotional instability.

    The ignorance of the biological risk factors of the disorder (neurotransmitter imbalance and problems with the limbic system) continues with this quote, which contains the assumption that all BPD is caused by abuse: "Dr Kerr thinks it would be better to describe it as "post-complex-trauma syndrome/disorder" which gives a clue to what some experts think triggers the disorder."

    I have heard that knowledge of BPD lags in other countries, compared to the USA. I didn't know the UK was this far behind.

    Randi Kreger
    Author, “Stop Walking on Eggshells,” the “Stop Walking on Eggshells Workbook,” and "The Essential Family Guide to Borderline Personality Disorder: New Tips and Tools to Stop Walking on Eggshells."

    (Available at www.BPDCentral.com)

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  • 13. At 7:04pm on 26 Nov 2009, steelpulse wrote:

    Quote : The question is still unanswered. Where does personality end and disorder begin?: Unquote
    Mr Easton, interesting piece. The insistence on either saint or sinners as shorthand for "what we have here is....!" chimes, by some commentators at least. And it aint ever that simple in my opinion.
    Can I suggest an answer to the query at the end of your thread? Or rather suggest that trying to give the two, personality and "disorder", beginnings and ends in exclusion of each other may not be possible in many if not all people.
    But thanks for the thread.


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  • 14. At 7:12pm on 26 Nov 2009, Randi Kreger wrote:

    This comment was removed because the moderators found it broke the House Rules.

  • 15. At 9:42pm on 26 Nov 2009, John Ellis wrote:

    PD was the first disorder i was diagnosed with at the age of 15 it was also called attention seeking selfish behaviour. Emotional blackmail.

    Randi Kreger
    "The ignorance of the biological risk factors of the disorder (neurotransmitter imbalance and problems with the limbic system) continues with this quote, which contains the assumption that all BPD is caused by abuse."

    So your basically saying that a ajuant/fault in the CB1 receptors or a lack of them can and will lead to such disorders. a fault in the endocannabinoid system? Would treating this imbalance in the limbic system with cannabinoids in the THC and THC/v's families be more effective than the current antipsychotics that are so freely given out.?

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  • 16. At 9:45pm on 26 Nov 2009, John Ellis wrote:

    http://www.ncbi.nlm.nih.gov/pubmed/18974922

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  • 17. At 10:52pm on 26 Nov 2009, John Ellis wrote:

    'The cannabinoid CB1 receptor and the endocannabinoid anandamide' in the treatment of mood disorders

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  • 18. At 02:32am on 27 Nov 2009, Andy Brooker wrote:

    Hi my name is Andy Brooker I met Mark Easton at the PD Congress in Birmingham last week

    I am posting to put the event that he describes in his blog in context it happened ten years ago during a suicide attempt.. after experincing many years of exclusion, stigma, ignorance, indifference and systemic abuses of power by so called mental health professionals my condition had worsened to a point where I could no longer bear the emotional pain any more.

    I have only a vague memory of the event as I was experiencing what i now understand to be a transient psychotic episode or disassociative state during the time I was throwing things through the window. I wanted to explain to anyone who reads Marks piece that even though this incident was the 2nd serious suicide attempt in a relatively short period of time I was not sectioned when assessed at A&E that night!!! not because I didn't pose a risk to myself and others but because of my PD diagnosis.

    I had to return to the scene of the devastation just hours after the police arrived I was still in a terrible mental state and in significant pain after lacerating my chest and arms and overdosing my parents where in a state of shock also and we had to clear up all the debris and blood. I was crying my Mum was crying and my father did not know how to cope with what he saw.

    We received no support from the local CMHT and at the next outpatients appointment with my consultant pyschiatrist we where met with his usual defensive denial of the seriousness of the situation and again I was forcibally persuaded to accept that in his opinion I was not suicidal. Even though I had written a suicide note overdosed on paracetomol attempted to hang myself and cut my wrists and chest with a razor blade 40/50 times. It still took another 5 years of unremitting mental agony and further attempts at suicide before I was finally admitted to the Henderson Hospital a residential Therapeutic Community in the summer of 2005.

    I was then aged 39 I first came to the notice of CAMHS at aged twelve but had been not been able to access appropriate treatment for 27 years.

    My personal view is that the because of the stigma surrounding this diagnosis so many people are just left and left and left, they suffer more and more and more for years and years and years just like I did... some, just like me, finally cannot bear it anymore and either attempt suicide or act they're distress out on other people and end up in the criminal justice system.

    70% of all completed suicides in this country are made by people who have a Personality Disorder.

    As Nick Benefields chart shows the resources to treat and care for the significantly larger population of people with PD outside of the CJS/Forensic field is disproportionately lower.

    The Henderson Hospital which had been successfully treating people with PD for over 60 years closed after a commisioning fiasco in 2008.

    Another centre of clinical excellence Main House in Birmingham that also specialises in treating people with moderate to severe PD is about to close as well due to similar funding issues.

    My fear is the loss of these two reputable centres of clinical excellence for Personality Disorder will put a burden on other services. Even worse more people will not get the type of intensive treatment they so desperatley need and could inevitabley lose hope and take their lives or end up "acting out" impulsivley because they can no longer live through each day with the intolerable mental distress of having PD and end up in a secure unit or prison for years and years and years...

    My experience of having PD and the decades of exclusion stigma professional indifference and systemic abuses of power is very common and despite the tireless work of many dedicated and passionate professionals in this field and the campaining and informing voice of service users/ex service users like myself and our carers we still have a long way to go as a nation if we are to prevent, care, treat and support the significant number of people who's lives are ruined by this life threatening condition and those who are at risk of developing it.

    Thank you for reading my post
    Andy Brooker EMERGENCE incorporating Borderline UK and Personality Plus

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  • 19. At 09:30am on 27 Nov 2009, General_Jack_Ripper wrote:

    Andy Brooker #18

    Hi Andy, thanks for sharing your experiences with us all here, you've certainly given us a lot to think about.
    From an outsiders perspective it appears that the diagnosis and treatment of PD is about as effective as the rest of our mental health provisions, in other words, totally inadequate.

    I don't want to make this a party political argument here but I've got to say that our already poor mental health services have been woefully neglected under this government, in our area we've seen lots of people who used to be treated at residential centres or assisted living centres have now been moved back into the community with little or no support and this has lead to a lot of problems both for the individuals concerned and the community they have been placed in.

    I'm no expert in this field but it appears to me that what most people with these problems need is support and the knowledge that that support is there when they need it, unfortunately budget restraints and inexperience or even ignorance of the problem within the health service itself is preventing this support from being given.

    My greatest fear regarding this issue is that with the coming financial restrictions the government will be facing we will be seeing many of the front line services for mental health either cut back or removed altogether and this could have a catastrophic effect on many people’s lives.

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  • 20. At 10:13am on 27 Nov 2009, Dempster wrote:

    The question is still unanswered. Where does personality end and disorder begin?

    The answer is at Her Majesty’s Revenue and Customs, your personality ends there are and disorder begins.

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  • 21. At 11:51am on 27 Nov 2009, michelle ayres wrote:

    Attending the congress was really heartening for me. I have worked in mental health for over 25 years. It is good to see the positive government moves to enable service providers to support clients with personality disorders. It did however feel somewhat 'top down' to me at times although there were some great initiatives working from the 'bottom up' in terms of projects, art work, support centres etc.
    See also www.bpdtool.co.uk - a pictorial framework for clients and clinicans which can be developed with individuals in a creative way.

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  • 22. At 12:02pm on 27 Nov 2009, Lesley Campbell wrote:

    I agree with the others on the topic of self-assessment. I don't think it is responsible to point people in the direction of these tools. Especially the 4degreez tool, which has been an age old internet meme, one I think I completed for the first time as a 15 year old back in 2001! It certainly isn't a serious assessment.

    However it is so refreshing to have someone in the mainstream press highlighting personality disorders and taking them seriously. PDs are so often regarded as a rubbish catchall for difficult Mental Health patients and it is time that it is seen as a valid diagnosis and a condition worth treating.

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  • 23. At 12:03pm on 27 Nov 2009, stanilic wrote:

    It goes beyond personality into definitions as to what is normal?

    How far are our reactions to what we choose to define as a Personality Disorder, behavioural responses determined by cultural references? To my mind the British are instinctively puritanical and far too deferential towards authority. Not only should you not frighten the horses, you must also know your place.

    Abuse can proliferate within such a society as it is easy to define those who are just being different as criminal. This can allow the abuser to avoid detection as his victims are dragged howling away to mental institutions or even prison.

    In previous times individuals with what we would call a personality disorder have been accepted as religious ecstatics, great artists, witty eccentrics, famous inventors and the like. I have been fascinated to recently discover that the 3rd Duke of Bridgewater, who initiated the widespread use of canals in the primary phases of the Industrial Revolution, was deemed at the age of 12 to be ineducatable. He was just different and fortunately for him had the personal fortune to remain different.

    The question we have to address in dealing with individuals defined as having personality disorders is are we really dealing with a social or even a cultural disorder in ourselves. Remember last year we had a massive banking crash caused by irrational exuberance matched to gross stupidity, but the people responsible were considered perfectly normal and had been previously extolled as paragons. Chucking a bit of furniture about is very small beer in comparison.

    Who has the problem? What is normal?

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  • 24. At 12:18pm on 27 Nov 2009, jon112dk wrote:

    There seems to be an interesting theme here - the demand for 'support' from the health system and the relationship with medicalisation.

    Part of the reason that record spending on 'mental health' is not achieving results is the constant widening of the definition and rising demands on what 'health' is supposed to cover.

    To what extent is it a 'health' issue if someone exhibits distress and disturbing behaviour? Is getting distressed or angry and cutting yourself an 'illness'? Is it in the province of 'health care'?

    How about the person who has never exhibited a 'mental health problem' loses his job and (understandably) becomes low in mood? Is that an 'illness'? Or is it a perfectly normal experience? Should it be labelled 'depression' and attract health funding?

    One of my work colleagues offended me this morning - we'll work it out. What if I fail to control my anger and hit him - could I label that a 'health problem'? ("impulsivity" "lack of control of behaviour") Would you like to pay for it via the NHS or would you want the police to deal with me?

    How much of human behaviour/experience do people want medicalised?

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  • 25. At 1:28pm on 27 Nov 2009, Marianne wrote:

    Your article on Personality Disorder is most interesting. An historical dimension to the defining of mental disorders is worth consideration. Back in the 1920S and 1930s, some of the people who were classified as 'morally insane' were young women who had given birth to babies outside wedlock. The fact of having had sexual intercourse before marriage was, in itself, considered to be proof of 'morally insanity'. Young woman who were incarcerated as a consequence of their 'immoral behaviour' often spent the rest of their lives in psychiatric hospitals such as Napsbury in London Colney. It is also worth noting that the psychiatrist Henry Maudsley was among those who accused the pioneering young doctor, Marie Stopes, of immorality when she proposed that research be undertaken into the sexuality of women - a subject that was then taboo.

    Meanwhile, in France, the psychanalyst Lacan maintained that there was a clear and unbridgeable distinction between 'neurotic disorders' (that are susceptible to talking cures) and psychotic disorders that could be treated only with medication. Now, it seems that many specialists in the field disagree, arguing that it is possible for an individual to move from a neurotic to a psychotic disorder, and back again.

    Looked at from these various angles, the sciences of psychiatry and psychotherapy seem to lack rigour to say the least. I think that there should be much greater scrutiny of some of the labelling, linguistic constructs, theories, and practices adopted, but these professionals are remarkably opposed to any form of outside scrutiny or regulation. In the private sector, psycho-analysts and psycho-therapists can charge huge amounts of money to clients with presumed mental health disorders, but they are universally opposed to any form of external evaluation of clients' progress. 'It's up to the client to choose whether to continue or not' is the usual stock answer.

    The now widespread practice of using some of these pseudo-scientific labels outside clinics is also a cause for concern, and poses a real threat to individual liberty. For example, is it right to label Wittgenstein as suffering from a disordered personality, as one psychologist did, merely because he didn't understand Wittgenstein's semantic philosophy? Would we want to label an insurance clerk who prefers to spend his evenings reading Tolstoy or writing literature himself (perhaps another Kafka) rather than watching football with his workmates at the pub as anti-social or, God forbid, 'a loner'?

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  • 26. At 4:31pm on 27 Nov 2009, David Murrell wrote:

    Marianne - Well as someone who would rather sit in the pub alone reading a book, or writing than go to a party or watch football with the lads, I think I have a personality problem.

    Possibly disorder is going too far, but I know that I find it difficult to look people in the eye, especially if the person is female, does not matter if they are a friend, work colleague or a shop assistant. I find large social gatherings almost physically painful, I have a tendency to sit in the corner and drink, sometimes I drink enough to get some confidence just enough to make sure that I make sure that I make a prat out of myself.

    I know I have a problem and I know that it affects my life, I don’t go and chat up the pretty girl at the bar, so I go home alone. Am I happy, most of the time since I enjoy my both my own company and that of a good book, but I could be happier. I avoid meaningful human companionship, so I miss out on most of the really good parts of life.

    Do I want to be medicated, not really, I am a lot better than I used to be, it only takes me weeks to make new friends, not months. I suppose if I was sensible I would find out if anyone could help me, but I am wary of the stigma that still exists about these things. After I would rather be alone than thought a self pitying drama queen!

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  • 27. At 6:23pm on 27 Nov 2009, bizarreAllegra wrote:

    Much though use of the term 'personality disorder' may be in dispute among clinicians, it is still widely used, and as long as this is the case I think you should be careful about bandying the term around in an indiscriminating fashion.
    At present the diagnosis of personality disorder is subdivided into numerous different types (for example in DSM-IV - the Diagnostic and Statistical Manual of Mental Disorders). The type you seem to be talking about in your blog is 'antisocial personality disorder' (which includes the condition that covers those formerly known as 'psychopaths'). As well as this, however, there are types of personality disorder such as avoidant personality disorder, sufferers from which experience feelings of 'social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction' - a far cry from a personality that could ever have been described as 'psychopathic'.
    I believe that you, and others, are doing a great disservice to people given such a diagnosis by lumping them together in the public mind with those who commit violent crimes or other aggressive acts.
    It is quite possible, as you suggest, that the term 'personality disorder' will ultimately be abandoned, but until this has happened, please let us distinguish clearly between its various sub-categories.

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  • 28. At 04:30am on 28 Nov 2009, NZcommentator wrote:

    Those who in any way interested inthis area, wilhave read "We need to talk about Kevin' by Lionel Shriver. If not, I encourage it.

    A novel, but it touches every nerve about parenting, abnormal childish development, and personality development. Perhaps it strongest theme is of the desolation felt when nothing is right and there seems to be no way to put it right.

    One tip though - when you get to the end, for goodness sake don't look at the 'book group discussion topics' on the last page. You will be recoiling from the conclusion of the tale, and need to soak it up - not immediately read wet attempts to encourge analysis. Some things are better felt, thatn thought about.

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  • 29. At 10:17am on 28 Nov 2009, fiona Thompson wrote:

    I am a service user with a diagnosis of Borderline Personality Disorder. I attended the Congress last week and performed a piece of theatre highlighting the dilemmas and frustrations faced not only by servie users but also their carers and professionals involved in their care.

    Even with a long history of severe self harm, eating disorders and alcohol abuse I can honestly say that the only person I was ever a danger to was myself and have never been involved wth the police or prison system. When I was in treatment I met many people with this diagnosis who were in the same position. I feel that parts of this blog played into public fears that we are people to be afraid of and a potential threat to society when the reality can be very different. Sadly fear of being thought of in this way often kept me isolated over the years and afraid to either ask for help or 'come out' about my difficulties.

    Thankfully I did take that leap of faith and the treatment I received changed my life and while I still have disordered urges I am able to choose not to act on them 99% of the time and am able to have fulfilling and meaningful relationships and recently returned to full time employment. I am grateful for being able to manage my condition and for the help and support I received and it is only due to having experienced such poor mental health that I am able to fully appreciate what so many take for granted, to wake up and not start planning how to hurt myself, to eat a meal without being afraid and panicking, to see a broken bottle in the recycling bin and not think of it in terms of a potential chance to self harm.

    My journey has been long and painful but in recovery I have discovered what it means to be human, to have empathy, tolerance and acceptance. Please let us stop scaremongering and remember those whose worst enemy is themselves.

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  • 30. At 10:32am on 28 Nov 2009, themagus wrote:

    Even while decrying it, there is s till a tendency to go black and white or ‘saints and sinners’ on this issue. Randi Kreger rightfully uses the ‘and’ word: here, it is both permissible and justifiable when she writes “ … they have a disorder, AND they are responsible for their behaviour”.
    Having said that, the work of Dr.Katherine Benziger and Dr. Arlene Taylor on personality assessment gives us useful clues as to who is less likely to correct the influence of an abusive upbringing and who might cope. According to them; we are all born with innate and natural brain preferences - parts of the brain where the flow of electricity through a bath of neuro-chemicals is more efficient. Naturally left brained individuals to whom ‘rational’ thought and routine comes more easily are more likely to cope with problematic youth experiences, particularly if they are naturally extraverted in character. Creative, ‘feeling’ types, particularly when introverted will find the going tougher. For example, entrepreneurial types driven by a natural creativity and a dislike for routine often run the gauntlet when leading balanced lives.
    So when it comes to PD, while the effect of childhood is undoubted, some people are naturally predisposed to better cope than others. More at www.benziger.org

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  • 31. At 11:02am on 28 Nov 2009, oobuc5 wrote:

    very complex ,and what of the person who does control their accelerated emotions,well most of the time ,but makes a concienciouse effort to,
    dyslxia plays a big part in this there are differing degrees on one side
    of it i sometimes have to read a page 3 times ,because some of us speed read so we cant take it in ,on the other hand we can diagnose faults on a complex machine just by looking and listening and a million more thingss

    the thing is i was not diagnosed with it i had to grow up in a system that did not know what was wrong with me ,i did not find out till later in life ,by then it was nearly to late ,

    one point i learnt is ,that your system will adapt to a situation it has to , maths was the worst subject for me [i mean bad ]
    yet i got a job as an engineer on precision gear cutting machines, maintaining and modifing them ,

    the trick is to know the signs when pressure is building not giving in to it ,or if its to great be on your own cuff your self to a pipe an
    drink the bottle,at least yo wont hurt anyone else .

    as for the trigger it depends what has happened to you in your life
    and why ,i think i know a lot of my triggers and i try to avoid them
    i have been out of shape in the past and if bruce willis was in front of me he would have a bad day, i call it gravity perception changes /
    its like a hard drive or an LP, it has tracks on it, track 1 is long the other track diameters get smaller and smaller until the last track and the information on this track is fast and condensed but to all intent and purpose it sounds normal ,the no,1 track has a long way to go to deliver the information ,and the last track being smaller in diamiter
    has to compact the information .
    the common espression they use today is[his brain is wired different]

    i have known people who cant read or write but can do an exellent job of work. a lot of people bought up in the system as we know it are at a disadvantage if up against a person with what you call [learning difficulties ]i have beat a universcity bod to a job ,and i have found faults in cnc machines that a profesional company could not find ,

    some of it is the frustration of knowing you can do better but unless you have papers from the system you cant get the job,

    ok im done

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  • 32. At 12:13pm on 28 Nov 2009, John Ellis wrote:

    31# the common expression they use today is[his brain is wired different]
    All brains are wired the same they just dont have the chemical software to run properly. We try to introduce man made software that mimics what we want but fails to work as it should.

    age 23 Sat in a Park listening to a summer rhythm and blues afternoon.
    1 bad word a switch was flicked, the software crashed something failed within. In the kitchen packets of DG's everywhere I cant do this anymore. empty packets everywhere all the mirrors smashed hands broken and bleeding life slipping away and it did.Many hours hours later pulling out tubes from my throat still aggressive confused, someone says you are lucky to be here. I tell then to polity F O.

    Did I get help afterwards...? Did I get sectioned...? No No and NO. 80+ episodes between 11 and this last one at 23 since then Its been self contained until 6½ years ago when the train tracks looked damn tempting one night on the way home from work that's when I knew the software was crashing again.

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  • 33. At 12:59pm on 28 Nov 2009, curtinman wrote:

    I have known a number of ppl suffering from a personality disorder over the last 10 years. Due to the quite close nature of my relationship with a couple of these people I have come to learn about this disorder .

    I am a health professional myself which helped me discover the nature of these disorders to a degree. If this had not been the case I perhaps would have regarded these people as selfish and nasty. There is no doubt their behaviour IS often selfish and nasty but it is the result of disfunctional emotional developement.

    I have tried(god knows I've tried!)to remain objective and scientific in my view of the antisocial and often bizarre behaviour that I have witnessed at close quarters . I will share some of my common observations of the behaviours that I have seen with the PD sufferers in my life.

    1.PD behaviour at times of stress(to them)is like that of a young child.Perhaps like a temper tantrum but on a grander scale.

    2.Exaggerated reations to negative stimuli . For example I witnessed a mothers reaction to her child falling over and cutting his lip . It wasn't a big cut. The sort that happens to most children . However the reaction of the mother and the "horror" etched on her face was as if she'd seen her child knocked down by a car. It was a real reaction ,she was'nt faking it but it was not proportionate.

    3.Delusional/Paranoid perceptions . Innocent comments often are viewed by a PD sufferor as a personal attack when there was none . This elicits an again exaggerated aggressive reaction . This reaction is dispropotionate but perhaps to the PD it seems proportionate to the actions they perceive to have happened.

    4.An apparent disregard for the feelings of others with extremely hurtful and/or abusive displays .

    These are just a few of the observations I have seen. It suggests that the world of a PD sufferor is one where reactions to situations are not graded in the same way the as majority of the population. This leads to a dynamic where there aren't reciprocal levels of behaviour that are required for creation and maintainance of healthy adult social relationships. In short the behavior they require of others is different from the behaviour that they display and in a major way. The PD sufferor may make friends easily but loses them just as easily and on bad terms. There is a high turnover rate.

    The frustrating thing to me has been their lack of awareness of their behaviour. Can't they see how the way they behave is different from almost everybody else? No they cant. They percieve a different world to most others and what we perceive is our own reality.

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  • 34. At 1:50pm on 28 Nov 2009, FrodoBaggins00 wrote:

    To say, 'even if someone has had an abusive childhood that does not absolve someone of their actions' misses the point. And generally, the media and justice system only perpetuate this simplistic view. The actual fact is, for someone who had an abusive upbringing there is a much shorter distance for them to go (in their mind) before they take the action of committing an act from the point of conceiving it in their mind as opposed to someone who had a healthy upbringing and developed a better sense of impulse control, foresight etc.. Those skills are developed subconsciously from a very young age and depend on many factors.

    Another point is, all these classifications of personality disorders are decriptions of behaviour that is thought of as 'abnormal' correct? But to do that surely there must be a definition of normal as well? And there isn't. There isn't a template for a normal personality. I know some people who might be considered (according to these definitions) to be have a 'mild personality disorder' but then, where do you draw the line between someones personality and them having a personality disorder?
    Also personalities don't fall into strict categories and can change over time. It is problematic to classify human behaviour like this because someones personality can't be reduced to discrete components for analysis but instead they have to be considered as an organic whole.

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  • 35. At 2:29pm on 28 Nov 2009, John Ellis wrote:

    34#
    Another point is, all these classifications of personality disorders are descriptions of behaviour that is thought of as 'abnormal' correct? But to do that surely there must be a definition of normal as well? And there isn't.

    To True one of the major PD's is gender based. Gay people (waits for flack). or do we not include sexual preference as a disorder of the human personality?

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  • 36. At 4:12pm on 28 Nov 2009, bizarreAllegra wrote:

    The novel "We Need to Talk About Kevin" does not, in my opinion, relate to any kind of reality except the author's perception of parenthood and childlessness. I strongly dispute that its cardboard cutout child portrayals have anything to do with the reality of personality disorder of whatever kind. It has been overpraised to a degree.

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  • 37. At 4:18pm on 28 Nov 2009, clamdip lobster claws wrote:

    Having worked with children most of my life it seems that PD occurs early in a child's life. If children are normalised or socialised well, The underlying symptoms can be somewhat mitigated.
    Many parents unconsciously fuel a child's neurosis by not giving them an alternate perspective. For example, a parent polishes her son's fingernails rather than exposing him to more male pursuits. Sometimes the simple act of setting limits and saying "No!" to a child can save him from a lifetime of emotional pain. Often children get a lot of attention from adults when they exhibit certain negative behaviours. It's important not to let these behaviours develop into full blown neuroses. I think the number of children suffering from the real affects of PD are quite low. Childhood has a lot more to do with properly managing behaviours and problems before they turn into full blown crises.

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  • 38. At 6:03pm on 28 Nov 2009, Carol Gearing wrote:

    Hello my name is Carol Gearing; I am the birth mother of Andy Brooker whom Mark Easton mentions in his blog.

    I am rather surprised that Mark seemed to only concentrate on the negative stereotypical view of PD, totally the opposite of what the Congress was all about. My son spoke with great passion about his journey and that of others with PD, about challenging stigma and how without specialist treatment he wouldn’t be in the position he is in now. Yet Mark only chose to highlight and sensationalise the “trashing my home” incident and not the story leading up to it. The decades of professional incompetence, negligence and ill treatment by numerous professionals working in a number of agencies began in his infancy when they failed me as his mother by placing him in a family that was unable to look after him neglecting his emotional needs and violently punishing him on a regular basis for his bizarre and obviously disturbed behaviour. I believe this had a significant affect on his emotional and psychological development and increased the severity of his emerging disorders as he grew up.

    Social Services failed him again at the edge of 12 by failing to prevent further neglect even though his case was investigated when his adopted family requested he be put in a home for mal-adjusted children. When he entered into adult mental health services in his early twenties after a suicide attempt he was failed yet again by being excluded from accessing treatment because of this diagnosis. A diagnosis that I feel in many ways that could have prevented if they had screened his adoptive family more stringently and intervened earlier when the first signs of significant disturbance where plainly evident in his extreme behaviour in both primary junior and secondary school all of which was met with same violent abuse thinly disguised as punishment he was experiencing at home. I heard many stories of vindictive and abusive teachers dishing out extreme physical punishment, only to be met with “I expect you deserved it” by his adoptive parents.

    What angers me the most was that he repeatedly told his teachers, social services a child psychiatrist and his parents that he felt suicidal and nothing was done. My son had tried to get help from those around him and had backs turned on him and doors slammed shut at every which way from very early on in his life.

    As a mother who had to go through the trauma of adoption its was gut wrenching to know that this was going on through all those years when I was lead to believe he was having a better life than I would have been able to give him. Some while after we where reunited (he was then 24) and after trying many attempts at getting him help and failing, myself and his father (my ex husband) went to visit our son in a homeless hostel, we met a broken alcohol dependant twenty something spiralling down into a premature death. It was absolutely heartbreaking he had no real friends, no support from his adoptive parents, his mother sold the house and made him homeless, no hope and no future. Having to see him like that and hear how he had to endure such torment and not being unable to make the professionals understand, I felt totally helpless and useless. Myself and my ex husband where incensed with his parents for not finding help for him sooner, we had to try and pick the pieces of his broken life without having any idea of how to put it back together again.

    When he was eventually housed he was completely unable to look after himself and tried to commit suicide in a matter of weeks leading to my persuading him to come and live with me, to enable him to have structure, not feel so isolated and alone and hopefully find more improved treatment from our local CMHT.

    All I could do through those bleak years when he was self harming and repeatedly trying to kill himself was to keep battling, little did I know at the time but our CMHT was even worse, fighting tooth and nail to get him into treatment. This took us 9 years, during this time he was medicated to a point where we did not know where he ended it began. Due to the entrenched pejorative views held by our local CHMT towards people with PD anything that we tried to get them to pursue failed to materialise or was denied him due to the severity of his condition and his PD diagnosis. If it was not for the year he spent at the Henderson I genuinely believe he would be dead. What is even more sad is that this is not rare, its commonplace for many people with this diagnosis.

    In the last three years since he came out of treatment, he has made some positive moves forward and I am very proud that my son is involved in an organisation that aims to prevent other people having to suffer the decades of alienation anguish and despair that he was forced to endure.

    Like so many others like him, his life story is an indictment on our society that still cannot prevent the type of situations that he suffered as a child from occurring and denies the consequences of those experiences when they manifest in his behaviour as an adult. Would those who bemoan the trajedy of baby P now, but failed to prevent it have felt any compassion for him as an adult who almost inevitably could have developed this disorder and may have become a risk to himself and others?

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  • 39. At 7:53pm on 28 Nov 2009, John Ellis wrote:

    Carol well posted but an all to common story...Its good that its being told though in the open and honestly.

    Being medicated out of existence is not the answer just a quick fix for the health services and cheaper in the long run. You cant have a PD if you don't know who you think you are is the current way to treat us.

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  • 40. At 9:30pm on 28 Nov 2009, clamdip lobster claws wrote:

    I think Carol makes an overall good point about children in care. It seems criminal to me that birth records would be sealed. Most children have a deep longing to know who they are and where they come from. It's wrong that this sense of deep belonging would be artificially cut off. Recently, a man learned that his father was Charles Manson. Isn't it better that a child grows up knowing this so that he can try to understand the circumstances of his birth? Furthermore, there are various reasons why someone would choose to give up their own child. There must be a lot of guilt associated in doing this. I don't really know how useful it is to look back thinking about would've, could've, should've. As a parent you make choices. Some decisions are right and some are wrong. It's important that parents maintain a sense of self criticism when raising a child and endeavour to be a better human being at the next opportunity their children throw at them to grow and mature.

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  • 41. At 00:31am on 29 Nov 2009, jobsw32 wrote:

    I think the most important thing to recognise in mental health is that, when someone is diagnosed, then it should be believed. It's not just a quirk of character but a real set of behaviours that are risky to the sufferer.

    I went out with a girl who said she suffered with a personality disorder but I didn't want to believe that it was anything but soon realised she had an unfortunate tendency to fly into rages over trivial matters.

    That said when you look at people's lives, their upbringing, the relationships with the people nearest to them you can bet that there has been issues in the family relationships. This girl's mother had been kicked down the stairs when she was pregnant so to me it's not difficult to explain. There was a long history of having received major aggro from other human beings.

    I think you get out of people what you put into them, ultimately. You can't necessarily cure someone with a mental health problem they can suffer lifelong issues relating to others but then you can hardly learn to trust people who are kicking you around all the time.

    Conversly, kindness never hurt anyone. I believe mental health is intimately connected to the attitude of wider society, particularly towards violence, and is not just an individualistic phenomenom.

    Empathy towards others means treating them as you wish to be treated but if you have no sensitivity to pain, if you are hardened to it, and the other is not, then you are going to hurt them through lack of empathy, whether it was intended or not.

    That is how offences multiply in my veiw. Man kicks wife, wife kicks child, child kicks cat. There is no great mystery to it.

    I believe that people with mental health problems can be helped by simply softening their environment somewhat and showing them kindness but when the world is full of violence and pressures from other people, that's extremenly difficult. All it means is, there is plenty more pain to come.

    It's not a one man, it cannot be a one man effort to tackle mental health problems but a definite responsibility of everyone to consider the wellbeing of others. If we fail to do so, nobody is going to hold us accountable, we are the ones who will feel the pain even more.

    Just believe it before a drama turns into a crisis.

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  • 42. At 00:44am on 29 Nov 2009, KaylaK wrote:

    First of all I would like to thank Mark for including me in this article, and for helping raise awareness of Personality Disorder. It was a great privilege to be invited to perform at the PD Congress last week and I found it to be a fantastically informative and encouraging event.

    As someone living with Borderline Personality Disorder, I was pleasantly surprised to find that there are so many other people out there with PD who are living positively despite their struggles, and my aim at the conference was to underscore that it *is* possible to live a fulfilling life even when dealing with the most difficult emotional and psychological issues.

    I am a full time musician, and as such have been trying to raise awareness of Personality Disorders through my own music. At the Congress I launched the special edition single "On the Borderline", which is a personal reflection of living with PD. I have also recently been asked to create a short video which details my own experience, and is something that I am keen to share amidst an often negative climate regarding public perception of Personality Disorders.

    It is fantastic that a dialogue between service users, families, carers, professionals and the public has been created and I only hope that more people will find it possible to be open to those living with PD, in order to fully understand the multi-faceted nature of their experience. It is most certainly not all negative, nor something which should be brushed under the carpet. It's time to celebrate the uniqueness that is found in everyone living with these disorders, which often manifest themselves in immense creativity through Art, Music, Theatre, Dance and Writing.

    I would encourage anyone with an interest in finding out more or to connect with others with PD to do so, as it is often a lonely journey without support. I am very happy to engage with anyone interested online through http://www.kaylakavanagh.com, and hope to continue to raise positive awareness of PD in any way I can.

    Kayla

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  • 43. At 08:25am on 29 Nov 2009, jobsw32 wrote:

    Say science and research is thin clinicians are less interested in peoples anecdotes than they are in their own theories. I'm afraid that we don't understand the other side of the argument the flip side of super ego's, reputations wealth and volcanic tempers!

    Some people retaliate when they have been hurt others seek help and retaliate in a different way one is vigilate and the other is due process.

    We have layers and layers of institutional type thinking and it seems to take officials forever to make decisions on what is obvious to the rest of us.

    We don't need their evidence and research when we have our own knowledge and life experience to rely on. Enter the row between science and politics.

    Just because not succeed in pulling the wool does not stop people from trying it on.

    Some scientists are skeptics if you tell them the sky is blue so you just have to use the sense you're born with some people got it some people don't.

    We have managed and succeeded to exist, some us for a long time in difficult circumstances not as silly as we look maybe!

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  • 44. At 09:08am on 30 Nov 2009, NewFazer wrote:

    Amazing! About a month back JadedJean posted some very pertinent material to this blog on this subject. And got banned! Why?

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  • 45. At 3:48pm on 30 Nov 2009, Paultovey wrote:

    It was a co-incidence that the "National PD Congress" which was held in Birmingham was held a few days before the 23rd Nov 2009 Personality Disorder Network Local Meeting was put on at Carrs Lane Church and was attended by more 150 . I attended as a Mental Health Monitor and noted the distinct way that some staff really were grasping ideas that negative social family and care history can have profound effects on people's sense of Self and functionality. We all learned too that a treatment facility , Main House, run by the local Mental Health Trust was closing down. It only tended to deal with the acute side of BPD on an inpatient basis (12 local beds available per year and the other 12 for outside purchase) but some sufferers thought it did well. Others have been critical and wanted community provision . Nationally I may add I had recently independently stewarded the UK Wide Personality Disorders Spectrum Survey Online which was partly promoted by NALM (National Associoation For LINks Members) and it demonstrated up-to-date experience by BPD and other PD spectrum sufferers of the UK wide picture of service provisions ...

    The UK wide PD Spectrum Survey Report was sent to the Care Quality Commission and Dr Lynne Jones M.P.

    The informative survey (many people wanted therapy and were not getting it) is available

    SURVEY FOR DOWNLOAD HERE IF YOU CLICK

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  • 46. At 4:25pm on 30 Nov 2009, clamdip lobster claws wrote:

    I knew a woman who years later revealed that she was in an abusive relationship. Her husband also abused her son. She often discussed the death of her other child to her son. When he was eight years old he was placed in a mental ward for several weeks because he was found lying in the middle of a busy street, hoping to be run over so that he could be with his deceased sister in heaven. In essence, the mother brainwashed her own child by continually reminding her son about his deceased sister who died years before he was even born. If anything, I think PD is a problem exacerbated by the family dynamic. I think in these instances the entire family needs to be scrutinized because parents unconsciously pass on their dysfunctionality to their children or maybe dysfunctionality has a genetic basis. I learned later that my friend was abused by her father as a child. She also has a mentally challenged brother. My point in all of this is to say that given early intervention into a child's life, the affects of mental illness could be lessened with strategic psychological intervention. I'm wondering how much mental and emotional illness can be attributed to early childhood abuse? Probably a large percentage.

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  • 47. At 5:19pm on 30 Nov 2009, clamdip lobster claws wrote:

    jobsw32,

    What is obvious to the rest of us and what decisions?

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  • 48. At 10:46pm on 30 Nov 2009, travel2much wrote:

    Wow! Always struggled with emotions, always perceived as weird, always destructive in relationships. The last guy I went out with said there was something wrong with me in the head and I thought it was a parting shot. Test one - five highs and three very highs, similar high-scoring areas on the second test.

    So what now? Scary.

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  • 49. At 02:08am on 02 Dec 2009, tarquin wrote:

    Good, thought-provoking post Mark - I only wish 'society' could actually think intelligently about these issues

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  • 50. At 12:53pm on 02 Dec 2009, nonBPD wrote:

    This article is in part an excellent introduction to the current state of awareness of the problems of managing personality disorder, seen through the eyes of an independent observer. However, it comes close to falling into a trap.

    The article identifies the three groups affected: those whose behaviour attracts the diagnosis, those people, such as family, friends, and co-workers, who are affected by the behaviour, and the third parties who are brought into the cases. Such third parties include the doctors, social workers, prison officers, teachers, ministers of religion, therapists, psychiatrists and may be funded privately, by charities, or the state.

    However, there is a clue to an approaching muddle which the writer nearly gets trapped by. It is in the first sentence: the fondness for black and white thinking is characteristic of borderline personality disorder rather than the average person. As people diagnosed with BPD succinctly tell me, often very forcefully, they are like everybody else, only more so. Everybody can have mood swings, and everybody can switch perceptions of the world, especially when it comes to issues of love and hate, friends and enemies. It is when the swings are extreme, unpredictable except in the long term, and become the dominant focus of the person's life, decision-making and creativity and result in self-harm or harm to others that the problems begin and the diagnosis is attracted. The average person sees others people and the world about them as a complex mixture of black and white (and shades and colours); they expect to find some good in the most supposedly "evil" person; they expect to find some dark side in the most "saintly" person. The borderline sufferer cannot do this, and sees people as evil or heroes, with gradation achieved only by abrupt unpredictable switches of perception over time. This terrifies the target of the borderline sufferer as much as the sufferers themselves, because they cannot predict whether next month they will be perceived as an enemy or an ally.

    The muddle begins as soon as causal links are postulated because of correlation and start to become accepted through repetition. The most contentious issue is the connection between PD (especially BPD) and abuse, which in the article reaches its zenith in the attempts to re-define PD, after seventy years of internationally-agreed usage, with language that couples it to presumed abuse: "post-complex-trauma syndrome/disorder". Bunkum! Even the phrase tends to presume some trauma or causative agent. This confusion is gradually leading to statistical chaos, a drift I attempt to highlight, simplified, here.

    GPs ask people suffering emotional deregulation, self-harm or related behaviour if they were abused as a child, a positive reply tending to confirm (B)PD; thereafter, statisticians come along later and notice that adult persons diagnosed with BPD were reported by their GPs as suffering from childhood abuse, and point out the correlation. The obvious circularity and its impact on drawing meaningful conclusions from the data is nearly always overlooked and whistleblowers are shunned by their peers and find their research grants withdrawn. In extremely cases, bizarre new disorders are invented, for example MPD and MSbP to explain away anomalies. Nobody investigates whether the alleged abuse actually took place or not. If the sufferer denies it, they are told they are suffering from suppressed memories of it, and the box "victim of abuse" is ticked anyway!

    The research work most often cited is that from Teicher and others during the 1980s-1990s who reported a correlation between reports of childhood abuse and diagnoses of borderline. Once this correlation was noticed, clinicians seem to have taken to asking their patients if they were abused as a child or had unpleasant accidents, whereupon the diagnosis tends to be confirmed. This leads to therapist-patient delusion, in which the patient comes to believe that the supposed historic abuse is responsible for their present-day behaviour. It is remarkably easy for the patient to develop pseudo-memory of events that did not in fact take place and in extreme cases for both the patient and therapist to become so convinced of the reality and severity and impact of the historic past that they both take action against the perceived abusers. Given the tendency in the last decade to simplify human relationships into victim-perpetrator-rescuer models during therapy, and the use of victim-led legal procedures rather than evidence-based procedures, the scope for miscarriages of justice and erroneous therapy is huge. The defintion of abuse is nowadays so vague and so all-embracing that almost a majority of adults could, with suitably phrased questions, answer yes. Also the patient gets worse because they are realise they cannot change the past, making them depressed, yet fail to realise that their memory of the past is in fact a delusion. The statisticians conveniently ignore that the tick-box label is "the patient reports abuse" and not "the patient was abused". Failure to distinguish these two causes cases of compulsive false allegation-making to be under-recorded and a spurious correlation between abuse and BPD to be over-recorded. The data is being massaged.

    The problems faced by families of PD sufferers is immense and increasing. Not only is a normal daily life seriously compromised by the disruption and constant pandering to the increasingly un-meetable demands of the sufferer for unreasonable changes in circumstances, but they may have to deal with attacks on from the PD sufferer and episodes of self-harm and suicide. The attacks may be physical, emotional, or legal, and may drag in the therapists and health staff either as allies or enemies. The life-style ultimately is a trade-off between the emotional needs of the PD sufferer (which in the case of BPD is predominantly a need to avoid all pain, conflict and anxiety and to have 100% visibility of family members) and those of the family.

    This muddle has worsened during the last decade. Previously, BPD was generally seen as an organic problem associated with the hippocampus and amygdala through biochemistry which was not remotedly understood, but nevertheless a problem that could be partially controlled by medication, notably mood-stabilisers, anti-psychotic medication and medication more usually given as an anti-epileptic drug or self-medication by herbs. This empirical (and cheap, but not always legal) approach has been eclipsed by the rise of immensely expensive and contentious talking therapies, thus giving rise to a lucrative huge industry in therapists. The battle of medication versus therapy in identifying and treating or tolerating personality disorders is a war of money, career and politics, not of medicine or science.

    Finally there are complex issues of funding which distort research data. NHS psychiatrists faced with severe PD sufferers struggle to find funding from the adminstrators, who can sometimes "solve" the problem by dipping into an account agreed by the SHA and ring-fenced for "treatment for adult survivors of child abuse". However, this requires both the patient and the psychiatrist to tick the appropriate box. At this point the die is cast. The local authority is informed by the NHS, and invoke simplistic policies of "the abused becomes the abuser" and consequently take sanctions against the PD sufferer such as removal of children for fear of being held accountable should the PD sufferer physically harm the children (Lawson's Medean Borderline paradigm). Such a situation is improbable in any individual case but statistically inevitable: 2010 will see a Baby Q for sure. Mis-handling of rare cases by press-release and legislative and procedural changes is currently rife, but that is a much bigger issue than PD.

    The perjorative sense exists mainly in the mind of local authorities, who seek out people with it in order to remove their children, though it might be better to talk of a "disorder which affects personality".

    So overall, this article gives an excellent snapshot of the issues and maps out the battle lines for the next decade, a battle which, fought vigorously and honestly might produced deeper insights and alleviated suffering. Where the article comes perilously close to bias is when the author is nearly seduced by the abuse-causation camp currently erected by a coalition of PDs-in-therapy and therapists who attend conferences.

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  • 51. At 01:03am on 04 Dec 2009, heartofiron2002 wrote:

    Today my wife and I spent an hour in court to get a judge to force social services to pay for treatment/diagnosis of our 15yr old daughters probable bp/bpd, in the last 2yrs we have had different specialists diagnosing a multitude of different conditions,we have 3 children our eldest is at uni studying english/lit our middle child is finishing 6th to later go on to uni to study policing our youngest was diagnosed with cerebral palsy at 9 and went to a special school she was bullied there on 2 or 3 occasions and by the age of 11 started experincing fits and from that period started showing the early signs of bpd. Due to the amount of experts involved and their own ideas of bpd our family was investigated for abuse and neglect even though it was us who begged for help with our daughters behaviour for 2yrs while the experts were telling us we were not in crisis, one specialist said that soon as the child is taken out of the family home the violence she caused would stop we agreed to temporary care to prove a point and get respite from our daughters behaviour,when she went into a foster home her violence increased and extreme self harming started she spent the last 2 and half years being moved from secure unit to care unit and back again to secure while social services blamed everyone from the family to the care staff and even her schooling for her behaviour. the multiple experts never seem to read each others notes or communicate with anyone involved from the start of this behaviour so it can given a proper diagnosis infact all the experts have managed to do is drive a large wedge between the family and our daughter due to them giving no support for any single one of us and constantly blaming individuals or groups for our daughters actions.We have always loved our daughter and always will I just wish that their were support groups for families going through this and that the so called experts would all sing from the same hymn sheet and not come along with their own ideas on the causes of it so the process of healing could be speeded up.

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  • 52. At 10:59pm on 05 Dec 2009, NewUSMom wrote:

    If I meet someone who suffered worse childhood abuse than mine than I will entertain the idea that it may be responsible for their bad behavior as an adult. The trouble is that I had a horrible childhood and don't use it as an excuse to misbehave so have a hard time allowing others to blame their childhood for their adult behavior. My family, on both sides, has been blaming their childhood abuse for abusing their own kids for generations and each generation gets worse. I had to completely break all ties with them for fear of getting sucked into it. I don't think people should be allowed to do this. I take full responsibility for my own actions and am a better person for it -- its called being an adult.

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  • 53. At 11:35pm on 07 Dec 2009, jobsw32 wrote:

    47. At 5:19pm on 30 Nov 2009, clamdip lobster claws wrote:
    jobsw32,

    What is obvious to the rest of us and what decisions

    ~
    What is obvious to me is that you all are bitter and angry about what people have done to you and are looking for a scapegoat. Well if you think you are succeeding in preventing all crime by taking a pop at me you are sadly wrong it is you who are committing a crime on me and so are people in this land every day nag hassle nag hassle demand want take do what you like!

    You believe you are just but you are murderers as the rest of them.

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  • 54. At 03:44am on 26 Dec 2009, dennisjunior1 wrote:

    Mark:

    What will the authorities going to do, for the people who have Personality Disorders in society....

    =Dennis Junior=

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  • 55. At 1:48pm on 05 Jan 2010, John Ellis wrote:

    The Raw (and Ugly) Truth about the War on Drugs Mike Adams
    http://psychiatricnews.wordpress.com/2010/01/05/war-on-drugs/

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