Personality Disorder – What A Dreadful Term!

When I trained as a therapist, I had no desire or intention of specialising in working with Borderline Personality Disorder (BPD), sometimes referred to Emotionally Unstable Personality Disorder (EUPD). In fact, I go further, I actively intended not to! Having worked in the mental health system for many years, I’d been subject to, and had absorbed the very negative stigma surrounding BPD/ EUPD clients as ‘hard work’, ‘manipulative’ ‘unhelpable’, let alone ‘risky’. Why would anyone want to specialise in such work?

However, over my years in Psychotherapy practice I found I worked well with clients who identified with BPD symptoms. We developed a great rapport, and they would say how much the therapy helped them. The only problem was, I wasn’t observing lasting change in emotional distress and behavioral impulsivity. Yeah, we got on great, and they felt better immediately after each session, but the therapeutic connection wouldn’t last long, and they would soon be back in emotional distress. This is what leads many clinicians to compassion fatigue and ultimately back to the stigma of clients being ‘hard work, manipulative and ‘unhelpable’. I was well on my way to reaffirming this belief for myself.

This is when I decided to start looking for further training, there surely must be more we as therapists could do for clients in such cyclical distress! That’s when I came across Dialectical Behaviour Therapy (DBT), and off I went to train….. AND HATED IT! Woah, DBT was so different and directive compared to anything I’d trained in previously and grated harshly against my roots as a relational psychotherapist. I did however persevere, reminding myself of the evidence base, and eventually understood the interweaving of directive behavioural change strategies with compassionate validation. It took many years to truly get a handle on the approach, but eventually I did and now I co-lead our DBT service at RHCP. It is the greatest privilege to be alongside clients who struggle with emotional hypersensitivity, to help them finally learn about their emotions, and get back to a position where their emotions serve them, rather than living a life serving their emotions!

Being confident in my approach has changed my view completely of this highly stigmatized group. They are not hard work or manipulative, and certainly not unhelpable! They just feel their feelings quicker, stronger and for longer than most other people, and often for very valid reasons! They are the same feelings we all feel, just more intense, and any of us would behave in the ways they do if we felt as intensely as them. It’s time now we took the anti Mental Health stigma battle further than generic ‘mental health’, and look deeper at the most stigmatised disorders that are even judged negatively within the mental health system! Let’s start with the term ‘Personality Disorder’, What a dreadful term! How can we ever move away from stigma when someone is labelled as being disordered in the core of their personality! No one’s personality is disordered, and what hope of change do we offer people once given such a label?

Compassion is central to therapeutic intervention, can it not be central to psychiatric diagnosis too? A term such as ‘Emotional Regulation Disorder’ would surely offer a more encouraging starting point, a less judgmental diagnostic and a more ‘on point’ label for the difficulties being experienced?

I hope anyone who reads this who has been diagnosed with a Personality Disorder can know that even when a professional ‘specialises’ in working with a Personality Disorder, it does not mean they think your personality is disordered!