Borderline Personality Disorder

Coined in 1938 by Adolph Stern to describe patients who “fit frankly neither into the psychotic nor into the psychoneurotic group”, and seemingly bordered on other conditions; then established as we know it today by John G. Gunderson as “striking fluctuations from periods of confidence to times of absolute despair, markedly unstable self-image, rapid changes in mood, with fears of abandonment and rejection, and a strong tendency towards suicidal thinking and self-harm, with transient psychotic symptoms such as brief delusions and hallucinations also sometimes being present”; borderline personality disorder (or simply “borderline”, abbreviated BPD) has always reflected poorly on the mental health system.^[2]

The issues with this disorder are so rampant that they’ve been extensively documented, criticized & discussed within the psychiatric community itself for decades.^[2]^[3]^[4]^[5]^{[6][7][8][9][10][11][12][13]}^[14]^[15][17] From the diagnostic criteria, to the treatment options, to the actual treatment of borderline patients, to the validity of the illness altogether—it’s always been bad. Which leads to a very simple question: If the mental health system is everything it claims to be, and everything people who have never used it champion it to be, then how is anything I’m about to show you possible? How is it possible for a diagnosis this flawed and controversial to remain for over 40 years? How does a “sincere & well intentioned” system allow this to go on for such a stretch of time when a significant number of members within said system have made it abundantly clear that something needs to change? The unresolved issues of borderline predate the recording of Thriller.^[1] You’ve got to be kidding.

The following excerpts are from Borderline Personality Disorder: Treatment and Management by the National Clinical Practice Guideline, which reads:

“Borderline personality disorder is a heterogeneous condition and its symptoms overlap considerably with depressive, schizophrenic, impulsive, dissociative and identity disorders. This overlap is also linked to comorbidity and in clinical practice it is sometimes difficult to determine if the presenting symptoms are those of borderline personality disorder or a related comorbid condition. […] The level of comorbidity is so great that it is uncommon to see an individual with ‘pure’ borderline personality disorder. Because of this considerable overlap with other disorders, many have suggested that borderline personality disorder should not be classified as a personality disorder; rather it should be classified with the mood disorders or with disorders of identity. Its association with past trauma and the manifest similarities with PTSD have led some to suggest that borderline personality disorder should be regarded as a form of delayed PTSD.

[…] Currently, outside specialist treatment settings, there is still a heavy reliance on the diagnosis of borderline personality disorder being made following an unstructured clinical assessment. However, there are potential pitfalls in this approach. First, agreement among clinicians’ diagnoses of personality disorder has been shown to be poor. Second, the presence of acute mental or physical illness can influence the assessment of personality. The presence of affective and anxiety disorders, psychosis, or substance use disorder, or the occurrence of an acute medical or surgical condition can all mimic symptoms of borderline personality disorder; a primary diagnosis of borderline personality disorder should only be made in the absence of mental or physical illness. It is also preferable for clinicians to obtain an informant account of the individual’s personality before definitively arriving at a diagnosis of borderline personality disorder.

[…] The perceived enduring and chronic nature of personality disorder poses a challenge to a healthcare system that is historically, and to a large extent still is, strongly influenced by the biological [illness] paradigm of mental health. Essentially, mental health services within the NHS have been configured in such a way as to ‘treat’ people during the acute phases of their illness. As personality disorders by their definition do not have ‘acute’ phases some have argued that a personality disorder should not be the responsibility of the NHS. Given the confusion that surrounds the nature of personality disorder, it is not surprising that this has impacted on NHS care for people with this diagnosis. Until recently, personality disorder services in the NHS had been diverse, spasmodic and inconsistent.

Given the many problems associated with the diagnosis of borderline personality disorder, it seems clear that reclassification is urgently needed and this is likely to happen with the publication of DSM-V.”^[2]

The following excerpts are from Borderline Personality Disorder: To diagnose or not to diagnose? That is the question by Katrina Campbell, Karen-Ann Clarke, Debbie Massey, and Richard Lakeman, which reads:

“There is considerable controversy around psychiatric diagnosis generally and personality disorders speciﬁcally. Since its conception, borderline personality disorder has been controversial because of the stigma associated with the diagnosis and the therapeutic nihilism held by practitioners who encounter people with this high prevalence problem in acute settings. This paper reviews the history of the diagnosis of BPD and summarizes some of the controversy surrounding the categorical nature of diagnosis.

[…] Recent developments in the treatment of borderline personality disorder suggest that it is a highly treatable condition and that full clinical recovery is possible. This paper formulates an argument that despite problems with psychiatric diagnosis that are unlikely to be resolved soon, a diagnosis should be made with an accompanying formulation to enable people to receive timely and effective treatment to enable personal and clinical recovery.

[…] There are a number of further problematic issues with thinking about personality disorders according to a speciﬁc categorical type. Firstly, there is no robust empirical evidence that supports the view that personality disorders are categorical in nature, nor that there are 10 discrete and separate personality disorders as determined by the DSM-5 classiﬁcation system. It is routinely acknowledged that the categorical model is burdened with issues of low reliability, and difﬁculties of diagnostic co-morbidity and heterogeneity within the disorder itself, leading to problems with accurate diagnosis and treatment planning. Additionally, many individuals may be diagnosed with more than one category of personality disorder, which precludes a comprehensive understanding of their unique problems. It also prevents the identiﬁcation of a speciﬁc and evidence-based treatment, and further limits the prediction of its efﬁcacy. The issue is aggravated even more so by the high prevalence of people diagnosed with Personality Disorder Not Otherwise Speciﬁed (PDNOS). This particular category provides virtually no speciﬁc description about a particular person’s psychopathology and limits the utility of the diagnosis even more.

[…] Regardless, the dimensional model as proposed by the ICD-11 is not without criticism. Whatever the models used for diagnostic purposes, they should provide clinical utility and reduce the risk of ongoing stigmatization to people receiving the diagnosis. Further, accurate diagnosis will allow for access and referral to appropriate treatments. That being said, the underlying causes and the presenting symptomology needs to be acknowledged for each individual to ensure the treatment is appropriate for that person.

[…] Most mental health clinicians have had frequent contact with people diagnosed with BPD, yet the associated behaviours may continue to challenge clinicians’ ethical capacities, leading to the development of stigma towards the diagnosis of BPD.

[…] Many mental health professionals believe that people with BPD utilize a disproportionate share of mental health services and that the condition is not amenable to treatment despite contrary evidence. In fact, Raven proposes that exclusionary practice continues to operate within many mental health services resulting in sparse service provision for people with BPD. These negative beliefs and practices held by staff can be dire for people with BPD and can result in signiﬁcant harm. For example, an inquest into the suicide of two patients in South Australia diagnosed with BPD found that despite seeking assistance on numerous occasions from the local ED, the mental health sector response and availability of specialist treatment were inadequate. It is well documented that both clinicians and people diagnosed with BPD do not believe there are adequate services available for people with a diagnosis of BPD. Even if services are available and accessible, the negative attitudes expressed by treating healthcare professionals and the subsequent negative attitudes towards the diagnosis of BPD can result in premature termination of treatment potentially causing harm.

[…] many health professionals do not consider BPD to be a genuine diagnosis and believe the diagnosis to be self-induced or chosen. Subsequently, it has been found that people with BPD either are not informed about their condition or are told they have a differing diagnosis, such as bipolar affective disorder, compromising the principle of veracity.

[…] Psychiatric diagnosis in general is controversial. Bourne’s criticism of personality disorder diagnosis, that they ‘…suffer empirically from problems of internal consistency, test-retest reliability, inter-rater reliability, construct validity, diagnostic co-occurrence and unclear diagnostic boundaries’, can and has been levelled at psychiatric diagnoses generally. Preceding the publication of the DSM-5, the former editor of the DSM-IV stridently criticized diagnosis as having led to a pandemic of iatrogenic harm due to the medicalization of everyday life and the use of pharmacological treatment in large sectors of the population. The United States National Institute of Health
essentially gave the DSM ‘a vote of no conﬁdence’ and refused to fund further research into diagnostic categories.”^[3] (Embarrassing by the way.)

The following excerpts are from The Structure of Borderline Personality Disorder Symptoms: A Multi-method, Multi-sample Examination by Ashley A. Hawkins, R. Michael Furr, Elizabeth Mayfield Arnold, Mary Kate Law, Malek Mneimne, and William Fleeson, which reads:

“We examined [in our study] the factor structure of borderline personality disorder (BPD) symptoms by using a multi-method, multi-sample approach. […] [The] results have implications regarding the nature, assessment, and treatment of BPD.
[…] The Diagnostic and Statistical Manuals (DSMs) have treated BPD as a unitary disorder, without clinically-relevant differences in facets or subtypes. However, the validity of this perspective hinges on the implicit assumption that BPD symptoms have a unidimensional structure.

[…] current results have several implications. First, they suggest that BPD is not heterogeneous, in terms of the nine definitional criteria in the DSM – people who tend to experience relatively high levels of one symptom tend to experience relatively high levels of all other symptoms. These results argue against the existence of separate facets of BPD symptoms and against subtypes of BPD with differing symptom configurations. Second, a single factor suggests that assessment and treatment focus on a single, coherent form of borderline pathology. The findings argue against the need to create new multidimensional diagnostic tools or to develop new treatments tailored for different “types” of BPD.

[…] In examinations of all DSM-based personality disorder symptoms, some research indicates five, seven, eight, or even ten factors, with BPD symptoms often cross-loading with other [personality disorder] symptoms and/or loading mostly on different factors. Similarly, in other examinations of clinically-relevant criteria beyond BPD, some studies have identified BPD subtypes. For example, Wright and colleagues identified six subtypes of BPD, Hallquist and Pilkonis identified four subtypes, and Bradley et al. identified four subtypes, based on a variety of different measures related to personality pathology. Thus, going beyond the DSM criteria for BPD seems to provide a different perspective on the structure of BPD symptoms and the heterogeneity of people with BPD, as compared to focusing squarely on BPD criteria. This warrants further research and conceptual integration with the clear unidimensionality observed when focusing solely on the DSM’s criteria for BPD.”^[4]

The following excerpts are from Borderline personality disorder: a spurious condition unsupported by science that should be abandoned by Roger Mulder & Peter Tyrer which reads:

“Twenty years ago, George Vaillant, in a paper entitled ‘The Beginning of Wisdom is Never Calling a Patient a Borderline’, noted that the diagnosis of borderline often reflects the clinician’s affective state rather than careful assessment. This was not an isolated opinion, but we argue that little has changed and that borderline in the context of personality has now become a toxic term that is hindering progress in research and treatment. The only accurate aspect of borderline is its title, a word that correctly signifies its complete lack of specificity. […] The triad of unstable mood, erratic relationships and disturbed behaviour may be readily identifiable but that does not make it a personality disorder; chronic sleep disturbance creates the same symptoms.

[…] The diagnosis of borderline or emotionally unstable personality disorder in the major DSM-III revision of classification in 1980 was only introduced as a grubby compromise to satisfy psychoanalysts who were unhappy with an atheoretical classification system. Revisions of ICD-10 and DSM-IV have highlighted the failures of previous labels. Both classification committees favoured a dimensional representation of personality pathology consistent with current evidence. Such a model implies that the central features of abnormal personality should be present, albeit to a lesser degree, across the range of personality disturbance.

Both recently accepted classifications of personality disorder, ICD-11 (World Health Organization) and the American DSM-5 Alternative Model of Personality Disorder have trait domains that link well with the commonly described Big Five domains of normal personality. All attempts to find a borderline factor have failed. If borderline was a true personality disorder, it would not be outside this system. Many clinicians and patients attune to the diagnostic descriptions of borderline features, as their features are easy to detect and very common from adolescence onwards and the diagnosis seems to give a reassuring degree of certainty to otherwise intangible complex symptoms and behaviour. But any positive aspects are overcome by its contradictions and the confusion created by overlap.

It is a mushy blancmange diagnosis that simply embraces too much pathology to be of any real value. Although borderline symptoms make sense as a syndrome examined in isolation, they disappear into a general factor when modelled alongside other personality disorders. The overlap of borderline features with almost every other psychiatric disorder, particularly ADHD, bipolar disorder and other mood disorders, also muddies the diagnostic waters. Both ICD-10 and ICD-11 diagnostic work groups rejected borderline and emotional instability in their classifications but they were forced in by powerful lobbies. It is not just Big Pharma that can influence diagnostic practice.

[…] One strong claim in favour of the diagnosis of borderline personality disorder is that it is linked to specific treatments. But the evidence of their efficacy has been overstated. When the patina of language such as dialectic, mentalisation, schema formation and transference is stripped away, the treatments offered are exactly the same as those offered for general psychological distress and dysfunction, now given an unnecessarily new title, structured clinical management. The methods used to reduce distress are transdiagnostic and apply to all patients. No medications have been found to be of any consistent benefit in the treatment of borderline personality disorder, and the two largest and best designed studies using olanzapine and lamotrigine were unequivocally negative. Despite this, almost all patients with the disorder appear to receive not just one, but many psychotropic drugs for this condition and several US guidelines continue to recommend drug combinations for the condition. A just published Cochrane review concluded that ‘no pharmacological therapy seems effective in specifically treating BPD pathology’.

The indiscriminate use of borderline in multiple contexts is a major source of stigma. Those with emotional instability, a syndrome that undeniably exists but is best thought of as a mood disorder, are combative and often eloquent in seeking care, and employ what were once called ‘immature defences’ such as splitting and projection. Put in simpler form, they distract and annoy the clinician. There are many other reasons patients challenge their doctors, but in the current climate, this behaviour – whether expressed in accident and emergency departments, general practitioners’ surgeries or psychiatric settings – leads to eye-rolling, nods and winks to colleagues and the whispered comment ‘another borderline’ that foreshadows inappropriate and unsympathetic intervention.

Health professionals are the worst offenders in promoting stigma and the consequent angry reactions it provokes. As a consequence, the patients so identified are seen as more difficult to manage even when their behaviour is no worse than other patients who are not labelled with borderline pathology. It also makes it more difficult for these patients to have other psychiatric disorders recognised such as depression, anxiety and ADHD. […] It is almost as though the mere hint of borderline pathology devalues all other symptoms, not just psychiatric but also medical, on the grounds that they are exaggerated and distorted and can be conveniently disregarded and attention given to more needy patients.

Increasingly, mention of ‘emotional instability’ in correspondence about a patient will be used to exclude the patient from a range of mental health services on spurious grounds of inappropriate behaviour or diagnostic mismatch. This only serves to increase the sense of alienation that many already feel and the sad fact is that now any mention of emotional instability is a major source of refusal to treat by many parts of the psychiatric service. This reinforces the view that the diagnosis of borderline is being used increasingly as one of exclusion; this only serves to increase the sense of alienation and anger by sufferers.

[…] The diagnosis of borderline, of emotionally unstable, personality disorder is widely and inappropriately used, informs little, creates confusion and uncertainty, and generates tremendous stigma. It has no basis in the scientific study of personality and is used indiscriminately to describe myriad negative interactions in human relationships that have cause far beyond personality function, extending from simple disagreement to total functional breakdown. Because of its profligate usage and scientific inaccuracy, the management and specific treatment of this group of conditions is severely compromised and has become a major bar to understanding. Borderline no longer has a place in clinical practice.”^[5]

The following excerpts are from Should Borderline Personality Disorder Still Be a Diagnosis? by Daniel J. Winarick which reads:

“A recent commentary suggested that borderline personality disorder ‘has no right to exist,’ adding to an ongoing BPD controversy. […] In a commentary-response article published [by] Peter Tyrer, a personality psychologist, engaged in what some might call heated rhetoric—or perhaps even “fighting words.” Tyrer is a well-known and prolific personality researcher with a focus on tracing the history and evolution of personality disorder categories from antiquity to the present as well as psychometric, longitudinal, and construct validation research. […] In my view, Tyrer takes a turn towards controversy by saying that […] borderline personality disorder “has no right to exist.”

[…] Tyrer points out that BPD has its roots in scientifically questionable practices—specifically, psychoanalytic theory. But I argue that he falls short of addressing the elephant in the room: BPD is one of the most common, severe, scientifically studied, and treatment-ready syndromes in psychiatry that are also highly co-morbid with a variety of other mental disorders. And one major problem with Tyrer’s last position, in particular, is that virtually all of the post-DSM-III PDs, including BPD, have their roots in psychoanalytic theory. This is not, in my view, a rationale for removal; it is simply a descriptive and historical fact.

[…] The diagnosis of borderline personality disorder has a long and controversial past that continues to spark debates in psychology today. […] Borderline personality disorder (BPD) is associated with severe psychiatric risk; has an identifiable, reliable, and valid symptom profile that is easily recognizable by psychologists and psychiatrists; and is one of the few personality disorders that has benefited from huge levels of research funding and attention. In fact, two widely known evidence-based treatments have been developed specifically for BPD—dialectical behavior therapy (DBT) and transference-focused therapy (TFP).

[…] To suggest that this syndrome “does not have the right to exist” is, in my view, absurd and suggests a chasm between clinical practice and academic psychology. Research should be informed by real-world practice. As noted by the historian of psychiatry, G.E. Berrios, while recognizable patterns of behavior have been observed throughout time, their labels change. The construct of borderline personality disorder exists, has a right to exist, and is one of the better-understood forms of psychopathology in psychiatry. A debate about the merits and pragmatic clinical implications of relabeling BPD something apparently less stigmatizing would be worthwhile.”^[6]

The following excerpts are from Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies by Falk Leichsenring, Peter Fonagy, Nikolas Heim, Otto F. Kernberg, Frank Leweke, Patrick Luyten, Simone Salzer, Carsten Spitzer, and Christiane Steinert, which reads:

“BPD remains a challenging disorder, from both research and clinical perspectives. At present, for example, there is still controversy concerning its conceptualization as either a specific personality disorder or a level of general impairment in personality functioning. The treatment of BPD remains challenging as well. As to pharmacotherapy, there is no consistent evidence showing that any psychoactive medication is efficacious for the core features of the disorder. Indeed, no medications have been approved by regulatory agencies for treating BPD. […] almost 50% of BPD patients do not respond sufficiently to psychotherapy.

[…] Another critical issue is the number of criteria that have to be fulfilled in order to be able to assign a diagnosis of BPD. A patient with intense feelings of emptiness, highly unstable interpersonal relationships, severe identity disturbance, and self-harm, for example, may not fulfill the diagnostic criteria due to missing a fifth criterion, despite severe impairment in functioning. Furthermore, with five of nine criteria required for the diagnosis, there are 256 possible ways to meet the DSM-5 criteria of BPD, suggesting considerable heterogeneity among BPD patients. This heterogeneity represents a challenge for research on etiology and treatment.

[…] On the other hand, proponents of a categorical model emphasize that BPD is a clinically useful diagnosis and one of the best researched ones, especially with regard to the development and testing of psychotherapeutic interventions. Moreover, it is argued that some of the most important concepts related to our understanding of mental disorders and psychopathology – such as mentalization and its neurobiology, trauma, and relationship dynamics – have been stimulated by research on BPD.

The final decision to include a “borderline specifier” in the ICD-11 was preceded by intense discussion and controversy. This decision has been seen as a political and practical compromise in order to strengthen the acceptance of the new system. Considering that there is a lot of ongoing research and funding related to BPD, and that several academic careers have been built upon its research and treatment, abolishing it has been likely seen as too far-reaching.

[…] BPD is a common mental disorder, associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The construct of BPD is internally consistent and more homogeneous than often assumed. However, it is still controversial whether BPD is better represented by a categorical or dimensional approach. Future research is required to clarify this issue. This is also true for the elucidation of the risk factors, the neurobiological underpinnings, and the role of social cognition and neurocognition in the disorder.

[…] As another limitation, the quality of psychotherapy studies was found to be modest. Further high-quality studies are required, in both adults and adolescents. Taking the shift from categorical to dimensional concepts into account, research on psychotherapy of BPD (and of personality disorders in general) needs to take dimensional outcome measures, as well as personality traits, into account. Treatment research on dimensionally defined (severe) personality disorders is required. In addition, high-quality head-to-head comparisons of the major forms of psychotherapy with a sufficient statistical power, adequate treatment implementation, and control of bias and researcher allegiance are needed.”^[7]

The following excerpts are from Why Borderline Personality Disorder is Misdiagnosed by Alan E. Fruzzetti, which reads:

“BPD is one of the most commonly misdiagnosed mental health conditions. It’s so misdiagnosed, in fact, that there isn’t even an accurate prevalence rate for the condition. What we do have is an estimate of 2–6% of the population, which actually makes BPD very prevalent. So how is it possible that a prevalent condition is so misdiagnosed? Here are just a few reasons why that could be.

[…] BPD is one of the most heavily stigmatized mental health conditions a person can experience. […] Even if individuals are determined enough to push through the stigma and seek treatment, they may encounter even more stigma. Some mental health professionals are reluctant, or even refuse, to diagnose and/or treat BPD even when a person clearly meets diagnostic criteria.

This problem is even more pronounced among adolescents: Many clinicians fear that even correctly diagnosing a teenager with BPD will only worsen their problems because of stigma. In addition, many professionals incorrectly believe that it is not possible to diagnose BPD in adolescents. This results in underdiagnoses and inaccurate prevalence rates. Worst of all: It prohibits teens from receiving the specialty care they need when early detection and early intervention are essential to recovery.

People with BPD typically also meet the criteria for multiple other diagnoses, including depression, anxiety, post-traumatic stress disorder, substance use disorders, eating disorders, bipolar disorder, and so on. […] When these other diagnoses are the focus of treatment, they can dominate professionals’ attention, preventing any significant focus on the whole pattern of difficulties, resulting in missed diagnosis of BPD. In particular, there is evidence that BPD is commonly misdiagnosed as Bipolar Disorder, Type 2. One study showed that 40% of people who met criteria for BPD but not for bipolar disorder were nevertheless misdiagnosed with Bipolar Type 2.

[…] Some of the problems with diagnosing result from the fact that there was no evidence of effective treatment for BPD until the 1990s. The first published evidence for the effectiveness of Dialectical Behavior Therapy was by Marsha Linehan in 1991. Before then, many clinicians blamed people with BPD for not getting better, rather than acknowledging that professionals had not yet figured out how to treat people with BPD successfully, or trying to find more effective pathways for treatment. Today, unfortunately, many professionals continue to think that BPD is not treatable despite growing evidence that it is. This leads some professionals to avoid giving the diagnosis even when someone meets the criteria.

Gender is another factor in misdiagnosis. The epidemiological rates of BPD in males and females are roughly equal. However, females are over-diagnosed and males are underdiagnosed significantly. This happens in part because women are overrepresented in most studies and treatment. Stereotypes about masculinity and femininity are also likely at play. It’s no surprise that females, who have long been stereotyped for being “emotional” or “hysterical,” are the ones who are over-diagnosed.”^[8]

The following excerpts are from Diagnosing borderline personality disorder: Reports and recommendations from people with lived experience by Vanessa Tedesco, Nicholas John Stephen Day, Sophie Lucas, and Brin F. S. Grenyer, which reads:

“While a minority of participants in this sample stated disinterest or non-acceptance of their BPD diagnosis, this was described in the context of health practitioners not taking the time to adequately explain what this label meant. Similarly, a recent systematic review conducted by Lester et al. specifically explored service users’ experience of receiving a diagnosis of BPD, which included a mixture of negative and positive experiences. Negative experiences included reluctance of mental health professionals to provide a diagnosis at all or being diagnosed but never having this explained.

When participants were diagnosed, some described not being provided adequate information about their diagnosis, leading to resistance of their diagnosis, feeling infantilised or becoming hopeless due to misinformation such as BPD being ‘untreatable’. Alternatively, positive experiences included participants feeling the diagnosis provided a clearer understanding of themselves, their difficulties, helped them feel less alone and gave a sense of relief. As such, this suggests that more negative experiences are associated with diagnoses being delivered without adequate information; however, when diagnoses are communicated effectively, this may result in a host of more positive experiences and begin the process of individual recovery.

[…] The majority of participants (93.3%) indicated their BPD symptoms emerged in either childhood or adolescence. The average age for symptom emergence was 12.1 years old, and the average age of receiving a diagnosis of BPD was 30.2 years, with an average gap between symptom emergence and diagnosis of 18.1 years.

[…] When asked, the majority of participants (85%) stated they felt like that they could have benefited from a diagnosis of BPD in adolescence. For instance, one participant stated: ‘I think that in adolescence it could have definitely been diagnosed. That’s what frustrates me and upsets me. If I had that diagnosis in my teens getting that early intervention support and then not having to go through more suicide attempts and hospitalisations and stuff like that. Like, actually having some sort of understanding.’

Another participant stated: ‘Even my physician, she said that she’d made notes throughout her seeing me but didn’t want to bring it up until I was an adult essentially … I think it would have made a lot of sense, it would have helped me a great deal to be diagnosed at 15.’

[…] All participants had received a diagnosis of BPD; however, on average, participants had an additional 2.5 diagnosed comorbidities. Discussing the experience of receiving a diagnosis of BPD, consistent themes of feeling relief at diagnosis were contrasted with challenges of living with this disorder and the associated stigma.

[…] [A few participants shared their negative experiences with getting diagnosed. Participant 4 said] ‘There was no support at all … there was no networking, there was no follow-up … I wasn’t even spoken to by the doctors about what I could do—it was more, “here’s a diagnosis, go fend for yourself.”’

[Participant 2 said] ‘The psychiatrist, who I’d never met before in my life, started to ask me numerous questions about life and about how I’m feeling and all of that. Then after maybe 30 minutes they go “I’m going to diagnose you with borderline. Here’s a pamphlet about what it is. When you walk through those doors, no-one is going to want to talk to you.” … and that was my introduction to borderline.’

[Participant 8 said] ‘It was a very horrible experience; [the doctor] actually said some very nasty things about BPD to me about me like “you have BPD, that means you are this particular type of person, you’re very manipulative, you’re resistant to treatment.”’

[Lastly, Participant 10 said] ‘Some compassion and understanding would be nice … not, here, go sit in this grey room. Oh, we’re going to bring in some students and they’ll ask you lots of questions. Right. Okay. That’s it. You can go now. Like, you’re just not treated like a person.’

[…] Participants routinely reported the positive benefits they have gained from engaging in psychotherapy for personality disorder. The two main benefits that participants reported from treatment were ‘gaining insight’ and ‘changing problematic behaviours’. […] However, participants often also discussed the difficulty in accessing treatment. This difficulty was related to factors like living in rural area, prohibitive costs, time demands of the treatment, not finding the treatment/therapist to be the ‘right fit’, long waitlists or not having access to specialist treatment.

[…] It was clear from participant reports that missing features of diagnosis included follow-up treatment recommendations, absence of personalising how the features were present in everyday life and that time was not always taken to explore the difficulties in depth.

[…] calls to recast BPD as a trauma disorder persist, arguing that this offers a clearer, less stigmatising and more treatment informed conceptualisation of a patients difficulties. Certainly, the links between adverse childhood experiences and BPD have been consistently identified, with meta-analyses reporting that individuals with BPD are 3.15 times more likely to experience childhood adversity than other psychiatric groups. However, at the same time, approximately 30% of individuals with BPD do not report traumatic experiences in their childhood. Further, while there is an overlap between trauma disorders and personality disorder, meaningful differentials have also been consistently identified.

[…] it was also clear that despite using the same term (‘trauma’) participants meant very different things by it. Trauma, as per complex post-traumatic stress disorder diagnosis, refers to events of ‘an extremely threatening or horrific nature [such as torture, slavery and genocide campaigns]. While some participants’ descriptions of their early childhood experiences would certainly meet this definition, others, who described more chronic relational traumas of emotional invalidation and empathic failures, would not. This bears considering as re-casting BPD as a trauma disorder would therefore either require an expansion of the definition of trauma or instead eradicate key aetiological social-environmental concepts that have been held for decades and which hold significant empirical value.”^[9]

The following excerpts are from Engendering misunderstanding: autism and borderline personality disorder by Jay Watts, which reads:

“Female autism can be misdiagnosed as borderline personality disorder, leading to mistreatment and unnecessary harm. […] There is a common myth that clinicians can easily recognise borderline personality disorder, leading to a shortcut in the diagnostic process and the potential for missing signs of autism in early childhood. […] Clinicians must be encouraged to pursue thorough differential diagnoses, especially for women and transgender individuals who experience emotional lability with self-harm.

Autism is underdiagnosed in girls, women, and transgender individuals due both to diagnostic bias, and the quieter, less visible signs and symptoms of female autism.
As females are so adept at camouflaging difference, distress generally only becomes manifest during mid childhood and adolescence, when mental illness gets misidentified as primary cause.
Early mood difficulties often transform into more serious distress with emotional lability and self-harm. This can get misrecognised as borderline personality disorder, causing preventable harm.
Borderline personality disorder is something that clinicians often feel they can recognise immediately, increasing the need to consciously think about differential diagnoses especially when presented with females who self-injure.

[…] International data suggests the average time between initial psychiatric evaluation and a diagnosis of autism spectrum disorder (ASD) is over a decade, with most patients receiving alternative diagnoses during that interval. One of the most common and damaging misdiagnoses is borderline personality disorder (BPD). Why? Autistic traits are present in early childhood but are not diagnosed until later, if at all. The likelihood of diagnosis varies according to class, ethnicity, geographical location, and, crucially, gender. Women and transgender individuals are routinely overlooked due to the male-biased phenotype to which parents, educators, and clinicians have been socialised.

[…] The male bias means that autistic girls and Transgender individuals are less likely to be referred for assessment, with early problems commonly being attributed to shyness or something that one will grow out of. If they do manage to progress through the system and receive a formal assessment, they are subject to ‘false negatives’ as many of the most common assessment measures remain male-biased.

[…] BPD is often given as a diagnosis as its symptom constellation so closely resembles the distress patterns experienced. BPD is a highly contentious diagnosis, characterised by intense and unstable emotions, a distorted sense of self, unstable relationships, and frequently, self-harm. Women are overwhelmingly diagnosed with BPD (75%), and it has repeatedly been seen as ‘dustbin’ diagnosis for traumatised females whom society find difficult. BPD is one of the most feared diagnoses in psychiatry as it can be used to deny patients help and kindness, even when they have severe suicidal tendencies. Due to its lack of construct validity, it was to be removed from ICD-11 until an eleventh-hour intervention when it was reintroduced due to political lobbying.

[…] These symptoms appear cyclical because masking is misrecognised as functioning well, meaning that responses like autistic ‘burnout’ seem to come from nowhere, or be excessive, to the neurotypical gaze. This provokes a punitive response from strangers, family, and clinicians, which becomes internalised and enacted on the self, in the following pattern: 1. Masking diﬀerence, which is extremely diﬃcult to sustain 2. Burnout, meltdowns, or self-injury, which can lead to feelings of failure and further punishment, resulting in 3. Mortifying guilt and shame, fueling the need to mask their struggles once again This pattern looks like BPD to most clinicians, especially given the autistic tendency to have one or two intense, close relationships. Once a patient is diagnosed with BPD, it is difficult to escape its explanatory reach. Stimming behaviours such as banging one’s head against the wall or finger-flicking, for example, are commonly misread as self-injury or attention-seeking. This can direct the treatment to behavioural therapies that aim to ‘extinguish’ precisely what is keeping the individual together provoking a stand-off between clinicians and patients.”^[10]

The following excerpts are from The epistemic injustice of borderline personality disorder by Jay Watts, which reads:

“Borderline personality disorder (BPD) remains among the most passionately disputed diagnoses in psychiatry. Its nosological origins can be traced back to the transformative era of DSM-III in 1980, when its inclusion acted as a concession to the psychoanalytic fraternity, sparking widespread dissatisfaction among task force members. This tendency to yield to the status quo has been a consistent theme throughout the subsequent evolution of personality pathology. The taskforces for both ICD-10 and DSM-IV leaned towards a shift in dimensional representations, only to be abruptly pulled back on the cusp of ratiﬁcation. The recently unveiled ICD-11, despite its pivot to a dimensional framework, chose to retain BPD as a trait qualiﬁer at the last moment, succumbing to the pressure of political lobbying.

The result is a seemingly endless debate that pleases no one. Researchers ﬁnd themselves burdened with a de facto diagnosis that collapses the new statistical model. Clinicians grapple with a diagnosis so heterogeneous and overlapping with many other conditions, such as autism, attention-deﬁcit hyperactivity disorder (ADHD), bipolar disorder and complex post-traumatic stress disorder (PTSD), that it jeopardises the credibility of diagnostic systems.

[…] Above all, this impasse silences the decades long outcry from survivor and patient groups. These groups have continuously told us that the BPD construct conﬁrms their worst fears about themselves, enabling iatrogenic care that retraumatises them.

[…] Psychiatric diagnoses can both inﬂate and deﬂate testimonial credibility, depending on the speciﬁc diagnosis and the context. Diagnoses such as obsessive–compulsive disorder (OCD) or depression are more likely to inﬂate testimonial credibility as they legitimise suffering, providing a tool to bat away micro-aggressions such as ‘I get sad too’ or ‘Yeah, I always go back to check the oven’. Conversely, diagnoses such as schizophrenia and personality disorders are far more likely to deﬂate testimonial credibility. Schizophrenia does this by attacking the speaker’s rationality, through the notion of lack of insight. BPD does so by not only individualising problems that have been relationally unseen or unregistered, such as trauma or undiagnosed autism, but locating them in problems with one’s very being rather than a condition, illness or divergence one has. This is especially epistemically harmful as it attacks the person’s character, slurring their very moral essence and framing them as what Dotson terms ‘a bad affective investment’.

This discourse enables clinicians to accept and perpetuate the harmful ‘heartsink’ stereotype associated with BPD without unsettling their ideas of themselves as helpers. Patients often face belittling, contradictory responses, including avoidance, withdrawal of warmth, rejection and reluctance to provide care, owing to the lingering idea that BPD is not a genuine mental illness, but rather portrays patients as ‘attention-seeking’, ‘manipulative’ and ‘difﬁcult’. Consequently, this can lead to maltreatment and dismissal of patients through DARVO (deny, attack, and reverse victim and offender) tactics. Psychoanalytic concepts such as ‘splitting’, which can deny patients access to clinicians they feel safer with, and ‘projective identiﬁcation’, which enables the expression of feelings of hatred and disgust that would be unacceptable in other contexts, are intimately entwined with the idea of BPD, serving as a ‘personality disorder shield’.

[…] This establishment of a predetermined narrative is both merciless and baseless, exaggerating claims and imposing a sense of inevitable doom. Despite evidence that 85% of individuals with the BPD label achieve recovery at 10 years, 3 the label provokes more negative clinician ratings of problems and prognosis than a more neutral behavioural description does.

[…] Even survivors who question the diagnosis with enquiries such as ‘How exactly do you expect an abuse victim to behave?’ ﬁnd themselves wrestling with an internalised perpetrator who carries not only the legacy of early abusive ﬁgures but is emboldened by personality disorder’s character slur that, in feeling so familiar, reinforces the label’s validity. This leads many to perceive the BPD label as a form of medicalised victim-blaming, whether the internalised perpetrator has been a sexual predator or, to give but one other example, a neurotypical world that has persistently placed all the problems in the patient.

[…] it is a recognition that the BPD construct often hinders access to help and ripples into unintended areas of life and that, more than 40 years after BPD was ﬁrst introduced in DSM-III as a patch-work solution that pleased no one, we can do better.”^[11]

The following excerpts are from Testimonial Injustice And Borderline Personality Disorder by Jay Watts, which reads:

“Women – for it is 75% women – with this diagnosis are labelled as ‘manipulative’ and ‘attention seeking’. This kind of language use, which would be seen as pejorative elsewhere, situates professionals as knowing something about the complicated nature of personality disturbance attributed to such women; it boosts membership of the in-group ‘professional’. But these hermeneutical claims just do not ﬁt the evidence. ‘BPD’ is so dubious a category scientiﬁcally that it was almost dumped from the latest version of the biggest international diagnostic bible. It clusters women who dissent, who disobey, who resist together, as if these reactions were signs of pathology rather than spirit against the odds.

Yet ‘BPD’ as a category remains, serving as a kind of shorthand between professionals that there is something diﬃcult about someone, that this particular patient might produce strong feelings like rage or desire in the clinician, that a distance needs to be kept. Staﬀ who like women with this diagnosis are seen as procuring ‘splitting’ between team members, and are forced themselves to toe the line of being equally distant to show professional competence. A&E staﬀ, reading this label in notes, take suicide attempts less seriously. GP receptionists act with hostility, the prejudice against women with ‘BPD’ being that they are time-wasting yet again for attention, undeserving somehow. These reactions imply connecting with women with this diagnosis is what Fricker calls an ‘ethically bad aﬀective investment’. These deny women the kind of relationships that could help heal. This discursive disenfranchisement kills.

[…] These credibility slurs are experienced viscerally by survivors. Many people report, for example, a sudden shift to kindness, understanding and empathy after a change of diagnosis from ‘BPD’ to ‘Bipolar Affective Disorders’. Self-harm and suicide attempts are suddenly reacted to with compassion and care. By contrast, those who cannot get their diagnosis changed feel branded for life.”^[12]

The final and following excerpts are from Splitting Complex Post-Traumatic Stress Disorder and Borderline Personality Disorder by Jay Watts, which reads:

“Complex Post-Traumatic Stress Disorder (C-PTSD) has long been hailed as a beacon of hope in the maze of psychiatric diagnoses, even among those of us who have felt harmed by such labels. […] When ICD-11, the diagnostic manual used by Europe and half the world, recently acknowledged C-PTSD, it was perceived as a potential breakthrough for those of us profoundly impacted by such trauma. Expectations were high for increased understanding, empathy, and support. However, the rapidly changing landscape suggests that the recognition of C-PTSD might be a double-edged sword, inadvertently further marginalizing the very individuals it aimed to assist—those diagnosed with Borderline Personality Disorder (BPD).

[…] Clinicians often diagnose BPD when encountering individuals, primarily women, who engage in self-harm, with females representing 70% of those diagnosed. This association with femininity does a disservice not only to women but also to men and non-binary folk in pain, as it perpetuates a misogynistic trope that dismisses patients as ‘attention-seeking’, ‘manipulative’, and ‘playing the victim’.

[…] The majority of those diagnosed with BPD are trauma survivors, with approximately 70% scoring high on adverse childhood experience measures, being especially likely to have experienced emotional and sexual abuse. Trauma therapist Judith Herman first suggested C-PTSD as an alternative diagnosis to the BPD label in 1992. Her reasoning was straightforward: she knew that the label was frequently perceived as stigmatizing and injurious by trauma survivors, often amounting to no more than a ‘sophisticated insult.’ Additionally, she argued that the existing trauma category of Post-Traumatic Stress Disorder (PTSD) only addressed reactions to isolated, one-off traumatic events, like flashbacks. C-PTSD was thus proposed as a diagnosis to encompass the unique symptomatology resulting from chronic, recurrent trauma experienced over an extended period, such as enduring child abuse, domestic violence, or imprisonment during wartime, rather than from a singular traumatic incident.

[…] Herman’s suggestion, which had been built not only off the work of her patients but the labour of survivor movements, was initially met with controversy. However, as the subsequent three decades unfolded, the idea of C-PTSD gained increasing acceptance. This progression happened in parallel with significant and ongoing shifts in societal recognition of trauma. What was once deemed uncommon began to be acknowledged as remarkably prevalent—with one in four of us having been abused.

[…] Not everyone was in favour of the C-PTSD category, however. Some disagree with the term ‘disorder’ to describe the aftermath of trauma, viewing it as the medicalization of understandable trauma effects. Nevertheless, many saw in C-PTSD a potential diagnostic home. Thus, when C-PTSD was officially approved as a diagnosis by ICD-11 in 2019, to be introduced into clinical practice from Jan 2022, it was met with widespread relief and celebration. But was this relief premature?

[To be clear] If we are to have a diagnostic system, I support the inclusion of C-PTSD. I eagerly welcome the increased training it will provide for clinicians, helping them to understand the profound impact of prolonged trauma on our minds, bodies, and souls. However, we face a significant challenge in our mental health thinking, including among those who are critical. We often overlook the interconnectedness of ideas and fail to anticipate how they might affect one another. Just like a single keystroke can reshape the meaning of a word, the addition of C-PTSD sends ripples throughout the diagnostic system, reshaping other constructs in its wake. These ripple effects can be perilous, potentially undermining the very positives that survivors and trauma therapists were striving for.

From this position, C-PTSD is much more problematic. While one might intuitively expect C-PTSD to provide a nosological refuge for those who’ve lived through protracted trauma such as enduring childhood sexual, emotional, or physical abuse, or neglect—as the label on the bottle suggests —the reality is far more complicated. The category’s strict definition ironically creates an exclusionary boundary, leaving out as many individuals as it shelters.

[…] C-PTSD unintentionally reinforces one of the most problematic diagnostic categories of our time, BPD. […] In the UK, there has been a growing sense of change in the air surrounding the diagnosis of BPD. Recent developments, including a national consensus paper endorsed by prominent organizations, have called for the abandonment of the BPD label. This is not only due to the exceptionally poor construct validity of BPD, which renders it a scientific embarrassment even to mainstream clinicians, but also because of the contempt it so often engenders within our care systems and the despair it causes many survivors.

[…] Not only does BPD have exceptionally poor levels of reliability and validity, but it provokes high levels of discrimination and notoriously poor treatment not only in society but from healthcare providers. […] Further, the BPD diagnosis has low functional utility, often blocking access to help, and can solidify patients’ ideas that they are fundamentally flawed, i.e., that problems lie in who they are, not in a condition that they have.

[…] All of this bears an uncanny resemblance to how BPD is defined, doesn’t it?? BPD, after all, is supposedly a pattern of instability in emotions, self-image, and relationships, quite literally the DSO criteria. Intense and unstable emotions, impulsive behaviors, self-destructiveness, chaotic relationships, recurring thoughts of self-harm—all things associated with BPD seem to fit like a glove.

It’s no wonder then that most clinicians, professionals, and carers held the belief that individuals stamped with the BPD label who have experienced trauma would finally have a home in this new diagnostic label. But alas, that’s not proved to be the case. ICD-11 and the beholden research community decided to throw a curveball by introducing specific criteria, not just to determine IF emotional regulation issues, disturbances of self-concept, and interpersonal problems are present, but to delve into HOW they manifest. This occurred alongside a last-minute U-turn, indicating that BPD, a diagnostic category that has been found scientifically problematic by each and every DSM and ICD taskforces since its inception, still persists as a ‘trait qualifier’ in the ICD. This descriptor code allows it to remain as usable, as character assassinating, and as potentially damaging as it has been in the past.

[…] When a patient’s attitude shifts between interest, indifference, and disappointment, it can bruise a professional’s self-image. If inadequately trained, many resort to weaponizing the BPD label as a defensive reflex, thereby avoiding the sometimes-confronting reality of trauma responses as a necessity for survival, which, with the right understanding, deserve respect and admiration. Ascription to personality for one grouping, then, says far more about professionals’ trainings and the systems they operate within than much else.

[…] It’s disconcerting to see how our diagnostic systems mirror society’s unease with those who step away from the norm and who unflinchingly show their trauma—through physical signs or attempts to spur recognition among professionals and significant others. The BPD label, in this context, can be seen as a punitive form of regulation, steering treatment towards behavioural management and compliance, therein reinforcing hegemonic norms while dodging the need to face the harsh realities of human cruelty and the deep pain it inflicts.

[…] BPD’s reliability and validity is so poor even the chair of the ICD taskforce called it an ‘abrogation of diagnosis’, and it was to be removed from ICD until a very last-minute U-turn, based predominantly on concerns about how health insurance claims would be coded. Treatments ‘for’ BPD, such as Dialectical Behaviour Therapy (DBT), Mentalization-Based Therapy (MBT), and Transference-Focused Therapy (TFT), address underlying common factors that are transdiagnostic, not exclusive to BPD, and are highly likely to be useful for many patients who will now get a label of C-PTSD. Furthermore, a recent meta-analysis has shown that trauma therapy is both safe and highly effective for trauma survivors diagnosed with BPD. Therefore, the division between BPD and C-PTSD is neither necessary, useful, scientific, or ethical. Treatment pathways should emphasise choice, a key predictor of good outcome.

[…] What is entirely missing, at least from professional discussions, is any real consideration of the impact of being excluded from the new category of C-PTSD, particularly for vulnerable patients. What does it mean for someone who has experienced complex trauma to have their patterns or behaviors placed in the ‘personality’ side of a Venn diagram presented as fact on Instagram, rather than being recognized as part of a trauma-centered label? To ask one’s psychiatrist if one meets criteria for C-PTSD now it exists as a diagnosis only to be told, ‘no, it’s definitely a personality disorder’? To stand up to abusive partners, poisonous family members, unsympathetic healthcare professionals, and barristers vying for custody of our kids, only to be met with the contemptuous retort, ‘If they genuinely believed you were traumatized, they would have diagnosed you with C-PTSD, wouldn’t they?’

No-one seems to have thought to ask—but any survivor, I reckon, can tell you without a second’s thought. Traumatized children and adults who are abused, groomed or gaslit are very often told that their trauma is not legitimate somehow; that the ‘real’ victims are over there and that we are too seductive, too difficult, too wily, too angry, too impulsive, too complicit somehow, to be believable, let alone worthy of care and compassion. Having trauma registered as such is thus incredibly important for us as survivors because we have nearly always been told otherwise in messages that can echo in the thoughts and voices that haunt us.

We are at a crucial turning point in the mental health system’s understanding, or lack thereof, of trauma—a point that presents many possibilities and pitfall. We must ensure that C-PTSD does not become a silencing tool, muffling the voices it was specifically designed to amplify and empower. This requires challenging the diagnosis of BPD, instead of using it as a foundation for defining C-PTSD, thereby avoiding the [division between] ‘deserving’ and ‘undeserving’ victims which has been used to silence and smother trauma survivors’ testimonies for centuries. Let’s fulfil C-PTSD’s promise and bin the diagnosis of BPD once and for all!”^[13]

Aside from the obvious, I think if there’s anything these excerpts highlight it’s that the motives and attitudes of those within the system are commonly extremely misaligned from how the system likes to posture itself. You can’t do anything meaningful about the widespread stigmatization and mistreatment of patients by “professionals” other than to change whose even allowed to obtain & maintain these positions.

A medical “professional” willing to look down on a patient and treat them like shit especially when they haven’t even done anything is one that has something inherently dark about their character. Whether or not it’s the system’s fault for creating these people, it’s still the system’s inherent responsibility to make sure that “professionals” like this aren’t able to last long.

I also find the idea that “professionals” simply need to be won over or educated better is a nasty one. They are already being paid to do a job they’ve spent a decade being “educated” on where the entire point of it (allegedly) is to help people who need it. Not to mention these are simply just grown ass adults. Majority of which are over 30. Why exactly should anyone have to bend over backwards to make them act like there’s a soul somewhere in that body? As nasty as these people are the real focus should be on creating an environment that naturally forces them out, however that may be accomplished, if the system itself has no desire to prevent their existence. They are actively harming people.

I want to close this out with dedicated words about Jay Watts, whose work I’ve already used within this chapter. She’s an award winning consultant clinical psychologist and relational psychotherapist, having done psychotherapy professionally for 25 years.^[16] Her work is so great it made me almost scrap Myth altogether. She’s published dozens of articles throughout her career that can be found on her Academia page and has appeared in a scarce amount of videos.^{[17][18][19][20]}^[21] I’ve only really consumed what you see here but she does have views of the world and mental illness very similar to mine (in the context of Psychiatry’s Mirror II) that are significantly more detailed. She also works hard to provide healing for those that need it through her work. She herself has gone through psychiatric abuse which is part of why she does what she does.^[21]^[22] I’d love for Myth to provide her a much bigger platform, so if anything about her sounds interesting to you, you can easily find her work on Academia here and by searching “Dr Jay Watts” on YouTube. If you’re reading this, hi Jay!!

The next chapter:

My Experience With Psychosis

Thriller Timeline by Thriller40 – 2022
Borderline Personality Disorder: Treatment and Management by National Clinical Practice Guideline – 2009
Borderline Personality Disorder: To diagnose or not to diagnose? That is the question by Katrina Campbell, Karen-Ann Clarke, Debbie Massey, Richard Lakeman – May 2020
The Structure of Borderline Personality Disorder Symptoms: A Multi-method, Multi-sample Examination by Ashley A. Hawkins, R. Michael Furr, Elizabeth Mayfield Arnold, Mary Kate Law, Malek Mneimne, and William Fleeson – October 1, 2015
Borderline personality disorder: a spurious condition unsupported by science that should be abandoned by Roger Mulder, Peter Tyrer – April 12, 2023
Should Borderline Personality Disorder Still Be a Diagnosis? by Daniel J Winarick – August 3, 2022
Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies by Falk Leichsenring, Peter Fonagy, Nikolas Heim, Otto F. Kernberg, Frank Leweke, Patrick Luyten, Simone Salzer, Carsten Spitzer, Christiane Steinert – January 12, 2024
Why Borderline Personality Disorder is Misdiagnosed by Alan E. Fruzzetti – October 03, 2017
Diagnosing borderline personality disorder: Reports and recommendations from people with lived experience by Vanessa Tedesco, Nicholas John Stephen Day, Sophie Lucas, Brin F. S. Grenyer – November 23, 2023
Engendering misunderstanding: autism and borderline personality disorder by Jay Watts – March 16, 2023
The epistemic injustice of borderline personality disorder by Jay Watts – February 23, 2023
Testimonial Injustice And Borderline Personality Disorder by Jay Watts – February 14, 2017
Splitting Complex Post-Traumatic Stress Disorder and Borderline Personality Disorder by Jay Watts – June 21, 2023
Personality Disorders by Mind
Controversies in the classification and diagnosis of personality disorders. by C. W. Lejuez & K. L. Gratz – 2020
Dr Jay Watts by Jay Watts
How are personalities formed with Dr Jay Watts by A Different Kind of Woman – June 6, 2017
Dr Jay Watts by Liverpool Hope University – November 5, 2016
Mental Health After Neoliberalism | Mobilising New Economic Futures by New School Economics Goldsmiths University – August 23, 2018
Dr Jay Watts YouTube Channel – April 4, 2010
Jay Watts Academia Account
Psychiatric Survivors Movement by International Mental Health Collaborating Network

The Myth of the Mental Health System

w r I t t e N b Y b L e S s I n g S s t r A N d e d

My Experience With Psychosis