Hello and welcome to Healthcare Magic. Thanks for your query.

I understand that you are very distressed and devastated about the psychiatrist's report. Your feelings and fears due to this are valid and quite natural.

Now, personality disorders have to be diagnosed with care and caution, since it can have a very stimatizing impact on the patient and secondly, patients with this diagnostic label are often looked upon with a negative perspective and there's a general impression that there can be no productive treatment strategies for these patients.

Now, firstly, as a psychiatrist, let me tell you that it is difficult to diagnose a personality disorder, just based on the information obtained in one session. By definition, "personality" refers to "a person's enduring pattern of a person's emotional, attitudinal and behavioural patterns", and it is not easy to understand all about this long-standing nature or enduring pattern of behaviour about a person in just one interview. In addition, corroborative history from relatives or friends is required to clarify the diagnosis.

Now, to clarify this issue of Borderline Personality Disorder, I will give you the list of the official American diagnostic criteria for getting a better idea...

A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by FIVE (or more) of the following:

1) Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5

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

3) Identity disturbance: markedly and persistently unstable self-image or sense of self.

4) Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5

5) Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars or picking at oneself (excoriation).

6) Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).

7) Chronic feelings of emptiness

8) Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9) Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms

Now, one of the common diagnostic terms when it comes to this issue of personality problems is labelling it as "XXX Personality "TRAITS", rather than XXX Personality "DISORDER". The difference is that when a person is said to have some personality traits, it means that he / she has some features of the disorder but does not fulfill the full diagnostic criteria to call it a personality disorder.

Though personality, as such refers to a person' long-standing nature and is difficult to change, still the whole point of bringing in a category called "personality disorders" in the psychiatric disagnostic system was because more people with these problems can be identified and treated. But, unfortunately, as time went by, many people started using this diagnostic category to label someone who they found "difficult to handle or treat", thus creating a widespread belief that anyone diagnosed with a personality disorder is just "written off". Now, this attitude is very incorrect and the truth is that people with personality problems do experience a lot of distress, difficulty in coping with life's pressures and so, need more emotional support and professional help. Also, it is absolutely NOT true that treatment doesnt work. Medication may not be the only solution, nevertheless does help a lot of people. Moreover, regular psychotherapy with a dedicated therapist does make a huge difference in symptom relief, preventing future crises and improving the overall functioning level.

So, please don't get dejected thinking that recover is not possible or that you may be "branded" for life. If you feel that the diagnostic label was inappropriate, you can have a polite discussion with the psychiatrist about this and clarify these issues. (It would be wise not to take a beligerent stand as it may only be misinterpreted as emotional instability!) I would also advise you to try CBT as it has been proven to be quite effective for a variety of psychological problems, including obsessive compulsive disorder.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

---

Hello again,

Yes, even if you have a few traits of borderline or obsessive compulsive personality types, with appropriate therapy and sincere efforts from your side, you will definitely be able to overcome your problems, to a point where you no longer are given this diagnosis.

Human behaviour is largely "learned"...that is, since early childhood, we acquire our attitudes, characteristics and behaviour through a process of conscious or unconscious learning. People with personality disorders have consciously or unconsciously 'learned' behaviours and attitudes, which are not healthy and adaptive for normal social functioning.

Now, the core concept of psychotherapy is that what can be learned can be unlearned and what has not been learned properly can be learned. What I mean to say is that these people with maladaptive behaviours, when offered a conducive and supportive environment, and proper guidance, can learn and acquire healthy attitudes and behaviours, which will enable them cope well with the normal social demands.

Quite frankly, as a psychiatrist, the real challenging issue in treating people with personality problems is that they often don't realize that their behaviours are unhealthy and maladaptive. Once this realization or "insight" is there, then this itself is half the road to successful therapy. The other half is motivated and persistent efforts to change and improve themselves.

In your case, firstly you don't seem to be having a full fledged personality disorder as such. Secondly, you seem to have a good insight about whatever few unhealthy behaviours you may have. Thirdly, you are willing to take sincere and dedicated efforts to improve yourself. Therefore, I can assure you that you will be able to do overcome whatever problems you may be having.

Regarding your second question, any psychiatric diagnosis, especially complicated ones like personality disorders, need detailed and repeated assessments to get a clear and definitive picture. So, if I suspected some "traits" or features of a personality disorder, I would call back the person for a more detailed assessment, and there have been cases where I have even needed multiple sessions to reach a diagnosis of a personality disorder. So, I think you need not feel so scared and apprehensive about going back. Maybe, a more detailed assessment would give the doctor a clearer picture about your diagnosis and will help him understand you and your problems better.

I would advise you not to feel let down by your diagnosis, but aim to get the best out of therapy, so that, irrespective of your diagnosis, you would be able to handle your problems better, be relieved of your distress and be able to function to your full potential.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

---