How to: BPD

Mental health and mental illness are big buzz words, and that’s not a bad thing. A lot of people are working hard to break down the stigma around mental health/illness, and that’s a good thing! But it’s led to an odd side effect, in that people are really, really hung up on diagnoses, how to get one, what each disorder is, and how to treat them. 

That’s not a bad thing, necessarily. It’s an important conversation to have! Every disorder is different, with different symptoms, signs, and treatments. But here’s the thing - 

Diagnoses and disorders don’t actually exist. At least, not in the way you probably think of them. You see, a diagnosis from the DSM-5 or the ICD-11 are just labels for clusters of symptoms. If you fit the diagnostic criteria, you can be diagnosed. There’s no specific test, no markers in your blood or other physical scans, just reported symptoms that tend to occur together and when they do, we call it “XYZ Disorder”. Disorders don’t really cause symptoms - symptoms that occur together cause diagnoses. Symptoms exist, those are measurable, and when they occur in a way that we as humans recognize as a specific disorder, a clinician may use that label as a way to shorthand communicate what you’re experiencing.

Here, let’s take an example. 

A. Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it difficult to control the worry. C. The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months); Note: Only one item is required in children. 1. Restlessness or feeling keyed up or on edge. 2. Being easily fatigued. 3. Difficulty concentrating or mind going blank. 4. Irritability. 5. Muscle tension. 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance  or another medical condition F. The disturbance is not better explained by another mental disorder

This is the diagnostic criteria for Generalized Anxiety Disorder, one of the most common diagnoses made. In the U.S., 3,1% of the population is diagnosed with it. That’s 6.8 million people. And they were diagnosed simply because they ticked the boxes that correspond with the diagnostic criteria. Because they felt worried a lot for at least six months, couldn’t control that worry, and felt restless, on edge, fatigued, tired, irritable, tense, and/or had difficulty concentrating/sleeping. That’s all it takes to be diagnosed. And what does that diagnosis of GAD mean? It means that one clinician can refer you to another, and put “GAD” in the referral notes. Now, the new clinician knows that you’re experiencing a lot of worry, and that you have at least three of the other symptoms listed above. They already have an idea of what to look for, and while a good clinician will tailor your treatment to YOU, the diagnosis of GAD gives them a couple of ideas of what to try first. It also tells your insurance what they’re paying for, as each diagnosis has a specific insurance code. 

Yes, it is recommended you go to a professional so that they can rule out differential diagnoses, make sure you’re evaluating your symptoms correctly, and so that they can get the treatment you deserve. But a professional does not have access to any diagnostic tools that you yourself do not have access to. A mental illness diagnosis is very different from a physical illness diagnosis. In general, physical illnesses have very specific physical causes that we can identify, treat, and remove, and very specific physical indicators that can tell doctors with certainty what disorder you have or don’t. (Note that this, of course, isn’t true for all physical illnesses, and also that your ability to GET a physical illness disorder depends on your demographics, access to healthcare, and several chronic physical illnesses are very, very hard to pin down as well). Physical illnesses also have tests used to diagnose that we as laypeople do not have access to - blood tests, MRIs, X-Rays, brain scans…. the list goes on and on. Mental health diagnoses are literally just lists of symptoms, and you can make a list of your own symptoms at home.