4 ms·

This is a BS article that's basically a clinician's pet peeves and grievances. I know three close people with a BPD diagnosis. They had both a similar constell

This is a BS article that's basically a clinician's pet peeves and grievances. I know three close people with a BPD diagnosis. They had both a similar constellation of personality traits and all three were first medicated with antidepressants to no avail (a common trait in BPD is that it is easy to confuse for major depression). They took BPD-specific drugs and after a few trials and errors their quality of life increased _tremendously_, and there is evidence that BPD and associated personality traits are highly inheritable. It is completely possible that a combination of adequate diet, exercise and sleep and lifestyle changes may take away these symptoms as they may possibly manifest the weird ways in which our minds and bodies react to the difficulties of modern life. But for most people that's just an option. People may debate the minutiae of the biological underpinnings and the quantification of certain classes of symptoms. But that doesn't change that I've seen people who had a monthly episode of behaving like complete trash who totally changed their lives after taking lithium or other medication.

christkv 3y ago
I've known two women who were diagnosed with BPD that later turned out to be Autism. Their doctors believe BPD traits developed due to the issues their autism had on their socialisation as kids and teens. Getting on Ritalin massively improved their and their families lives. At least in women I suspect more than a few BDP diagnosis mask autism.
- jychang 3y ago
  Does Ritalin improve autism? It’s an ADHD drug.
  - hirvi74 3y ago
    Stimulants improve a lot of things -- ADHD, Depression, Binge Eating Disorder, Narcolepsy, Chronic Fatigue Syndrome, etc.. It wouldn't surprise me if stimulants improved Austism in some individuals because, if I recall correctly, I think 60%-70% of people with Autism have ADHD as well.
- exmadscientist 3y ago
  Ritalin! That's interesting. I have a family member (by marriage, I didn't know her when she was young) who sounds an awful lot like your description. Unfortunately for her getting her "misdiagnosis" "corrected" (her words) seems to have made things a lot worse, at least for family members dealing with her. Splitting behavior doesn't help matters at all. This stuff is so complicated and so hard that we really barely have any handle on any of it. It's important to remember that diagnoses are just words; the map is not, is never, the territory. But I'd never heard of Ritalin as an option here, so thanks for bringing it up. I'll mention it to that side should it be appropriate.... (Tangent: I need a family with better general mental health, myself included. Anyone know where I can get one? Do they sell them at Amazon or do I have to risk AliExpress?)
- mapt 3y ago
  Unfortunately, there is no "turned out to be autism", just as there is no "turned out to be BPD". We don't have affirmative biomedical tests for these conditions. Until we do, they are just constellations - funny imagined shapes - that we're drawing in a galaxy of traits on display in that person's life. Your picture of a "tree" overlaps about 30% with my picture of a "mushroom". But it's not the case that "First it was identified as a tree but later turned out to be a mushroom". We pretend that these things are distinct biomedical disorders because it makes it easier to talk about them, easier not to literally murder the person displaying them, and (bizarrely) because it's legally required to classify them in order to bill a therapist/psychiatrist for their treatment, but in reality they're parts of a maladaptive personality that just look very roughly similar to other maladaptive personalities we've seen in the past.
  - type0 3y ago
    > But it's not the case that "First it was identified as a tree but later turned out to be a mushroom". sometimes a tree can't function without a mushroom and vice versa, a true symbiosis
carabiner 3y ago
The only thing that worked for my BPD as a man was DHT (testosterone) cream, unfortunately it became scheduled (illegal) in the US.
tptacek 3y ago
As the article points out, the diagnostic features of BPD are common to a bunch of different conditions. There have been decades of research trying to establish a reliable "borderline" factor that would set the condition outside existing categories of disorder; they've all failed. What makes that especially pernicious is that, tracing all the way back to the era of Freud, BPD has been viewed as essentially untreatable --- but many of the combinations of disorders that can produce the triad of attributes used to diagnose BPD are highly treatable. The fact that you've known people whose lives were changed by medication would tend to strengthen the authors point, right? We're all cognitively adept at identifying patterns and giving them names, but that doesn't make our intuitions about those patterns science.
- Delk 3y ago
  > What makes that especially pernicious is that, tracing all the way back to the era of Freud, BPD has been viewed as essentially untreatable I've got the impression that BPD, unlike other personality disorders (or things labelled as such), isn't actually considered essentially untreatable, at least not nowadays. BPD probably has a notorious reputation, possibly because of the potentially emotionally taxing nature of living with or treating emotionally unstable people, and perhaps because it could be difficult to treat. But no modern factual source I've come across has considered it untreatable. Even a superficial source such as Wikipedia says the majority of those who have been diagnosed achieve recovery over time [1]. I've also read from reputable sources [2] that in 5 or 10 years the majority of patients no longer fulfil the diagnostic criteria. That doesn't invalidate what you're saying, of course. The symptoms do overlap with a lot of other disorders (which is also true of many other psychiatric diagnoses, which is why differential diagnosis is important). And the very fact that just about every other thing that's called a personality disorder is considered nearly untreatable (and stable over time), while BPD isn't, is probably a reason to consider whether it should belong in the same category. [1] https://en.wikipedia.org/wiki/Borderline_personality_disorder#Prognosis https://en.wikipedia.org/wiki/Borderline_personality_disorde... [2] the ones I remember are non-English but I haven't got the impression that they differ from Western mainstream
pessimizer 3y ago
> They took BPD-specific drugs Is there any good evidence that there are BPD-specific drugs? ----- 2015: Pharmacotherapy for borderline personality disorder--current evidence and recent trends > Abstract > Drug treatment of patients with borderline personality disorder (BPD) is common but mostly not supported by evidence from high-quality research. This review summarises the current evidence up to August 2014 and also aims to identify research trends in terms of ongoing randomised controlled trials (RCTs) as well as research gaps. There is some evidence for beneficial effects by second-generation antipsychotics, mood stabilisers and omega-3 fatty acids, while the overall evidence base is still unsatisfying. The dominating role SSRI antidepressants usually play within the medical treatment of BPD patients is neither reflected nor supported by corresponding evidence. Any drug treatment of BPD patients should be planned and regularly evaluated against this background of evidence. Research trends indicate increasing attention to alternative treatments such as dietary supplementation by omega-3 fatty acids or oxytocin. https://pubmed.ncbi.nlm.nih.gov/25413640/ https://pubmed.ncbi.nlm.nih.gov/25413640/ ----- 2021: Pharmacological Treatments for Borderline Personality Disorder: A Systematic Review and Meta-Analysis > Results > Of 12,062 unique records, we included 21 randomized controlled trials (RCTs) with data on 1768 participants. Nineteen RCTs compared pharmacotherapies with placebo; two RCTs assessed active treatments head-to-head. Out of 87 medications in use in clinical practice, we found studies on just nine. Overall, the evidence indicates that the efficacy of pharmacotherapies for the treatment of BPD is limited. Second-generation antipsychotics, anticonvulsants, and antidepressants were not able to consistently reduce the severity of BPD. Low-certainty evidence indicates that anticonvulsants can improve specific symptoms associated with BPD such as anger, aggression, and affective lability but the evidence is mostly limited to single studies. Second-generation antipsychotics had little effect on the severity of specific BPD symptoms, but they improved general psychiatric symptoms in patients with BPD. > Conclusions > Despite the common use of pharmacotherapies for patients with BPD, the available evidence does not support the efficacy of pharmacotherapies alone to reduce the severity of BPD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478737/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478737/

christkv 3y ago

I've known two women who were diagnosed with BPD that later turned out to be Autism. Their doctors believe BPD traits developed due to the issues their autism had on their socialisation as kids and teens. Getting on Ritalin massively improved their and their families lives. At least in women I suspect more than a few BDP diagnosis mask autism.

jychang 3y ago
Does Ritalin improve autism? It’s an ADHD drug.
- hirvi74 3y ago
  Stimulants improve a lot of things -- ADHD, Depression, Binge Eating Disorder, Narcolepsy, Chronic Fatigue Syndrome, etc.. It wouldn't surprise me if stimulants improved Austism in some individuals because, if I recall correctly, I think 60%-70% of people with Autism have ADHD as well.
exmadscientist 3y ago
Ritalin! That's interesting. I have a family member (by marriage, I didn't know her when she was young) who sounds an awful lot like your description. Unfortunately for her getting her "misdiagnosis" "corrected" (her words) seems to have made things a lot worse, at least for family members dealing with her. Splitting behavior doesn't help matters at all. This stuff is so complicated and so hard that we really barely have any handle on any of it. It's important to remember that diagnoses are just words; the map is not, is never, the territory. But I'd never heard of Ritalin as an option here, so thanks for bringing it up. I'll mention it to that side should it be appropriate.... (Tangent: I need a family with better general mental health, myself included. Anyone know where I can get one? Do they sell them at Amazon or do I have to risk AliExpress?)
mapt 3y ago
Unfortunately, there is no "turned out to be autism", just as there is no "turned out to be BPD". We don't have affirmative biomedical tests for these conditions. Until we do, they are just constellations - funny imagined shapes - that we're drawing in a galaxy of traits on display in that person's life. Your picture of a "tree" overlaps about 30% with my picture of a "mushroom". But it's not the case that "First it was identified as a tree but later turned out to be a mushroom". We pretend that these things are distinct biomedical disorders because it makes it easier to talk about them, easier not to literally murder the person displaying them, and (bizarrely) because it's legally required to classify them in order to bill a therapist/psychiatrist for their treatment, but in reality they're parts of a maladaptive personality that just look very roughly similar to other maladaptive personalities we've seen in the past.
- type0 3y ago
  > But it's not the case that "First it was identified as a tree but later turned out to be a mushroom". sometimes a tree can't function without a mushroom and vice versa, a true symbiosis

carabiner 3y ago

The only thing that worked for my BPD as a man was DHT (testosterone) cream, unfortunately it became scheduled (illegal) in the US.

tptacek 3y ago

As the article points out, the diagnostic features of BPD are common to a bunch of different conditions. There have been decades of research trying to establish a reliable "borderline" factor that would set the condition outside existing categories of disorder; they've all failed. What makes that especially pernicious is that, tracing all the way back to the era of Freud, BPD has been viewed as essentially untreatable --- but many of the combinations of disorders that can produce the triad of attributes used to diagnose BPD are highly treatable. The fact that you've known people whose lives were changed by medication would tend to strengthen the authors point, right? We're all cognitively adept at identifying patterns and giving them names, but that doesn't make our intuitions about those patterns science.

Delk 3y ago
> What makes that especially pernicious is that, tracing all the way back to the era of Freud, BPD has been viewed as essentially untreatable I've got the impression that BPD, unlike other personality disorders (or things labelled as such), isn't actually considered essentially untreatable, at least not nowadays. BPD probably has a notorious reputation, possibly because of the potentially emotionally taxing nature of living with or treating emotionally unstable people, and perhaps because it could be difficult to treat. But no modern factual source I've come across has considered it untreatable. Even a superficial source such as Wikipedia says the majority of those who have been diagnosed achieve recovery over time [1]. I've also read from reputable sources [2] that in 5 or 10 years the majority of patients no longer fulfil the diagnostic criteria. That doesn't invalidate what you're saying, of course. The symptoms do overlap with a lot of other disorders (which is also true of many other psychiatric diagnoses, which is why differential diagnosis is important). And the very fact that just about every other thing that's called a personality disorder is considered nearly untreatable (and stable over time), while BPD isn't, is probably a reason to consider whether it should belong in the same category. [1] https://en.wikipedia.org/wiki/Borderline_personality_disorder#Prognosis https://en.wikipedia.org/wiki/Borderline_personality_disorde... [2] the ones I remember are non-English but I haven't got the impression that they differ from Western mainstream

pessimizer 3y ago

> They took BPD-specific drugs Is there any good evidence that there are BPD-specific drugs? ----- 2015: Pharmacotherapy for borderline personality disorder--current evidence and recent trends > Abstract > Drug treatment of patients with borderline personality disorder (BPD) is common but mostly not supported by evidence from high-quality research. This review summarises the current evidence up to August 2014 and also aims to identify research trends in terms of ongoing randomised controlled trials (RCTs) as well as research gaps. There is some evidence for beneficial effects by second-generation antipsychotics, mood stabilisers and omega-3 fatty acids, while the overall evidence base is still unsatisfying. The dominating role SSRI antidepressants usually play within the medical treatment of BPD patients is neither reflected nor supported by corresponding evidence. Any drug treatment of BPD patients should be planned and regularly evaluated against this background of evidence. Research trends indicate increasing attention to alternative treatments such as dietary supplementation by omega-3 fatty acids or oxytocin. https://pubmed.ncbi.nlm.nih.gov/25413640/ https://pubmed.ncbi.nlm.nih.gov/25413640/ ----- 2021: Pharmacological Treatments for Borderline Personality Disorder: A Systematic Review and Meta-Analysis > Results > Of 12,062 unique records, we included 21 randomized controlled trials (RCTs) with data on 1768 participants. Nineteen RCTs compared pharmacotherapies with placebo; two RCTs assessed active treatments head-to-head. Out of 87 medications in use in clinical practice, we found studies on just nine. Overall, the evidence indicates that the efficacy of pharmacotherapies for the treatment of BPD is limited. Second-generation antipsychotics, anticonvulsants, and antidepressants were not able to consistently reduce the severity of BPD. Low-certainty evidence indicates that anticonvulsants can improve specific symptoms associated with BPD such as anger, aggression, and affective lability but the evidence is mostly limited to single studies. Second-generation antipsychotics had little effect on the severity of specific BPD symptoms, but they improved general psychiatric symptoms in patients with BPD. > Conclusions > Despite the common use of pharmacotherapies for patients with BPD, the available evidence does not support the efficacy of pharmacotherapies alone to reduce the severity of BPD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478737/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478737/