Could EUPD come under the neuro diverse umbrella?

[UndertheCedartree]

I have been to a neuro diversity conference today. One thing that came up was that Emotionally Unstable Personality Disorder (BPD) should be categorised as a neuro developmental disorder like Autism. I found this so interesting as I've often thought the same. There is so much cross over between EUPD and other disorders like ASD and ADHD, for example many of the differences in the brain are the same, impulsiveness and black and white thinking can happen in EUPD and ADHD/Autism.

I would love to hear from anyone who has experience of these disorders what you think?

I’m not a psychiatrist so feel free to take this with a pinch of salt. I’m a social worker who has worked in a personality disorder service and in a specialist autism setting.

Many patients reject the PD diagnosis because it’s stigmatised. Professionals make assumptions. They have pre-conceived ideas and unconscious biases. This affects care and treatment.

I’ve certainly come across people who have an ASC and a PD. Of course some are incorrectly diagnosed. My experience is that people with a PD diagnosis have an utterly appalling time in mental health services and will, understandably, not feel connected to a diagnosis that is stigmatised and not properly treated. It is understandable as to why they are disconnected with the PD diagnosis. We really do need to move on from “attention seeking woman cut herself, give her a plaster and send her home”.

There are a lot of similarities and a lot of people are misdiagnosed.

I was misdiagnosed but backwards. Received an Asperger’s diagnosis at 15 and it seemed to fit but something didn’t feel right.

I was in and out of psychiatric care and I finally saw someone and had another ADOS test at age 21 to be told he didn’t think I had autism and referred me to a psychiatrist who diagnosed me with BPD. It seemed like everything just fit into place after that. I have seen multiple other psychiatrists who all agree I am textbook BPD. I really struggle with splitting & relationships.

As a neurodivergent layperson, I find a lot of value in the term because it doesn't present my conditions as illnesses or flaws which need eradicating. It helped change my view to a much more positive one where I see the strengths and beauty in having a brain that's slightly out of the ordinary. And I don't know how to phrase this without sounding derogatory to people with personality disorders but I don't think ASD, ADHD etc should share "space" with conditions born out of trauma which are illnesses in the way our conditions aren't.

I realise this is very subjective and don't consider my opinion to be any more valid than the next person's. I know some neurodivergent people do view their conditions as more debilitating than I do but personally I've made a concerted personal effort to view mine as positives, albeit positives that have caused me a lot of difficulties and pain along the way!

I didn't have any early traumatic experiences, I had a happy childhood. My trauma came from my ADHD (diagnosed as a child) because I would put myself in really dangerous situations around dangerous people self medicated with drugs and alcohol etc. But once I became an adult I was told I couldn't have ADHD + trauma it must be EUPD or bipolar. I destroyed my mind and body with all kind of drugs only to discover that it was never going to work because I was trying to treat the wrong conditions. I'm not manic, I'm hyper. I'm not depressed, I get overwhelmed easily. I wasn't trying to self harm or self sabotage by putting myself in bad situations in my late teens/early 20s I just had poor judgment of danger and poor impulse Control. Im not lazy and disorganised, I don't lack will power, my brain just works differently. Being told I had EUPD nearly killed me. It became a self fulfilling prophecy. The right diagnosis has freed me to get help for the trauma (and work through it!) and come up with strategies to manage my ADHD (I may go on medication eventually but giving my body and mind time to heal from those unnecessary mental health meds is important to me right now). Best of all I have found a (mostly online) community who think like me and have their own strategies and stories. I don't feel alone.

I think EUPD is a horrible damaging diagnosis. It made people question me when I had other health issues, as a parent, as a partner and gave my abusive partner (now ex) a lot of power. Because it was like being branded dysfunctional, selfish, destructive, immoral and incurable all at once. I really do question whether it exists for anyone, but for myself personally I cannot understand why my ADHD diagnosis did not just automatically follow me into adulthood.

EUPD is mainly trauma-based, like CPTSD. Of course it's the way a certain type of brain reacts to that trauma, but I would like the trauma to centre more prominently than the idea that it's a type of neurodiversity.

@cuno

I'm not saying all women diagnosed with EUPD/BPD are autistic. But I am saying a lot of autistic women are diagnosed with EUPD/BPD instead of autism as the diagnostic criteria for autism favours men. I would argue most women diagnosed with BP have simply experienced trauma and not autistic, and reacting to that perfectly naturally but in a way that is deemed "wrong" by a patriarchal society, so it is then medicalised to put women in their place.

Some do think EUPD is cPTSD But how would that account for the differences observed in the brain? Personally, I don't feel my EUPD is caused solely by trauma. I think the invalidating environment is key. I really don't recognise the idea of being medicalised and put in my place. I need meds, they have helped me enormously. Therapy has too. The 2 main psychs I had were both men and hugely supportive. They were both very forward thinking and up to date, though. They did not ascribe to any of the crappy myths around EUPD.

@Mickarooni

The change of name from BPD to EUPD did not alter the stigma. The vast majority of people with this diagnosis have been through extreme trauma and often, end up re-traumatised by their experiences in the mental health system. I don’t think it hugely matters what they name it. Women presenting in a certain way will be stigmatised regardless unless there is a huge change in the way certain behaviours are viewed.

I have been lucky to have been looked after by brilliant psychs. They did not stigmatised the diagnosis and were very up to date. The diagnosis was key for me to be able to access gold standard treatment.

@Macademiamum

I think a lot of people are diagnosed with EUPD when really they have a neurodiversity and a mental health condition or trauma as well. I say that as a women with ADHD and then trauma who was the victim of misdiagnosis as EUPD and bipolar

Yes, I do think EUPD could be better understood as ND plus trauma, perhaps.

[quote Svadhyaya]@UndertheCedartree are those differences in the brain not caused by the trauma though?
I know - I was referring to the label "personality disorder" and what this implies.
Out of interest, are you a mental health professional?[/quote]
Well, I think it's possible. However, not everyone with EUPD has experienced trauma, so perhaps not!

Sorry, I misunderstood. You mean other people think there is something wrong with your personality?

I'm actually a nurse who studied adult nursing at undergraduate level and mental health at masters. I'm also autistic and have EUPD. Hence, why I'm really interested!

Do you mind me asking what treatment you have had for your EUPD?

Except the differences in the brain people with EUPD are born with are really similar.

There is not nearly enough research to make such a sweeping statement.

Autistic people also have problems with inter personal relationships. What do you think are the differences?

In a lot of cases autistic people don't particularly want those relationships, or they're just happier on their own so they struggle to make them work because they need a lot of solitude. They also typically struggle with social skills and cues to help make a relationship work.

Often those with BPD will self sabotage a relationship by toxic behaviour and it becomes a vicious circle.

For example someone with BPD tend to fear abandonment and being alone, whereas someone with autism tends to crave being alone.

@UndertheCedartree I think I see it more as a Venn diagram where there will be co-morbidity but they are two distinct disorders.

It would be difficult to know from brain scans whether the differences in EUPD brains had been caused by the trauma or would have been there from birth, unless that person had also had their brain scanned at birth, which of course they wouldn't have done as at that point in time it wouldn't have been known they would go on to develop EUPD.

I'm probably not explaining it well - more just the title itself is a horrible title. I actually have found a lot of freedom in having the diagnosis as it's like my whole life made sense.

I have had psycho-dynamic therapy with a psychiatrist and am beginning DBT with a psychologist. I've also tried most drugs on the planet just to be able to make it through the day.

I also have ADHD so I guess that classes me as neuro-diverse but I see that as separate from the EUPD.

@Awalkintime

UndertheCedartree In DSM 5 (The disagnostic manual for mental health) states the same criteria for it as DSM 2 did for hysteria. Trauma would be present as that what would cause the behaviour not the label. What I mean by fitting the narrative is that women show behaviour that is erratic or out of what 'well behaved women' should present like in society. When they are diagnosed and medicated, the medication dopes them so their behaviour changes and then someone will say, like it was that after all.

If a deer ran away from a fox we wouldn't say they are mentally ill and had some disorder causing erratic behaviour when triggered.

I'd look at the work of Dr Jessica Taylor and mental health. It is eye opening about how women are diagnosed with this when they've been raped or suffered DV. It is horrific what she is uncovering.

Thank you for that. We use the ICD in the UK so don't really know the DSM.

I'm not really sure about meds doping women, certainly not long term. But not to say it doesn't happen but it would be very bad practice. My meds don't dope me and if any of my patients were feeling 'doped' I would try to address it (theoretical ly currently as I am not working). Meds can also only do so much. Therapy is needed to address most of the issues. For example a patient can be given an anti-anxiety med to help with anxiety but therapy is needed to help with interpersonal issues.
I will look at that work, thank you. I can certainly believe a lot of women could be misdiagnosed.

@Schuyler

I’m not a psychiatrist so feel free to take this with a pinch of salt. I’m a social worker who has worked in a personality disorder service and in a specialist autism setting.

Many patients reject the PD diagnosis because it’s stigmatised. Professionals make assumptions. They have pre-conceived ideas and unconscious biases. This affects care and treatment.

I’ve certainly come across people who have an ASC and a PD. Of course some are incorrectly diagnosed. My experience is that people with a PD diagnosis have an utterly appalling time in mental health services and will, understandably, not feel connected to a diagnosis that is stigmatised and not properly treated. It is understandable as to why they are disconnected with the PD diagnosis. We really do need to move on from “attention seeking woman cut herself, give her a plaster and send her home”.

I completely agree with everything you say. I think you have been very observant and are quite shrewd in your conclusions.

However, I have to say while I agree many, many women with EUPD are let down by mental health services, I was actually one who was given outstanding care and I was really helped.

@EveryAvenue

There are a lot of similarities and a lot of people are misdiagnosed.

I was misdiagnosed but backwards. Received an Asperger’s diagnosis at 15 and it seemed to fit but something didn’t feel right.

I was in and out of psychiatric care and I finally saw someone and had another ADOS test at age 21 to be told he didn’t think I had autism and referred me to a psychiatrist who diagnosed me with BPD. It seemed like everything just fit into place after that. I have seen multiple other psychiatrists who all agree I am textbook BPD. I really struggle with splitting & relationships.

That's interesting. I'm autistic and also have EUPD. I definitely feel that both diagnosis bring different things to understanding me. I would not feel only one or the other would tell the full story. Splitting is awful. It is really common in ASD too as it comes from black and white thinking.

@cuno

I think a lot of girls and women with autism are misdiagnosed with EUPD/BPD, and tbh I think the disorder is used largely as a stick to beat women with. Rather than lumping it in as a neurodevelopmental disorder, they need to get the diagnoses right to begin with.

I agree.

I have 2 nieces (sisters), both early 20s. One is diagnosed with AS, the other with EUPD, but they way they behave and interact with others is really similar.

Has anyone here ever heard the label 'inadequate personality'? I went to the GP once and saw this on the screen in front of him, under my name. I had been having counselling at the time so I imagine the label had come from my counsellor. No one ever told me directly, but it was there on my notes. I was very upset as you can imagine. And when I googled the term it made me feel even more upset. This was about 20 years ago, so hopefully they don't use labels like that anymore.

UndertheCedartree
You're welcome. It is really interesting, I can't wait for her new book. This is her take on personality disorders. www.facebook.com/jessicaforenpsych/videos/651507439428374

We use the ICD in the UK so don't really know the DSM.

We use both.

Splitting is awful. It is really common in ASD too

I have never, ever heard that before. Can you point me to a source?

@DaisyStPatience

As a neurodivergent layperson, I find a lot of value in the term because it doesn't present my conditions as illnesses or flaws which need eradicating. It helped change my view to a much more positive one where I see the strengths and beauty in having a brain that's slightly out of the ordinary. And I don't know how to phrase this without sounding derogatory to people with personality disorders but I don't think ASD, ADHD etc should share "space" with conditions born out of trauma which are illnesses in the way our conditions aren't.

I realise this is very subjective and don't consider my opinion to be any more valid than the next person's. I know some neurodivergent people do view their conditions as more debilitating than I do but personally I've made a concerted personal effort to view mine as positives, albeit positives that have caused me a lot of difficulties and pain along the way!

EUPD is not born out of trauma. It is caused by differences in the structure of the brain and growing up in an invalidating environment. Most people with EUPD have suffered trauma but not all. Many autistic people have also suffered trauma. I take your point, though that it could suggest that ASD is a mental illness for example. But I think it would be great if people could see the strengths of those with EUPD. Most are so empathetic and supportive for example.

@BluesCluesToo

Has anyone here ever heard the label 'inadequate personality'? I went to the GP once and saw this on the screen in front of him, under my name. I had been having counselling at the time so I imagine the label had come from my counsellor. No one ever told me directly, but it was there on my notes. I was very upset as you can imagine. And when I googled the term it made me feel even more upset. This was about 20 years ago, so hopefully they don't use labels like that anymore.

That's an absolute disgrace and I am so sorry you were labelled as such and made to feel like that. Have you thought about obtaining all your medical records to see what they have on file about you and make a complaint? I know it was 20 years ago but it doesn't really feel like much has changed in that time, it's just the same old shit with different names.

I don't believe in old white men diagnosing women with personality disorders. In fact I would go so far as to say there are no such things as personality disorders and maladaptive behaviours result from stress and trauma.

Did you know asthma and stress are Very interlinked? We don't treat the stress we just give inhalers out though.

@Macademiamum

I didn't have any early traumatic experiences, I had a happy childhood. My trauma came from my ADHD (diagnosed as a child) because I would put myself in really dangerous situations around dangerous people self medicated with drugs and alcohol etc. But once I became an adult I was told I couldn't have ADHD + trauma it must be EUPD or bipolar. I destroyed my mind and body with all kind of drugs only to discover that it was never going to work because I was trying to treat the wrong conditions. I'm not manic, I'm hyper. I'm not depressed, I get overwhelmed easily. I wasn't trying to self harm or self sabotage by putting myself in bad situations in my late teens/early 20s I just had poor judgment of danger and poor impulse Control. Im not lazy and disorganised, I don't lack will power, my brain just works differently. Being told I had EUPD nearly killed me. It became a self fulfilling prophecy. The right diagnosis has freed me to get help for the trauma (and work through it!) and come up with strategies to manage my ADHD (I may go on medication eventually but giving my body and mind time to heal from those unnecessary mental health meds is important to me right now). Best of all I have found a (mostly online) community who think like me and have their own strategies and stories. I don't feel alone.

I think EUPD is a horrible damaging diagnosis. It made people question me when I had other health issues, as a parent, as a partner and gave my abusive partner (now ex) a lot of power. Because it was like being branded dysfunctional, selfish, destructive, immoral and incurable all at once. I really do question whether it exists for anyone, but for myself personally I cannot understand why my ADHD diagnosis did not just automatically follow me into adulthood.

That all sounds so traumatic, I'm so sorry.

My experience of EUPD has been very different. It enabled me to get the best treatment. It enabled me to meet an amazing group of supportive women.

I'm not lazy and disorganised, I don't lack will power, my brain just works differently This really stands out to me. How damaging you were led to believe this. But this statement is also true of those with EUPD, they are none of those things and their brains work differently.

@cuno

I think a lot of girls and women with autism are misdiagnosed with EUPD/BPD, and tbh I think the disorder is used largely as a stick to beat women with. Rather than lumping it in as a neurodevelopmental disorder, they need to get the diagnoses right to begin with.

This.

True EUPD is not neurodevelopmental, it results from trauma. However it's often misdiagnosed ASC or ADHD. And as PPs have said used as a stick to beat women rather than used as an indication of support and therapy needs.

OP, it sounds as though you’re quite wedded to one specific form of words. “Invalidating environment” isn’t an alternative to trauma. It is one form or effect of neglect/abuse/trauma.

It could easily be rather circular:-

Childhood trauma is known to cause structural brain changes.

Untreated personality disorders could impair parents’ ability to provide a secure and loving childhood.

Rinse & Repeat.

This is what the NHS has to say about the causes of Borderline PD;

Causes - Borderline personality disorder

There's no single cause of borderline personality disorder (BPD) and it's likely to be caused by a combination of factors.

Genetics

Genes you inherit from your parents may make you more vulnerable to developing BPD.

A study found that if 1 identical twin had BPD, there was a 2-in-3 chance that the other identical twin would also have BPD.

However, these results have to be treated with caution, and there's no evidence of a gene for BPD.

Problem with brain chemicals

It's thought that many people with BPD have something wrong with the neurotransmitters in their brain, particularly serotonin.

Neurotransmitters are "messenger chemicals" used by your brain to transmit signals between brain cells. Altered levels of serotonin have been linked to depression, aggression and difficulty controlling destructive urges.

Problem with brain development

Researchers have used MRI to study the brains of people with BPD. MRI scans use strong magnetic fields and radio waves to produce a detailed image of the inside of the body.

The scans revealed that in many people with BPD, 3 parts of the brain were either smaller than expected or had unusual levels of activity. These parts were:

the amygdala – which plays an important role in regulating emotions, especially the more "negative" emotions, such as fear, aggression and anxiety
the hippocampus – which helps regulate behaviour and self-control
the orbitofrontal cortex – which is involved in planning and decision making
Problems with these parts of the brain may well contribute to symptoms of BPD.

The development of these parts of the brain is affected by your early upbringing. These parts of your brain are also responsible for mood regulation, which may account for some of the problems people with BPD have in close relationships.

Environmental factors

A number of environmental factors seem to be common and widespread among people with BPD. These include:

being a victim of emotional, physical or sexual abuse
being exposed to long-term fear or distress as a child
being neglected by 1 or both parents
growing up with another family member who had a serious mental health condition, such as bipolar disorder or a drink or drug misuse problem
A person's relationship with their parents and family has a strong influence on how they come to see the world and what they believe about other people.

Unresolved fear, anger and distress from childhood can lead to a variety of distorted adult thinking patterns, such as:

idealising others
expecting others to be a parent to you
expecting other people to bully you
behaving as if other people are adults and you're not