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?

Some think EUPD is just cPTSD

Why is that their thinking?

My mother had BPD, but not c-PTSD.
I have c-PTSD, but not BPD.

So how can that be true? genuine q - not snarking.

@georgarina

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.

This is interesting, as although most of us with EUPD have experienced trauma, we have all experienced invalidating environments. I'm not sure just focusing on the trauma is helpful. It is an important part but I think DBT ideally should be done first before trauma therapy. I think DBT would be so useful for Autism too. I do think cPTSD could be misdiagnosed as EUPD, though. But for me it wouldn't feel like the right diagnosis as it doesn't cover all my symptoms.

Some do think EUPD is cPTSD

Why throw that in after insisting trauma doesn’t cause EUPD/BPD for three pages? The “t” in PTSD is “traumatic”.

@CorrBlimeyGG

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.

Ok, fair enough. This is what I was told. I mean about what the changes in the structure were.

I know four women who were diagnosed with EUPD/BPD as young adults and then much later told they were either autistic or had ADHD. As others have said, women are so commonly misdiagnosed and fobbed off.

I was told by an NHS autism specialist that I just had an attachment disorder and ‘probably’ dyspraxia. A while later I spoke with an independent specialist who convinced me to get another opinion, and I was diagnosed with autism by a much more holistic, understanding psychiatrist. I also found out I have ADHD, as an aside.

I 100% believe that EUPD exists but I think there needs to be a lot more work put into separating which is which. It’s easy to say that EUPD is a neurotype when the researchers are unknowingly looking at undiagnosed autistic people.

Personality Disorders are made, not born. As others have said, they usually develop as a result of trauma, and if the individual receives appropriate care and treatment, they can recover (and some people I've worked with who were diagnosed with EUPD mellow with age) so it's not necessarily a lifetime diagnosis.

The last thing we need to do is confuse autistic female diagnosis by adding in EUPD. I have been arguing about this situation in my current work as many females with a childhood diagnosis of Autism are then being rediagnosed as having an EUPD diagnosis when they become an adult, This is due to a lack of understanding around females with autism in maintream psychiatry. EUPD is a label that is not positive, it then gets excused as the person is EUPD rather than understanding that females with autism are different to men, they may have traits similar to EUPD but they require a very different intervention.

We need to support females to get the right support but an appropriate diagnosis should guide that...someone with EUPD would required DBT whereas a female with autism would require a full sensory assessment, SALT assessment and functional behavioural analysis to assist in next steps....they are very different

Not to be gratuitously nosey, I hope, but I’m intrigued. Why are you so attached to the specific wording of “structural brain changes and invalidating childhood” (which seems to be proposed rather than proven and a very narrow wording) and so opposed to the role of trauma (widely agreed and accepted)?

Is there someone about the traditional concept of EUPD or PDs generally that you’re uncomfortable with? I’m not quite catching your motivation.

^ something, not someone.

@User135644

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.

Umm...I find this post just full of myths! I would say most with ASD do want relationships. In fact many get upset precisely because they want relationships but struggle with them. Of course some people may want permanent solitude but I would say most do not. Actually mostly those with EUPD are struggling with communication and social skills, which can be taught in DBT.

@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.

Absolutely this. Adverse experiences are clearly going to have some impact on you. Doesn’t mean it’s a ‘disorder’. More a perfectly normal response to something awful happening. Let’s stop labelling normal reactions.

[quote Svadhyaya]@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.[/quote]
Yes, that's true about scans. Wouldn't it be the same for any neuro developmental disorder, though?

Thanks for explaining, I think I understand. It's quite a heavy title. I feel the same about my life making sense.

That's great about therapy. I hope DBT really helps you. It changed my life. If I can give you one tip, practice, practice, practice! I wish you so much good luck!

@LakieLady - hmm, it's very interesting. There is so much cross over. I do think DBT would be so useful for those with ASD as well as those with EUPD.

@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.

Oh, I'm so sorry. I don't think that term is used any more. I assume it was a type of personality disorder that they felt you had traits of, perhaps?

Personality disorders are nothing to do with your personality. I'm sure you aren't inadequate in any way. That must have been horrible to see.

[quote Awalkintime]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[/quote]
Thank you, I'll have a look.

@UndertheCedartree not unless they were looking for cause and effect in the scans. So in order to say that an EUPD brain is born different they would need to be able to have scans of both non-EUPD and EUPD brains at birth and then those same brains in adulthood post-diagnosis. Which obv is impossible. And of course there's no way of studying the same brain raised in a traumatic vs non-traumatic environment without a parallel universe.
Whereas to determine whether an autistic brain is different from an NT brain they just need scans of both types of brain at any given point in time. Although I guess if they were trying to posit that autism is caused by differences at birth which are then triggered by external stimuli (which as you'll know isn't the case) then yes the same dilemma would apply.

Thanks for the tip on DBT!

@Thoosa

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?

But officially we use the ICD? Is that right?

What you've never heard that many autistic people have rigid thinking?

www.google.com/amp/s/taniaannmarshall.wordpress.com/2019/07/25/asperger-syndrome-and-splitting/amp/

This article is about Asperger's and splitting.

@TuscanApothecary

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.

Personally, for me I really don't think trauma is the whole story. Luckily it was a young white man who diagnosed me and he was brilliant. The most supportive psych I have ever had. He had my back 100% and was my biggest champion. I know many are not as lucky. The best thing about my diagnosis was the gold standard treatment I received. If I was just being treated for trauma, I would have been put straight into trauma

Therapy which I wouldn't have coped with. I needed DBT first to learn the skills to be able to cope with trauma therapy.

Umm...I find this post just full of myths!

...but @User135644 said "in a lot of cases", not that not a single autistic person on earth want a relationship. User's post resonates a lot with me - I only have one friend (I had two but one moved to a different continent) and I'm perfectly happy with that. I'm married but my need for solitude has caused arguments in the past and I need to remind myself to make sure I spend enough time with my husband. Of course I love him but a lot of the time I want to be left completely alone and just the presence of another person in the house agitates me. I moved away from my family years ago and when my mum texts me saying how much she misses me, I say it back out of politeness rather than actually missing her. Day to day, it doesn't occur to me to nurture my relationships and suddenly weeks have passed since I saw anyone.

So, it's not a myth, it's just not your experience. I don't seek out human company and I don't feel lonely - I don't care.

@TooManyPJs - trauma is not a part of the criteria for EUPD. Neither is it for ASD. Both often have experienced trauma.

EUPD is caused by biology (differences in brain structures) and environment (invalidating).

I know so many women with EUPD are let down. But not all. Some are given the correct support and therapy.

It's a type of PTSD. It's not a neurodivergence.

@Thoosa

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

Yes, I am because I was told that was what caused EUPD and it absolutely fitted for me (and many others)I expect it is circular. It could be considered traumatic, I agree.

You can't state that for a fact OP. There are two sides to this debate with people better educated on this than us. Personally I believe there will be a huge shift in personality disorders and trauma in the future.

And it was old white men who made the diagnostic criteria.

@ChargingBuck

Some think EUPD is just cPTSD

Why is that their thinking?

My mother had BPD, but not c-PTSD.
I have c-PTSD, but not BPD.

So how can that be true? genuine q - not snarking.

I think because people with BPD usually have experienced trauma, some people think that trauma causes the symptoms of BPD. So I guess they think BPD is misdiagnosed and it should just be cPTSD.