Public/online perception of personality disorders

[futureapppsy2]

It seems to be on trend in some online spaces--with bleed into real life--to ascribe personality disorders (notably antisocial/narcissistic/borderline) to, essentially, everyone you dislike. Everyone's ex is a narcissist or has BPD, everyone's parent is a narcissist, etc--basically, anyone who wrongs or hurts you has some underlying personality pathology that also alleviates any nuance from the situation and any responsibility of you personally (or, if you've decided you have a PD, nothing is really your fault, because you have that PD and can't help it). I think there's some degree of meaning-making to it, but also a lot of inappropriate and over-labeling of basic human interactions.

Thoughts or experiences with this?

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[calvnandhobbs68]

Yep, everyones mean boyfriend these days is a narcissist. Seems to be the thing. I've even had people tell me that in their family history "I don't think they were ever diagnosed but they're definitely a narcissist".

Out with old tired bipolar disorder, in with the hot new personality disorders.

 

[futureapppsy2]

Yep, everyones mean boyfriend these days is a narcissist. Seems to be the thing. I've even had people tell me that in their family history "I don't think they were ever diagnosed but they're definitely a narcissist".

Out with old tired bipolar disorder, in with the hot new personality disorders.

What sort of examples do they give your their family member's alleged "narcissistic" behavior when queried, out of curiosity?

 

[romanticscience]

What sort of examples do they give your their family member's alleged "narcissistic" behavior when queried, out of curiosity?

"gaslighting" phenomenologically seems to be not a denial of objective reality but a different opinion and/or denial of guilt causing the person's "invalidated" feelings.

 

[calvnandhobbs68]

What sort of examples do they give your their family member's alleged "narcissistic" behavior when queried, out of curiosity?

Lol I don’t care, family history of narcissistic personality disorder doesn’t mean much to me anyway even if it were true. I don’t have time to sit around asking why they thought grandma was a narcissist. They just tend to bring it up spontaneously when I ask about family history.

I care much more if a first degree relative was actually diagnosed with bipolar disorder or not.

 

[Alemo]

I care much more if a first degree relative was actually diagnosed with bipolar disorder or not.

“So she had bipolar?”
“Oh yeah she was really bipolar.”
“Did they take medication?”
“I think so. I’m not sure.”
“Were they ever in the hospital?”
“I don’t remember. Maybe. But they were mad all the time. Like her mood would go up and down.”
“Are you like that?”
“I don't think so.”
“How often does your mood change?”
“Not often. I only got depressed when I was with my ex-boyfriend. He was a huge narcissist.”

 

[comp1]

I think it's probably asking too much for people to switch from using the term disorder to trait, even though it's a lot more accurate. I'm just really happy if they use labels other than bipolar disorder. Statistically, it's a lot more likely to be something else if you're just grabbing labels.

 

[Marasmus1]

I don`t know about that. However, I have to say BPD is very likely much more prevalent than we think.

I would say %50 of the admissions in my adolescent, young adult inpatient unit either has BPD or BPD traits

 

[tr]

I don`t know about that. However, I have to say BPD is very likely much more prevalent than we think.

I would say %50 of the admissions in my adolescent, young adult inpatient unit either has BPD or BPD traits

Borderline traits are higher in adolescents across the board, and drop with age and maturity.

Even the healthy controls (black line), who are low to begin with, get even lower by late middle age.

Age effects on clinical and neurocognitive risk factors for suicide attempt in depression - Findings from the AFSP lifespan study - PubMed

Despite age-related changes in symptom severity or neurocognitive performance, key risk factors for suicidal behavior previously identified in studies with more restricted age-ranges are salient throughout the adult lifespan. In contrast, depressive rumination may be particularly salient in...

pubmed.ncbi.nlm.nih.gov

Buerke et al. Age effects on clinical and neurocognitive risk factors for suicide attempt in depression - Findings from the AFSP lifespan study. J Affect Disord. 2021 Dec 1;295:123-130.

 

[Stagg737]

Yep, everyones mean boyfriend these days is a narcissist. Seems to be the thing. I've even had people tell me that in their family history "I don't think they were ever diagnosed but they're definitely a narcissist".

Out with old tired bipolar disorder, in with the hot new personality disorders.

Agree, with pretty much everything you've said. It's almost always brought up spontaneously without me asking, and I usually don't bother to explore it unless the patient continues to be severely distressed by it (like having to share custody and they're always anxious about how it's affecting the kid).

Feels like everyone with a "know-it-all" attitude, someone who was arrogant, or someone who was self-confident and selfish gets labeled as a narcissist/narcissistic PD by some patients. People seem to completely lack the understanding that just being a d**che and having a PD are not the same thing.

 

[Marasmus1]

Borderline traits are higher in adolescents across the board, and drop with age and maturity.

Even the healthy controls (black line), who are low to begin with, get even lower by late middle age.

View attachment 352317

Age effects on clinical and neurocognitive risk factors for suicide attempt in depression - Findings from the AFSP lifespan study - PubMed

Despite age-related changes in symptom severity or neurocognitive performance, key risk factors for suicidal behavior previously identified in studies with more restricted age-ranges are salient throughout the adult lifespan. In contrast, depressive rumination may be particularly salient in...

pubmed.ncbi.nlm.nih.gov

Buerke et al. Age effects on clinical and neurocognitive risk factors for suicide attempt in depression - Findings from the AFSP lifespan study. J Affect Disord. 2021 Dec 1;295:123-130.

For many adolescents with borderline traits yes.

Probably not my inpatient folks who are overall much sicker with significant trauma history and multiple psychiatric comorbidity. I am not sure if there is any data about the age effects and neurocognitive risk factors trajectory in patients who are hospitalized very frequently.

 

[tr]

For many adolescents with borderline traits yes.

Probably not my inpatient folks who are overall much sicker with significant trauma history and multiple psychiatric comorbidity. I am not sure if there is any data about the age effects and neurocognitive risk factors trajectory in patients who are hospitalized very frequently.

The pink lines in the graphs above are suicide attempters, so they are pretty ill. Reduction in borderline traits over time is much more pronounced in the psychiatrically ill cohorts (pink line, depressed suicide attempters; blue line, depressed nonattempters) than in the healthy controls.

 

[futureapppsy2]

The pink lines in the graphs above are suicide attempters, so they are pretty ill. Reduction in borderline traits over time is much more pronounced in the psychiatrically ill cohorts (pink line, depressed suicide attempters; blue line, depressed nonattempters) than in the healthy controls.

The tendency of some clinicians to jump to assumptions of borderline in suicidal patients without first assessing for and (if applicable) treating any active Axis 1 disorders really gets me.

 

[Marasmus1]

The pink lines in the graphs above are suicide attempters, so they are pretty ill. Reduction in borderline traits over time is much more pronounced in the psychiatrically ill cohorts (pink line, depressed suicide attempters; blue line, depressed nonattempters) than in the healthy controls.

I do agree with that. Most patients with borderline traits improve with age. (But clinically I would be careful about translating this improvement into overall improvement in well being, self esteem, stable sense of self and forming secure relationships)

Well, as per the study results, overall borderline traits went down in all three groups. However, age did not moderate the effect of borderline traits on attempter status. Looking at the data, there is significant number of aging people with borderline traits , who continue attempting suicide a.k.a. quite sick.

I am suspecting there is group of patients, even with diminished rates, continue having significant borderline traits (if not disorder) in late life. I believe these are probably the sample of adolescent patients with full blown borderline personality disorder I see almost everyday in the inpatient unit.

One of the primary researchers about personality disorder, Dr. Gunderson demonstrated the decline of borderline personality disorder diagnosis as the patients age in previous studies. However, he admitted that most of these patients, though do not attempt suicide or engage non suicidal self injury, continue struggling significantly in their interpersonal relationships, feelings of emptiness and coherent sense of self.

Also this study did not specifically look at patients who are diagnosed with borderline personality disorder in adolescents after careful clinical examination. Obviously, a rating scale measuring overall bpd traits can not (and should not) replace the measure of borderline personality disorder after careful clinical interview.

 

[Marasmus1]

The tendency of some clinicians to jump to assumptions of borderline in suicidal patients without first assessing for and (if applicable) treating any active Axis 1 disorders really gets me.

What gets me more is seeing clinicians trying to treat borderline personality disorder with a cocktail of medications and billing for every single DSM 5 disorder in the book while refusing to even document anything borderline related (why? because it is stigmatized?) in their notes and potentially closing the door for their access to evidence based treatments for their specific personality pathology.

 

[futureapppsy2]

I do agree with that. Most patients with borderline traits improve with age. (But clinically I would be careful about translating this improvement into overall improvement in well being, self esteem, stable sense of self and forming secure relationships)

Well, as per the study results, overall borderline traits went down in all three groups. However, age did not moderate the effect of borderline traits on attempter status. Looking at the data, there is significant number of aging people with borderline traits , who continue attempting suicide a.k.a. quite sick.

I am suspecting there is group of patients, even with diminished rates, continue having significant borderline traits (if not disorder) in late life. I believe these are probably the sample of adolescent patients with full blown borderline personality disorder I see almost everyday in the inpatient unit.

One of the primary researchers about personality disorder, Dr. Gunderson demonstrated the decline of borderline personality disorder diagnosis as the patients age in previous studies. However, he admitted that most of these patients, though do not attempt suicide or engage non suicidal self injury, continue struggling significantly in their interpersonal relationships, feelings of emptiness and coherent sense of self.

Also this study did not specifically look at patients who are diagnosed with borderline personality disorder in adolescents after careful clinical examination. Obviously, a rating scale measuring overall bpd traits can not (and should not) replace the measure of borderline personality disorder after careful clinical interview.

I think it's critical to distinguish between actual BPD and "this person attempted suicide and seems acutely emotionally ill, so I'm assuming they have BPD." Good, accurate BPD diagnosis can be critical and life-saving/life-improving, particularly if it allows the person to access good, evidence-based treatment like DBT. On the other hand, I cringe to see, say, people with MDD or PTSD being labelled as having BPD without the primary Axis I disorder ever being properly treated. Is DBT likely to benefit them still? Sure, but they would likely benefit more (and, in the case of PTSD, significantly more) from treatment for their actual Axis I disorder. If symptoms stick around after treatment, then a PD diagnosis should definitely be on the differential, but it shouldn't be a diagnosis given out after, say, one encounter in an inpatient setting and before Axis I conditions have been treated.

 

[clausewitz2]

I think it's critical to distinguish between actual BPD and "this person attempted suicide and seems acutely emotionally ill, so I'm assuming they have BPD." Good, accurate BPD diagnosis can be critical and life-saving/life-improving, particularly if it allows the person to access good, evidence-based treatment like DBT. On the other hand, I cringe to see, say, people with MDD or PTSD being labelled as having BPD without the primary Axis I disorder ever being properly treated. Is DBT likely to benefit them still? Sure, but they would likely benefit more (and, in the case of PTSD, significantly more) from treatment for their actual Axis I disorder. If symptoms stick around after treatment, then a PD diagnosis should definitely be on the differential, but it shouldn't be a diagnosis given out after, say, one encounter in an inpatient setting and before Axis I conditions have been treated.

Yeah, I am very much done with colleagues who assume anyone with repeated suicide attempts/is labile/cuts themselves must therefore have BPD. In my more nihilistic moments I am sympathetic to the feminist critique that frequently in practice MDD = "sympathetic suffering white woman" and BPD = "unsympathetic suffering white woman".

Don't forget the folks with ADHD who get slapped with the BPD label but somehow magically improve on a reasonable dose of stimulants.

 

[futureapppsy2]

Yeah, I am very much done with colleagues who assume anyone with repeated suicide attempts/is labile/cuts themselves must therefore have BPD. In my more nihilistic moments I am sympathetic to the feminist critique that frequently in practice MDD = "sympathetic suffering white woman" and BPD = "unsympathetic suffering white woman".

Don't forget the folks with ADHD who get slapped with the BPD label but somehow magically improve on a reasonable dose of stimulants.

Also, the women/non-binary folk who start experiencing suicidality and depression in their 20s in the aftermath of a traumatic event and get labeled as having BPD without ever being assessed or treated for PTSD.