Psychiatric diagnoses have far-reaching consequences for every area of your life: welfare, employment, health and travel insurance, physical and mental health assessment/treatment, adoption rights, and social stigma, to name but a few. Yet they are just subjective opinions with no scientific basis and can change over time. In my experience, ‘Borderline Personality Disorder’ (BPD) is a particularly stigmatising diagnosis which condemns us to exclusion and neglect, or to punitive judgmental treatment. I recently challenged my diagnosis of BPD and was successful in getting it removed, and replaced with my former diagnosis of ‘Schizoaffective Disorder’, with a history of complex trauma. Of course, I believe that all these labels are a pile of nonsense, but for now we do need them to access welfare, treatment and support. So, the best we can do with the current system is to match our mental health challenges to the nearest corresponding diagnosis to get a best fit. But I’m not sure if psychiatrists are the right people to do that because they often don’t listen or get to know us properly.
I was successful in getting my diagnosis reverted because my psychiatrist could see that I was well-informed and quite prepared to make life difficult for them. You see, when I insisted that he do a paper trail he had to admit, under duress, that the label of BPD was given to me by a previous psychiatrist who only saw me once, and for literally five minutes, then cheerfully discharged me without any discussion of the fact he’d just changed my diagnosis to BPD. According to my latest psychiatrist, this label then ‘stuck’ because no-one thereafter had had the time, or was bothered, to read my notes to see that there was a long, entrenched history of what they call ‘psychosis’. So, each time a new psychiatrist came along, BPD was rubber-stamped and perpetuated because it was the last thing in my file – decided on a whim by someone who’d spent just five minutes with me and not even consulted his colleagues or my notes!
I only found this out because I happened to be going on holiday and required confirmation of my official diagnosis for travel insurance. Yet the consequences of being labelled thus would have been, and have been, hugely detrimental. For example, in the past, I was raped by a male nurse who told me after the attack that no one would believe me if I reported him because ‘everyone knew I had a personality disorder’. And you know, he was right about that: I wasn’t believed. I later found out that he’d been struck off for committing the same crime repeatedly with other patients… if only they had listened to me. Not to mention the suicide attempts I resorted to because of being punished and humiliated when I asked for help – and all because of that label. So, I stopped asking for help because there was nowhere safe to turn and I had lost all hope.
Now that I’ve managed to get BPD removed, I would encourage anyone who doesn’t agree with their diagnosis to do the same, but to enlist the assistance of an independent advocate or someone in the system whom you trust and can help you put a case together, and provide emotional support through what can be a very challenging process.
You need first of all to find out the facts of who gave you the diagnosis and when: what their rationale was – in other words which criteria in the DSM they thought you met, and what their evidence for this was; who was consulted and informed; and did they fill in a SKID II form to document and justify their decision. A caring nurse (who knew me well) helped me devise a list of questions you might also find useful to put to your psychiatrist to ascertain the facts (see Appendix 1) – and I would put these in writing.
If you disagree with their process or reasoning, you need to put a case together to show how your ‘symptoms’ and experience don’t match the criteria for that diagnosis – so you will need to familiarise yourself with the criteria in the statistical manuals (DSM or ICD) – and which diagnosis you believe you do meet the criteria for, if any. Pay attention to the number of criteria required to justify a diagnosis and how they are subdivided. So, in the case of BPD, one of the criteria is impulsivity, which could be in the areas of spending, gambling, binge-eating, sexuality, or whatever. But each of these examples don’t add up to separate criteria, they only justify one – impulsivity – however many forms of this you happen to display.
You should also note if there are any qualifying statements such as, in the case of BPD, the criteria ‘must be severe and prevalent across all areas of your life’. This immediately ruled out that diagnosis for me because my difficulties with relationships and intense anger – two of the criteria – were only prevalent in my contact with psychiatric services (quelle surprise) because I had been treated so badly by them, and were not problematic in any other area of my life. So, context is important to bear in mind. But whilst psychiatrists often lazily cite childhood trauma as a justification for a diagnosis of BPD, this does not actually appear in the DSM or ICD as a criterion – so you can catch them out with that, for example.
The circumstances in which psychiatrists give us these labels are most often shrouded in secrecy and subterfuge. They don’t follow due protocol of consulting or informing us, or conferring with their colleagues or our notes, and they don’t fill in the required paperwork or even check that our so-called symptoms match their diagnostic criteria. Instead, as my psychiatrist somewhat sheepishly admitted when I pressed him on the matter, ‘Psychiatrists just go with their hunch about a patient’. We can interpret that as ‘blatant prejudice and bigotry’. They are quite literally, a law unto themselves. So, let’s start holding psychiatry to account and take some power back over how we choose to self-define.
Postscript: I wrote to the psychiatrist (see Appendix 2) who was responsible for giving me the BPD diagnosis to let him know how it had affected me, but still haven’t had the courtesy of a reply.
Appendix 1: Preparation for Meeting with Psychiatrist re challenging BPD Diagnosis
Dear Dr X,
I have prepared the following list of questions which I would be grateful if you can provide the answers to. I appreciate you might need time to look through my notes or consult with your colleagues to answer these fully.
- Who changed my diagnosis from Schizoaffective Disorder to BPD?
- Who was consulted about this?
- Who was informed?
- Why was my diagnosis of Schizoaffective Disorder dropped and replaced with BPD?
- Why was I not consulted or informed?
- On what grounds was my diagnosis changed?
- Was a SKIDII completed?
- Which diagnostic framework was I measured against: DSM or ICD?
- Which of the diagnostic criteria for BPD do you believe that I meet?
- What is your evidence for this?
- Which of the diagnostic criteria for Schizoaffective Disorder do you believe that I no longer meet?
- What is your evidence for this?
- Where did discussions about changing my diagnosis take place?
- When did this happen?
Thank you very much for your time and consideration.
Appendix 2: Subsequent letter to psychiatrist who changed my diagnosis to BPD
Professor X (Consultant Psychiatrist)
31st March 2019
Dear Professor X
You may not remember me because you only met me once in 2011 during a consultation lasting five to ten minutes when I was admitted overnight; but you will have seen me over the years in passing as I was a patient of Professor Y’s and had a number of stays in ward 9 between 2003 – 2006, and before that, several lengthy admissions – some lasting years – in other wards when I was younger.
On the basis of the 5 – 10 minutes (let’s call it ten for the sake of magnanimity) you spent with me, you decided to drop Schizoaffective Disorder as my official diagnosis and replace it with Borderline Personality Disorder. Aside from the gross arrogance of making such a decision on the basis of so brief a consultation, you did not fulfil the required protocol of letting me know you had changed my diagnosis, or consulting with myself, or anyone else who knew me well, in reaching a decision with potentially devastating implications for my future care and wellbeing.
Having worked in the psychiatric system for a long time, you will be only too aware of how patients given a diagnosis of BPD are routinely stigmatised, mistreated and discredited. Even if you think yourself to be a humane well-meaning practitioner who treats all your patients with suave ‘kindness’ (which I do not doubt), nonetheless you are not so naïve not to know that branding someone with this label is tantamount to prejudicing their treatment for the worse at the hands of future colleagues.
I won’t labour the point but had you taken the time and care to read my notes and get to know me properly before making such a consequential decision, you would have discovered the damage that label had done to me when I was given it before, and how much I therefore feared it. In short, it put my life at risk because the punitive judgemental treatment I received when I was labelled thus in the past made me fear the hospital and so I jumped off Salisbury Crags and made several other serious attempts on my life because I had lost all hope and trust in professionals, so did not reach out for help.
Another notable consequence of being labelled with BPD is that I was raped by a nurse who blackmailed me by saying that he would say I was lying if I reported him and that no-one would believe me because of my diagnosis. Lo and behold, my psychiatrist (who had been responsible for the diagnosis) did not believe me and she punished me for ‘setting out to ruin his career’. Several months later I found out from a colleague of his that he had been struck off for sexually assaulting a number of female patients who also had the diagnosis, presumably because he thought he could get away with it, such is the stigma and hatred in the system towards those of us with that label. Inevitably, my psychiatrist did not seem to think I had a right to be told of his conviction or given an apology for the way she had treated my disclosure.
Now, of course, you are not to blame for a nurse raping me or the fact that my distress was so acute I tried to kill myself; but I do hold you complicit in a system which facilitates and perpetuates such abuse and despair by giving people a label which you know will discredit them, especially, as you did so with me, in such a cavalier and irresponsible fashion.
Thankfully, my diagnosis has now been changed back to Schizoaffective Disorder but this would not have happened had I not found out by accident, when applying for travel insurance, that you had changed my diagnosis to BPD which then stuck because subsequent psychiatrists spent so little time with me, did not gain my trust and, as was admitted to me, didn’t read my notes to gain a fuller picture. They simply followed your suit because it was convenient and conventional to concur with a professor.
I have a long history of severe distress, including paranoia, voices, visual and olfactory hallucinations and extreme mood swings (including prolonged periods at either extreme); there is also an extremely high prevalence of ‘schizophrenia’ and ‘bipolar disorder’, hospitalisation and suicide in my immediate and extended family. Yet none of this was reflected in your assessment of me. It would be interesting to know which of the diagnostic criteria for BPD you thought I fulfilled. Perhaps the fact that I had strong feelings of attachment towards professionals (which precipitated the crisis leading to my admission to your ward) and related to this, a childhood history of trauma and neglect? You should not need reminding that neither of these are in themselves actual criteria of either DSM or ICD, and that even if they were, would not in themselves be sufficient to justify a diagnosis of BPD.
Your assessment of me was, at best, ignorant and lazy; at worst, downright negligent and mean. Let’s be honest, Professor X: you simply did not find me a very credible patient and that was down to your personal prejudices/preferences. Whilst you hid your distaste of me in a veneer of pleasantry, you understood very well the dire implications for me of your decision to change my diagnosis to BPD, and that, I believe, is why you chose not to inform me, which meant I had no recourse to challenge it.
Psychiatrists like yourself have far too much unchecked power, and very little scientific basis for your actions. I believe that all mental distress (whatever label it is given) has its roots in trauma, disorganised or insecure attachment and/or overwhelming pressure. But very few psychiatrists bother to scratch beneath the surface of the ‘symptoms’ they see, and rather resort to a caste system of privileging people whom they like and feel sympathy for by giving them an axis 1 diagnosis (which results in benevolent favourable treatment and welfare) and for the rest, condemning us to judgement and misunderstanding by blaming our distress on character defect. All psychiatric diagnoses are fundamentally flawed and lack substance, as is now widely acknowledged even by many in your profession, but BPD is a particularly harmful and perfidious form of abuse.
I believe that we should all try to learn from our mistakes (particularly where they have power to hurt others) and that we should be held accountable for our actions. That is why I have chosen to write to you. I hope you will have the professionalism and good grace to question your practice in the light of what I have said, and that it might have a helpful impact on how you treat other people who, through no fault of their own, rely on you for help.
C.C. Dr C (GP)
Thank you for your informative and useful writing about questioning a diagnosis. Perhaps as I expected talking with health professionals seems an exasperating experience, and indeed any communication from them seems hard for them to do. Hope you have made good progress by now as your post was a few years ago, nonetheless it was useful for me, so I wanted to respond anyway. My story is a diagnosis given that I just happened to notice on the NHS app else I might never have known it had even been made and there are real consequences for me to have this it in terms of what the health service will or won’t provide (for one, they (NHS) don’t now have to ask my family for DNR approval if I’m ever very ill.
Never been consulted about this (treatment is supposed to be consensual I read from patient charters)
So, I was encouraged somehow on reading about how you challenged the system. I hope one day we have a health service of choice as in more the one provider, one healthcare provider is not to me a good option as it does not encourage competition or accountability or service improvement.
Hope this letter finds you well.
This is so useful! Thank you!
I have a BPAD 2 diagnosis from France dating from over 15 years ago. A few years ago I moved to the UK. They started changing my meds, not that it was really necessary but I wasn’t familiar with the system and I was too afraid to say no. And they insisted. Things started going downhill from then.
Finally in 2019 I saw a psychiatrist. Well, first my appointment was with a trainee (GPST1) and he concluded my symptoms are not in line with bipolar disorder.
Then I argued to get the appointment with the psychiatrist themselves. Managed to get one. The whole 45’. She had a look at the medical report from France I brought. After the appointment she sent me a clinical letter. More or less validating my diagnosis but also disagreeing with it.
Most importantly she stopped my antidepressant. Whilst she authorised the continuation of my mood stabilizers, she declared that I don’t need my antidepressant (I’ve been on all 3 meds for the last 17 years).
Suddenly things started getting « funny », I started getting more and more anxious. I couldn’t really put a finger on it thinking it was anxiety. It wasn’t. It was depression and a whole year of suicidal thought that ended with me overdosing on meds a few days ago. I almost died because a while ago a doctor didn’t assess me properly and stopped one of my meds.
Back to my clinical letters, from June 2020 my diagnosis is changed from BPAD to EUPD (with alcohol misuse). However my medical records have no trace whatsoever of any change of diagnostic. Nothing, nowhere. I made a SAR so I have all of my medical records at home.
But from the moment the EUPD replaces BPAD, it goes on all other letters and my new psychiatrist follows it, too.
Last week, due to being without AD for such a long time, I tried to commit suicide. My GP put me back on AD immediately.
This is insane.
I’ll be using your questions to file a complaint. They are great. I can’t believe someone could just go change my diagnosis on a whim and don’t feel accountable or anything. It’s just outrageous.
Thank you for this.
I was diagnosed with BPD ~8yrs ago by a psychologist during my first CBT session. Her reasons:
1. Uncertain of identity and future goals: I had recently become physically disabled, resulting in loss of job, career, PhD, savings and relationship. I was struggling. Shocker.
2. Impulsivity: Polyamorous for ~17 years, had 2 long-term partners (3 and 5 yrs?). She’d never heard of poly (?!) and translated 2 committed relationships into “promiscuous”.
3. Substance abuse, child abuse: “Drugs?” Experimented in uni (~15yrs before). Think I was trying to escape from trauma. “Oh? Child abuse?” Well, yes. “Ah-ha!” (Abuse should not be used diagnostically!) “Doing drugs now?” No. Taking (list of prescriptions). “Codeine!” *worried look* (I have chronic pain, so yes, codeine.)
4. Grandiosity: “Are you smarter than the average person?” Yes. (I have 2 honours degrees from a top 5 world uni. I’m pretty smart.) “High opinion of self…”
Blah blah blah…
Her final reason was, I sh*t you not, that I didn’t accept the diagnosis. Words fail.
Asked for a 2nd opinion. Months later, psychiatrist looked at the psychologist’s notes and agreed with her diagnosis. He also said “BPD patients don’t need meds” and stopped my long-term anti-depressant prescription (serious withdrawal syndrome). He cancelled our appointment and never even bothered to meet me.
I made an oral complaint, then a written one. He reinstated my prescription (whew), but still didn’t reinstate our appointment. Instead I was called in to see the psychologist. I was now a problem patient, and would no longer be seen there (the only 2ndary care centre in my region). ?! Only option for treatment was to go into the Personality Disorders Service. That or nothing. I fumed internally, but I knew I was very ill (see: life crashed and burned, above), and I NEEDED treatment. I went into the PD Service.
I believed the stigma too, until I got to know the other patients, so maybe I shouldn’t complain. On the other hand, medical people believed all the crap about BPD more than avg people (many of whom had never heard of it), and stigma within the NHS was a serious problem!
-My GP of 2 years suddenly started treating me like a 5yo (before that we’d had an adult relationship). It got ridiculous. I wanted to try the birth control implant. She questioned whether I should be “given” hormonal birth control at all, as I wouldn’t need to use condoms to prevent pregnancy, so I might get STIs. (I was ~36, never had an STI, and hormonal methods were backup in case of condom failure. Besides, shouldn’t she have been worrying I’d get pregnant?) She also questioned whether I should be on codeine – although wouldn’t say why. (Same dose for years, other meds far more toxic if I wanted to suicide, and I needed it for pain – I wasn’t going to sell it!) I had to switch GPs in the end.
– I got 10hrs therapy in the PD Service (not sick enough, budget cuts, etc.), but BPD patients weren’t accepted by any other service (too craaazy). Eventually I got counselling through a charity.
– I almost didn’t get into the Pain Management Programme because of the diagnosis (concerns about disruptiveness – I’m always being told to speak up, not calm down). Luckily the Pain Psychologist agreed that I’d been misdiagnosed and let me in.
All this diagnosis has done is cause stigma and make life more difficult. I’ve had little help from the NHS, although at least the PDS got me out of the house and being social, and the other patients are great. A couple of the staff were great, but were laid off a while ago.
I haven’t fought my diagnosis before because there was no other service that would treat me, and my MH fluctuates. I figured that at least I had PDS for bad times and crises.
Now PDS is closing. Budget cuts. There’s no replacement – they’re sending us back to our GPs (I’m really worried about a couple of the other patients…) I’ve also discovered C-PTSD, which fits me to a T. Counsellor, GP agree, pain psychologist suggested it. There’s no reason not to fight my BPD diagnosis now. I just didn’t know how.
I enjoyed reading this. I live in the U.S. Recently, I went to my college to be tested for a learning disability (I’ve had a history of learning disability since I was seven) and came back with a completely different report and a diagnosis of PTSD. I have had several concerns about what happened and how unethical it was. Thirty two pages of derogatory and degrading psychobabble about me. I came across your blog today. I have only been to Russia as far as Europe goes, so I am unaware of the laws in the UK regarding how learning disabilities and mental illnesses are diagnosed over there. Would you ever write a post comparing laws regarding diagnosis in the US and the UK? It would be a fascinating read. I wonder if you would know my legal rights in challenging my report and it’s diagnosis in the United States. I read this entire post (even though it was long) and I was cheering for you the whole way. I’m so sorry all those terrible things happened as a result of a psychiatrist’s snap judgment. I’m starting not to believe in diagnosis anymore. While they carry negative social stigmas, they are not an exact science. Also, my father is a psychologist and he gives me his opinion of different diagnosis labels and what certain phrases really mean.
Thanks for sharing your experiences, I think it must’ve been very difficult for you over the years and still continues to be difficult as you have been left not only damaged by the drugs but also damaged by the belief that your responses to trauma constitute a lifelong mental illness.
I would like to formally challenge the nonsensical label I got 17 years ago, I have spent a total of 33 days in hospital, 28 days in 2002 and 5 days in 2004 as I was remembering my childhood trauma, which to the badly trained mind resulted in a label of bipolar disorder. I personally questioned this label from the start so did not become addicted to the drugs that were thrust upon me as I only took them to get out of hospital, ditching them on my release.
I have a very good job and am not reliant upon benefits, I’m happy to be a UK tax payer but I really resent my hard earned cash going to a psychiatric belief system that not only damages individuals physically, emotionally and financially but also damages our welfare state by creating lifelong customers of the mental pharmaceutical industry, it’s the opposite of Robin Hood, take money from the poor and give it to the rich.
What would’ve helped me at the time would’ve been someone to talk to and if the psychiatrist explained that my feelings were just a part of the healing process, that I might experience a heightened state of awareness and if things got too much then there’s drugs to help take the edge off the experience, but only to be taken in the really short term, to help one sleep.
Excellent blog, Jo. You helpfully provide ‘nuts & bolts’ advice for anyone else who might be trying to remove a stigmatising label from the medical record.
Hi Jo,this article has been helpful for me to consider my next move in getting my BPD diagnosis reviewed.
I was given the diagnosis 15 years ago by a crisis team psychiatrist after a 30 minute home visit. It’s been on my notes ever since, despite subsequent psychiatrists diagnosing me with Bipolar 2 and successfully treating me with mood stabilizers. I got my medical notes and while there is not much in terms of pejorative language, BPD features in my notes often and in an unquestioned way.
I disclosed I had been sexually abused in childhood 6 year ago and since then, the BPD diagnosis seems more embedded than ever. I tried asking the NHS psychiatrist to review my case and explain his reasoning. He gave me a ‘have you got BPD?’ quiz he printed out from psychcentral.com and asked me to fill it out for him. I told him that if he wasn’t willing to discuss the ICD 10 diagnostic criteria in a calm, adult to adult manner with me; then I wasn’t prepared to waste our appointments ticking online pop quizzes in. He told me I was difficult and speaking in an ‘aggressive’ manner typical of a BPD patient. He then refused to see me again. He was also clear that he intended to continue withdrawing me from my mood stabilizers (‘people with bpd don’t need mood stabilisers, these meds will poison your kidneys’) despite this plan sending me into a depressive crisis. My psychologist rang him to question why he chose to reject this opportunity to discuss my diagnosis and remind him of the traumatic nature of past healthcare I had received, and that I left with a panic attack, but he never apologised.
I complained to his employers South and West Yorkshire NHS Foundation Trust about him but no action was taken. He is still practicing as a senior consultant with the Trust Psychiatric Services.
My current psychiatrist has reviewed my case and is clear about my bipolar 2 being hereditary and severe. However he refuses to discuss why C-PTSD (which I fit all the criteria of) is not applicable yet BPD (which I only fit 3 of the criteria of) remains on my medical notes. I sense he feels any discussion of the BPD diagnosis is dangerous territory and would rather avoid it. He focuses purely on my bipolar symptoms and will not discuss my actual current symptoms (dissociation, nightmares, flashbacks) or treatment for it, beyond offering zopiclone – which I don’t like resorting to.
I asked my psychologist care co ordinator (twice yearly appointments) what might be involved in challenging the BPD diagnosis without alienating my psychiatrist – as he is skilled at managing my mood disorder and thus is the only person able to prescribe my bipolar meds. No one seems to know what can be done.
The psychologists I have seen have validated and documented the negative impact of the BPD diagnosis on me, but it still there on my notes as a current diagnosis.
I feel as though I will have to live with the label but it makes me afraid to use my local CMHT and crisis services even though going without support is harming my ability to function. I feel as though every health professional I meet secretly think I am an attention seeking freak.