Personality Disorder Diagnoses and Gender in the Stigmatization of Trauma

[Milarepa]

::No graphic language is used in this post. Nevertheless, those who might be triggered by discussions of personality disorders, gaslighting, victim blaming, and sexual violence might way to proceed with caution.::

I've been reading Judith Herman's book "Trauma and Recovery" and thinking a great deal about the way that so-called "personality disorders" are used to further the stigmatization of trauma survival; particularly among women.

Herman points out in her introduction to the book that people who survive traumatic events that are an "act of God," such as a natural disaster, are not stigmatized; but those who witness atrocities on any scale and are changed by the witnessing are stigmatized.

Herman goes on to argue that the kinds of experiences we most frequently and persistently connect to PTSD are those that take place in the political or military spheres, which are traditionally male-dominated. Nobody says, "I don't believe you" to stories told by the combat veteran or the political prisoner when he comes home. So while male trauma survivors are stigmatized, they are believed.

By contrast, the kinds of traumas that women most frequently experience are in domestic or sexual life: domestic violence, rape or sexual assault, and molestation as children; and when survivors of these traumas come forward with their experiences, they are frequently not believed.

The severe "personality disorders" that are most commonly diagnosed in women (Borderline & Histrionic) live at that intersection of stigma and disbelief. The behavior and symptoms that result from trauma are therefore chalked up to who she is instead of what was done to her. Hence a disorder of personality rather than an injury.

I know that these are pretty half-finished thoughts; but I'm curious for a sanity check. What do you guys think?

[Kizzie]

Great food for thought Milarepa.  There was a day when combat vets were very much stigmatized as weak and to some extent still are or at least some die hard perceive that they are.  Big topic in my household as my H just retired from the Cdn Army and as an officer had to deal with a lot of cases of soldiers with PTSD.  But the resources are in place at least whereas for CPTSD not so much.

Perhaps this is due in part to the population it resides in most visibly as you say - victims of sexual and physical abuse which tend to be children and women.  In Canada at least we have a lot going on to rectify this, but the one that still hangs out there for me is ongoing emotional abuse.  It just isnt really on the publics or govts radar, possibly because academics and clinicians are still debating the diagnosis.

We ourselves are discovering what long term emotional abuse and neglect can result in, but it is nebulous, less tangible than physical or sexual abuse so it has and is taking time to figure out that all abuse is ultimately abusive.  I see a bit of a sub movement among those of us who "just" suffered from emotional abuse to raise awareness that ongoing abuse is traumatic and can result in psychological injury - CPTSD.  We  can do much to raise awareness  and will simply because we are coming forward in forums like this one, figuring it out, validating one another and then taking it out there IRL.

So I do think the visibility and value of the population victimized does have a lot to do with whether it is believed and received or not. 

[Kizzie]

Yes exactly BHeart, thats what I was hoping to get across in my post but see I didn't really make my point very clearly; that it's the underlying EA that we all have in common that we as victims need to understand and bring to the attention of the public and professional community.  When I started at OOTF it did not take me long to realize that EA is so very prevalent and there are far more of us who suffered its traumatic effects than has been acknowledged imo. 

EA in CPTSD deserve attention because it is the bottom line; that is, ongoing EA in whatever form it was inflicted injures us psychologically and we need are in need of treatment and support. I look at the Australian program in place and drool *see the Web Sites and Forums" section).  So I'm actually not minimizing EA at all, I'm saying quite the opposite, that it is the underlying trauma in CPTSD, no matter what the type of abuse and it does great damage to our sense of self, our souls if you will.  My point about those of us who "just" suffer from EA was that we are beginning to see that we are part of a larger group of wounded souls in need of attention where before we may have questioned whether or not EA was sufficient to be diagnosed as CPTSD/trauma. 

I know when I went to OOTF like so many I wasn't sure if I was the problem or if my FOO were the problem and then it all became so clear when I started to see the damaging effects of being around PD FOO. I felt the way I did (anxious, depressed, shaky), due to the ongoing EA I suffered not only in my childhood but into my adult years because of the constant triggering when I was in greater contact with my FOO and my H's, and didn't understand what we were up against - fully at least. That changed at OOTF where I was validated and found my voice and boy is it loud and clear about EA now lol!  It  is my hope that in some way this forum will advance the notion that there are so many of us out here, that we will add our voices to a growing community of people who are beginning to put it all together and will push in one way or another the attention/treatment we all deserve.   

Phew, sorry about the soap box but I am quite passionate about this.  Anyway, I think we're saying the same thing, I just didn't express it well in my earlier post    I'm glad you see EA is a unifying thread for all of us.   

[Kizzie]

Yay BHeart, you found a way to use the shark attack smiley!!     Now if I could only find one for a soapbox lol  :

[spryte]

Milarepa - you do make an excellent point although I do think that Kizzie has the right of it. To me it really seems more about the type of abuse than it does the gender. I think that the reason that the majority of the trauma PTSD cases that you see being "believed" are men, is because historically, it's been men coming back from war. I'd be really interested though to know more about how women who have specific trauma induced PTSD are being treated currently in the military.

I think the problem is that the constellation of symptoms of c-ptsd really do mimic a lot of other mental illnesses, like PD's. I think it was Rain who said in another thread that if C-PTSD were included in the DSM, most of it would become obsolete.

I recently went into a psychiatrists office to be evaluated for ADD (which I think is also a symptom of my CPTSD) instead...I got a diagnosis of BPD and an emotional breakdown - which of course, just served to strengthen her (and a second psych's) opinion of PD.

I got home and poured through the criteria for BPD with my cousin who is a psychologist who treats PTSD in vets. Her opinion? No. Not a chance. My secret opinion? Well...if you turn this tendency this way, and that tendency that way...could be...except...all of those things? Are things that are direct results of my abuse, they are not innate. They are fixable. And most importantly of all...I am fully aware of them, of how they have been impacting my life, and I have ALWAYS been looking for what's wrong and how to fix it, unlike most people with PD's who are very invested in "there's nothing wrong".

I think that statistically, more women deal with the kinds of trauma that cause c-ptsd and the sad truth is that there just aren't enough therapists who know how to tell the difference between it, and personality disorders. And, because I do know just as many men who have been in these kinds of relationships, I also know that men deal with it differently. Men are less likely to go to therapy, to even be diagnosed. I think symptoms in men present differently, sometimes more aggressively or in feelings of repressed anger - so maybe if they are going to therapy they are getting different diagnosis like bi-polar, ADD, anger issues.

I do whole heartedly believe that the fix is for EA to become something that is studied more, talked about more, and recognized in the medical field and courts. It's just horrific to me that there are so many of us out there, and so many still so sunk into these situations. I desperately want to be a therapist, but I have had to accept that there is very little that I can do (other than raising awareness) to "save" people from these situations before the damage is done...and instead, can only be there with tools and resources for afterwards, to help them put the pieces back together again.

I honestly think that's why so many people turn their heads when it comes to emotional abuse in families. There's just nothing anyone can do about it.

[mourningdove]

I've been reading Judith Herman's book "Trauma and Recovery" and thinking a great deal about the way that so-called "personality disorders" are used to further the stigmatization of trauma survival; particularly among women.

Herman goes on to argue that the kinds of experiences we most frequently and persistently connect to PTSD are those that take place in the political or military spheres, which are traditionally male-dominated. Nobody says, "I don't believe you" to stories told by the combat veteran or the political prisoner when he comes home. So while male trauma survivors are stigmatized, they are believed.

By contrast, the kinds of traumas that women most frequently experience are in domestic or sexual life: domestic violence, rape or sexual assault, and molestation as children; and when survivors of these traumas come forward with their experiences, they are frequently not believed.

The severe "personality disorders" that are most commonly diagnosed in women (Borderline & Histrionic) live at that intersection of stigma and disbelief. The behavior and symptoms that result from trauma are therefore chalked up to who she is instead of what was done to her. Hence a disorder of personality rather than an injury.

I know that these are pretty half-finished thoughts; but I'm curious for a sanity check. What do you guys think?

I read Trauma and Recovery recently, and I think this is exactly what Herman is saying (though she did note that rape is typically accepted as being traumatic). That's why she begins the book talking about the old diagnosis of "hysteria." From Trauma and Recovery:

Survivors of childhood abuse often accumulate many different diagnoses before the underlying problem of a complex post-traumatic syndrome is recognized. They are likely to receive a diagnosis that carries strong negative connotations. Three particularly troublesome diagnoses have often been applied to survivors of childhood abuse: somatization disorder, borderline personality disorder, and multiple personality disorder. All three of these diagnoses were once subsumed under the now obsolete name hysteria. Patients, usually women, who receive these diagnoses evoke unusually intense reactions in caregivers. Their credibility is often suspect. They are frequently accused of manipulation or malingering. They are often subject to furious and partisan controversy. Sometimes they are frankly hated.

These three diagnoses are charged with pejorative meaning. The most notorious is the diagnosis of borderline personality disorder. This term is frequently used within the mental health professions as little more than a sophisticated insult. (123)

[Kizzie]

"The most notorious is the diagnosis of borderline personality disorder. This term is frequently used within the mental health professions as little more than a sophisticated insult"      

Tks for this quote Mourningdove      

[Milarepa]