David Pyle

Psychiatrist

[David Pyle @DavidPylePsych]

@jaunty_aphorism @RITB_ The people I've known who qualify for this diagnosis have seemed to me to have all sorts of personalities, like any other group of people. And those personalities persist, come what may. And 'BPD' doesn't.

[David Pyle @DavidPylePsych]

@jaunty_aphorism @RITB_ I think the thing that I believe exists, and which I refer to as BPD because that's it's official name for now, represents persistent patterns of experience and persistent ways of reacting to things. But not PERSONALITY, in my view.

[David Pyle @DavidPylePsych]

@RITB_ @jaunty_aphorism OK! Have a lovely evening

[David Pyle @DavidPylePsych]

@RITB_ @jaunty_aphorism Can you explain further? With BPD more often it isn't - ?

[David Pyle @DavidPylePsych]

@RITB_ @jaunty_aphorism I think it does describe some people - I saw somebody last week who had been struck, when they read about BPD online, how it seemed to very accurately capture their experiences, and wanted to get a diagnosis to validate that - that they weren't mad.

[David Pyle @DavidPylePsych]

@RITB_ @jaunty_aphorism I understand that - but I'm suggesting it is worth thinking about where the problem lies, in the concept, or in the practice, because they dictate different solutions

[David Pyle @DavidPylePsych]

@jaunty_aphorism @RITB_ And that the description of that pattern contained in DSM-5 and ICD-11 does describe a thing that does happen to people, and is recognisable.

But that's separate from the question of how that concept is used in practice, which I could criticise all day.

[David Pyle @DavidPylePsych]

@jaunty_aphorism @RITB_ I wouldn't defend for a second how the diagnosis is used in practice an enormous amount of the time. What I am suggesting, is that the idea that there is a recognisable pattern of response that humans show, often in response to trauma, isn't in itself wrong.

[David Pyle @DavidPylePsych]

@looneyfox_1 Not ours, categorically not. That's appalling.

[David Pyle @DavidPylePsych]

@RITB_ I may have missed the explanation of the problems with the construct - not that it's beyond criticism.

I know bad practice is common practice. I'm not sure it's helpful to see it as something different because it's widespread.

I just think it's helpful to keep things separate.

[David Pyle @DavidPylePsych]

@RITB_ This is what happens in practice, and is malpractice, in my opinion. The fact that people cannot practice in a reasonably professional manner is separate from the validity of the construct. I feel it's helpful not to conflate incompetence with the validity of the construct.

[David Pyle @DavidPylePsych]

@RITB_ Self-harm in itself is clearly insufficient to make the diagnosis. What is your objection to the mention of self-harm in the diagnostic criteria?

And can you explain further what you mean by criteria and evidence being irrelevant with the diagnosis?

[David Pyle @DavidPylePsych]

@RITB_ Criteria for diagnosis are clear - they're in ICD-11 or DSM-5. If you're in the business of making diagnoses, you should be able to back up what you say. Anything else is sloppy. Bad practice doesn't mean the constructs are wrong, even if the labels are excruciatingly worded.

[David Pyle @DavidPylePsych]

@looneyfox_1 Makes sense. DBT suits some people, doesn't suit others - ideally there'd be a range of evidence-based therapies available, to cater for different people's needs.

[David Pyle @DavidPylePsych]

@KemtrupTweets This is absolutely excellent