Thursday, December 04, 2008

We know who you are, you? (or...why nothing works for us)

Borderline personality disorder (BPD) is a psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV Personality Disorders 301.83) that describes a prolonged disturbance of personality function characterized by depth and variability of moods. The disorder typically involves unusual levels of instability in mood; "black and white" thinking, or "splitting"; chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation. These disturbances can have a pervasive negative impact on many or all of the psychosocial facets of life. This includes difficulties maintaining relationships in work, home, and social settings. Attempted suicide and completed suicide are possible outcomes, especially without proper care and effective therapy. Onset of symptoms typically occurs during adolescence or young adulthood. Symptoms may persist for several years, but the majority of symptoms lessen in severity over time,with some individuals fully recovering. The mainstay of treatment is various forms of psychotherapy, although medication and other approaches may also improve symptoms.

As with other mental disorders, the causes of BPD are complex and unknown. One finding is a history of childhood trauma (possibly child sexual abuse),although researchers have suggested diverse possible causes, such as a genetic predisposition, neurobiological factors, environmental factors or brain abnormalities.The prevalence of BPD in the United States has been calculated as 1 to 3 percent of the adult population,with approximately 75% of those diagnosed being female, 25% male. It has been found to account for 20 percent of psychiatric hospitalizations. Common comorbid (co-occurring) conditions are other mental disorders such as substance abuse, depression and other mood disorders, and other personality disorders. BPD is one of four diagnoses classified as "cluster B" ("dramatic-erratic") personality disorders typified by disturbances in impulse control and emotional dysregulation, the others being narcissistic, histrionic, and antisocial personality disorders.

The term borderline, although it was used in this context as early as the 17th century, was employed by Adolph Stern in 1938 to describe a condition as being on the borderline between neurosis and psychosis. Because the term no longer reflects current thinking, there is an ongoing debate concerning whether this disorder should be renamed. There is related concern that the diagnosis stigmatizes people, usually women, and supports pejorative and discriminatory practices.

DSM-IV-TR criteria

The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the widely-used American Psychiatric Association guide for clinicians seeking to diagnose mental illnesses, defines Borderline Personality Disorder (BPD) as: "a pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts." BPD is classed on "Axis II", as an underlying pervasive or personality condition, rather than "Axis I" for more circumscribed mental disorders. A DSM diagnosis of BPD requires any five out of nine listed criteria to be present for a significant period of time. There are thus 256 different combinations of symptoms that could result in a diagnosis, of which 136 have been found in practice in one study. The criteria are:

1. Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behavior covered in Criterion 5]
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness, worthlessness.
8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms



Post a Comment

<< Home