Borderline Personality Disorder
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heyg ...@webtv.net (Geno Centofanti)
Symptoms - Borderline Personality Disorder Mental Help Net Staff Borderline Personality Disorder Symptoms A person who suffers from this disorder has labile interpersonal relationships characterized by instability. This pattern of interacting with others has persisted for years and is usually closely related to the person's self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) in a person's affect, or feelings.
Relationships and the person's affect may often be characterized as being shallow. A person with this disorder may also exhibit impulsive behaviors and exhibit a majority of the following symptoms: frantic efforts to avoid real or imagined abandonment.
a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation identity disturbance: markedly and persistently unstable self-image or sense of self impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 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) chronic feelings of emptiness inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) transient, stress-related paranoid ideation or severe dissociative symptoms Criteria summarized from: American Psychiatric ***ociation. (1994).
Diagnostic and statistical manual of mental disorders, fourth edition.
Washington, DC: American Psychiatric ***ociation.
"Larry Hoover" larryhoo...@sympatico.ca
Wrong, Eric. Pay attention, Eric. I'm pasting in an earlier reply on this topic. Read the abstracts.
Wrong. There is no prerequisite for an Axis l disorder.
In that case, in combination with alcohol abuse, the figure rises to 38%.
Really, this information is not hard to find, Eric. I stopped looking when I had answered your false ***ertions, but there's lots more information available.
Fortschr Neurol Psychiatr. 1999 May;67(5):200-17. Related Articles, Links [Outcome in borderline disorders. A literature review] [Article in German] Rothenhausler HB, Kapfhammer HP.
Psychiatrische Klinik und Poliklinik der LMU Munchen.
This paper reviews the current state of research results on borderline disorders in terms of course and outcome, variables predisposing to good or poor outcome, suicide rates and the influence of psychotherapeutical and pharmacotherapeutical strategies. It turned out that course and outcome of borderline disorders depend on the applied diagnostic criteria and on the length of the follow-up period. The outcome of the follow-up studies of borderline schizophrenia and of the borderline syndrome according to Grinker was on the whole worse compared to those of borderline personality disorder defined by DSM-III/III-R or DIB according to Gunderson or Kernberg's criteria. Further, it could be shown that the GAS or HSRS values of the short-term follow-up studies (up to five years) ranged from 46.4 to 59.2 points whereas those of the long-term studies with an average period of 13.6 till 20 years were measured in the lower and in the mid-60 s that reflects only mild difficulties in psychosocial functioning. However, the high rate of completed suicide in BPD was to be respected: The most extensive follow-up investigation with the highest trace-rate (PI-500) revealed a suicide rate of 9% till now, and the most lethal combination of circumstances was BPD x MAD x alcohol abuse (suicide rate of 38%).
Prognostic factors predisposing to poor outcome were substance abuse, admixture with antisocial and schizotypal elements, chronic hostility and affective instability with depressive and anxious features. Prognostic factors predisposing to good outcome were high IQ, extraordinary talent, high attractiveness, likeability and regular appointments with the Alcoholics Anonymous. Finally, the influence of psycho- and pharmacotherapeutical interventions were controversially debated. Several psychodynamic therapy studies resulted in satisfactory outcome scores concerning a subgroup of patients with personality traits like warmth, likeability, reliability, talent. Behavioral treatment strategies such as dialectical behavior therapy by Linehan significantly diminished parasuicidality and impulsiveness. Psychopharmacotherapy should target predominating psychopathological features: Low-dose antipsychotics against micropsychosis and prolonged severe dissociative symptoms, SSRIs and MAOIs against affective instability, and, lithium, carbamazepine or valproate against severe impulsiveness and aggressiveness.
46% unable to work at all over a three-year period, and 21% working some.
That sounds disabled to me.
Acta Psychiatr Scand. 1995 Nov;92(5):327-35. Related Articles, Links A prospective three-year follow-up study of borderline personality disorder inpatients.
Antikainen R, Hintikka J, Lehtonen J, Koponen H, Arstila A.
Department of Psychiatry, Kuopio University Hospital, Finland.
Prospective long-term follow-up studies on patients with borderline personality disorder (BPD) have been uncommon. Clinical data suggest that their treatment is highly demanding and that short-term results are sometimes limited. In this study, changes in symptoms and social management were monitored during a hospitalization period of 91 days (mean, range 21-296 days) and during a 3-year follow-up period in 62 patients admitted during 1989 to an open ward specializing in the psychotherapeutic treatment of BPD. The patients were thoroughly evaluated, using various rating scales, at the beginning and at the end of the index admission and after the follow-up period. Forty-two patients (70%) participated in the follow-up evaluation. Most patients suffered from overt anxiety and depressive symptoms at the beginning of hospitalization, and these declined significantly during hospital treatment. At the end of the follow-up period, depressive and anxiety symptoms were at the same level as on discharge, as ***essed by the Beck Depression Inventory and Hamilton Depression Rating Scale. Although treatment response was otherwise maintained, the patients often showed suicidal behavior. During the follow-up period the sample clearly differentiated in two groups: those continually fit for work (33%) and those chronically incapable of working (46%).
"Larry Hoover" larryhoo...@sympatico.ca
Did you not note that the article original is in German? Do you think every word has a direct translation? They talk of borderline schizophrenia and borderline syndrome, which aren't terms used in North America, either. The take home point was the significant suicide rate, something you categorically denied about borderline. In complex situations (axis 1 and 2 comborbidity), it goes to 38%.
wmae ...@aol.comnojunk (Wmaebe1)
The short answers to the above: Yes it does It Can It most definitely does!
Humph, ask the hubbies out there It absolutely does!
I have a full time job, never manage to put in a full week, sometimes taking off 2 or 3 days a week because something ticked me off at work, whatever. I must be damn good when I am there because nobody ever calls me on the carpet about it. My therapist has a difficult time believing this.
I don't think anyone here really gives a horses patut what you think. We know you're wrong. I am convinced that you have been diagnosed many times as having a personality disorder and you just don't like it. Too damn bad. We know what you're all about. Grow up already you whiny little brat.
pollyanna
wmae ...@aol.comnojunk (Wmaebe1)
LOL, I would love to spend a couple of days looking over your MENTAL health records. I can only imagine what they must say about you.
pollyanna
wmae ...@aol.comnojunk (Wmaebe1)
I'm sorry you had a bad experience with your meds for your personality disorder. What I truly don't understand is why you feel the constant need to take it out on everyone else. Why is it so hard for you to accept that you aren't the only one who feels rotten all of the time? I am diagnosed as having BPD and depression, and I feel extremely hopeless much of the time, sometimes sucicidal, but does that mean I should think that I'm more depressed than the next person? No one can truly understand how someone else feels so try to use a little restraint with the rest of us. I try to understand where you are coming from but you make it pretty difficult much of the time. Take care.
pollyanna
"Larry Hoover" larryhoo...@sympatico.ca
Somehow? All you need to do is open your mouth.
No, we read what you say. No 'reading into' required.
am.
That does not come across in what you say. I have never seen anyone else trivialize the experience of others the way you do. Your very next sentence proves the point.
RTFM, Eric. Read The ****ing Manual.
From the DSM: Diagnostic Criteria A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1.. frantic efforts to avoid real or imagined abandonment. Note: Do not include 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., spending, sex, substance abuse, reckless driving, binge eating).
Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
5.. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 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 8.. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) 9.. transient, stress-related paranoid ideation or severe dissociative symptoms Read item six. Now, read it again.
Your not liking the way the DSM is written is of no bearing on what the definition really is. Having five or more of those things going on in your life over an extended period of time is not trivial. Those so afflicted don't get to pick and choose, but Eric, which five traits would you pick?
It's only a butt pimple disorder, so you'd have no problem living with any of these, right? No, you're not going to answer that, because you're angry that I called you on your shit. Poor Eric.
"jake" inva...@invalid.com
disorders. Im against it.
B) huh?
"Larry Hoover" larryhoo...@sympatico.ca
Well, here's what the National Institute of Mental Health (NIMH) has to say about that: "Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women.1 There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases.2,3 Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations.4 NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.10 The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.11 Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.7" And to show the functional brain disturbance in BPD: Psychiatry Res. 2003 Jul 30;123(3):153-63. Related Articles, Links Impulsivity and prefrontal hypometabolism in borderline personality disorder.
Soloff PH, Meltzer CC, Becker C, Greer PJ, Kelly TM, Constantine D.
Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. solof...@msx.upmc.edu Prefrontal hypoperfusion and decreased glucose uptake in the prefrontal cortex (PFC) are found in violent criminal offenders, murderers and aggressive psychiatric patients. These abnormalities may be independent of diagnosis and ***ociated with impulsive-aggression as a personality trait.
Impulsive-aggression is a clinical characteristic of borderline personality disorder (BPD) where it is ***ociated with ***aultive and suicidal behaviors. We conducted FDG-PET studies in 13 non-depressed, impulsive female subjects with BPD and 9 healthy controls to look for abnormalities in glucose metabolism in areas of the PFC ***ociated with regulation of impulsive behavior. Statistical Parametric Mapping-99 (SPM99) was used to analyze the PET data with Hamilton depression scores as covariate.
Significant reductions in FDG uptake in BPD subjects relative to healthy controls were found bilaterally in medial orbital frontal cortex, including Brodmann's areas 9, 10 and 11. There were no significant areas of increased uptake in BPD subjects compared to control subjects. Covarying for measures of impulsivity or impulsive-aggression rendered insignificant the differences between groups. Decreased glucose uptake in medial orbital frontal cortex may be ***ociated with diminished regulation of impulsive behavior in BPD.
"Larry Hoover" larryhoo...@sympatico.ca
Changing your story, laddie? I was beginning to wonder if yer mother had dropped ye on yer head.
Velvet Elvis gamb...@REMOVEsofthome.THISnet
I think that's the whole point of Axis II disorders. By definition, they cannot be treated medically. That is why they are commonly considered the hardist disorders to treat.
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"Larry Hoover" larryhoo...@sympatico.ca
First, the DSM is a categorization system. Nothing more. Nature didn't divide things into these axes, we did. It is a logical fallacy to use the DSM categorization system to divide up what we see into groups, when it was our observations of uncategorized behaviours which led us to group them in the first place. It's like the old circular argument about the Bible and God. The Bible says God exists. The Bible is the true word of God.
When I look at some of the things that are on Axis 1, I see lots of things that could reasonably be called personality traits. For example: ADHD, ODD, pica, hypochondriasis, somatization disorder, intermittent explosive disorder, factitious disorder, pathological gambling, all the substance abuse disorders (you can't fix an alcoholic....he's gotta wanna be fixed), but my favourite is shared psychotic disorder (coming to believe in another's delusions). Now what the hell is medical about that? (Please, let's not get side-tracked by my list. The DSM is not infallible, OK?) Just because something is called a personality disorder doesn't mean it is one, either. How is it that there is Obsessive-Compulsive Disorder (Axis 1) and Obsessive-Compulsive Personality Disorder (Axis 2)? Do you flip a coin to distinguish between them, or check and see if they're insured or not?
I fail to see why a disorder first defined as lying on the border between affective and psychotic disorders (that's where the concept borderline came from) has been relegated to Axis 2. And furthermore, I fail to see the benefit in the distinction, in any case....unless you're trying to put somebody down.
At least the ICD-10 has pathological gambling, hypochondriasis, and such like under Disorders of Adult Personality and Behaviour.
Lar
"metta" kelly_marsops_NoS...@msn.com
FYI- according to my pdoc, the difference between OCD and OCPD is that with OCD, you know that your obsessions and compulsions are "abnormal", and that fact concerns you or makes you anxious. with OCPD, you don't recognize that there's a problem with your behavior. you think it's a quirk that everyone around you should just accept. or to put it bluntly, OCD bothers the patient more than those around her. OCPD bothers those around the patient more than it bothers her.
another distinction is that OCD is usually treated with SSRIs, but OCPD doesn't respond to them. my SO has some of both. with medication the OCD traits went away. the OCPD traits did not change at all.
-kelly
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