A_Discussion_of_the_Problems_Related_with_Identifying_and_Diagnosing_Borderline_Personality_Disorder

A Discussion of the Problems Related With Identifying And Diagnosing Borderline Personality Disorder Name: Institution: Introduction Numerous personality disorders have been medically identified over the years, some are genetic while others are acquired. Yet, a lot of these disorders remain uncharacterized and can only be classified according to the pattern of abnormal behaviors the patients exhibit. Therefore, in an attempt to develop a definite meaning to what a Personality Disorder is, the American Psychology Association (APA, 2000), using the DSM-IV-TR classification system, describes Personality Disorder as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of an individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment (APA, 2000). The DSM-IV-TR system used by the APA classifies personality disorders into 11 categories, among them, Borderline Personality Disorders. Borderline Personality Disorder Borderline Personality Disorder (BPD) is to date one of the most controversial conditions ever diagnosed in psychology. Since being introduced in the DSM for the very first time, psychologists and psychiatrists have been trying to give the apparently amorphous concepts behind the occurrence and manifestations of Borderline Personality Disorders a concrete form (APA, 2000). In this quest, they have described Borderline Personality Disorder as a prolonged disturbance in personality of an individual, usually in early adulthood or adolescence, which is characterized by heightened variability of moods and manifest in devaluation and idealization episodes, as well as instability in interpersonal relationships, self-image, and marked disturbance in the individual’s sense of self (APA, 2000). Some researchers, like Judith Herman (2005), even argue that Borderline Personality Disorder is just a name given Post-Traumatic Stress Disorder (PTSD) manifested in a particular way. In her book: Trauma and Recovery, she theorizes that when PTSD manifest in a manner that heavily affects the elements of identity and relationship patterns of an individual, it gets called Borderline Personality Disorder (Herman, 2005). Persons with Borderline Personality Disorder often shift between idealizing and demonizing others and if left untreated, can undermine relationships with family, co-workers and friends. Relationships with other people are often intense but very unstable and stormy, with frequent shift in feelings and difficulties in maintaining intimate, close connections. The individual also has trust issues and may get manipulative. But perhaps the most imperative and outstanding manifestation of Borderline Personality Disorder is the development of unpredictable and impulsive behaviors that range from addictions with spending drugs, alcohol and shoplifting to physically damaging actions like suicidal gestures. Surprisingly, Borderline Personality Disorder is a fairly common disorder with estimates being laid as high as 10-14% of the general population in the USA (Meyerson, 2009). The major cause of this disorder has been repeatedly cited to be genetic although sexual correlation has recently been established. Statistics show that the cases of Borderline Personality Disorder in women are 2-3 times the number of cases in their male counterparts. This finding is linked with the premenstrual tension and depressions that women undergo (Meyerson, 2009). This coupled with the greater incestuous experiences that women go through during their childhood are deemed to be major predisposing factors. Diagnosis of Borderline Personality Disorders Persons with Borderline Personality Disorder can sometimes be bright and intelligent, appearing warm and competent (Phend, 2009). This is however maintained until their defense is crumbled by stressful occasions such as the death of a parent or a break up of a romantic relationship (Hoffman, 2007). Diagnosis is therefore based on clinical assessment by a qualified mental health professional which often involves self-reported experiences by the patient in addition to the Doctors observations. In an attempt to make a precise diagnosis of Borderline Personality Disorder and clearly distinguish it from other personality disorders, Gunderson and his colleague, Jonathan Kolb (2009) constructed a clinical interview called Diagnostic Interview for Borderlines, Revised (DIB-R) to assess borderline characteristics in patients. This interview considers symptoms that fall under four major categories namely Affect, Cognition, Impulse action patterns, and Interpersonal relationships. Using these categories, the DIB-R has been able to identify four behavioural patterns that are peculiar to Borderline Personality Disorder and these are listed as: being very demanding and need to feel entitlement; fear of being abandoned, annihilated or engulfed; regression when treated and possibility of arousing inappropriately close or hostile treatment relationships. This approach makes the DIB-R the best known, and perhaps the most influential, test for diagnosing Borderline Personality Disorder. There are however, on the other hand, laid down criteria in the DSM-IV-TR that the diagnosis of Borderline Personality Disorder. This is indicated by the following: * A pattern of unstable interpersonal relationships that often alternate between extremes of idealization and devaluation. * Identity disturbance characterized by markedly and persistently unstable feeling of an individual’s sense of self. * Heightened impulsivity in areas that are potentially self-damaging, for example sex, substance abuse, and reckless spending. * Recurrent feelings of emptiness by the individual that often becomes chronic. * Development of self-mutilating behaviors or gestures that soon becomes suicidal. Possible Complications in Diagnosis Due to the need to meet the above mentioned criteria, various complications may be experienced in trying to make the diagnosis of Borderline Personality Disorder. These complications in diagnosis can best be classified according to the various models and theories that are used to study Personality disorders notably; The Medical Model This model approaches Borderline Personality Disorder as a mental condition, typically focusing on the underlying physiological malfunctions in the individual’s body. As such, this model has also been described as “biochemical”, “psychomedical”, or “psychiatric” model (Kernberg and Michels, 2009). It is this model that the DSM diagnostic system for abnormal behaviors relies on. Complications may however arise when clinicians limit assessment to only one interview, thereby limiting their capture of the flexibility of the stability of individuals over time and across situations, which is a critical feature for making a diagnosis of a personality disorder (Gunderson, 2009). It is necessary to conduct more than one interview and possibly supplement the data obtained with other information from more independent sources. The Psychodynamic Model This deals with a collection of theories and therapies that are concerned with the dynamics or rather, the motivating or driving forces of the mind and the critical role of the early years of an individual’s life on his/her future behavior (Kernberg and Michels, 2009). It typically focuses on underlying intrapsychic conflicts, maintaining that psychological problems in later life can be traced back to unresolved childhood conflicts. The chances of correctly identifying and diagnosing Borderline Personality Disorders lies squarely on the ability to establish the presence of these relatively stable traits across time and situations since at least adolescence or early adulthood. It is presumed that lasting personality characteristics develop by early adulthood or adolescence. However, the developmental phase for Borderline Personality Disorders may take a longer time than is expected (Royal College of Psychiatrists, 2001). This ultimately leads to late diagnosis and subsequent late intervention therapy. The Family Systems Model This model gives a broader perspective in the development of Borderline Personality Disorder by putting the ideas of symptomatology in the context of a family (Kernberg & Michels, 2009). Most importantly, this model utilizes the network of relationships between individuals in a family to try to explain the sources of Borderline Personality Disorder. Therefore, the abnormality in behavior developed by an individual, according to family systems theory, can only be understood from the evaluation of the family that the individual comes from. To be able to make a conclusive diagnosis of Borderline Personality Disorder therefore, individuals should be assessed based on their long-term patterns of functioning over time and across different situations, which also can be traced back in the family tree. The first major challenge is to determine what the individual’s normal personality traits are. These need to be separated from other symptoms that may have appeared after certain psychological misfortunes such as traumatic experiences, and/or substance abuse leading to intoxication, among others. The humanistic-existential models This model places great faith in the ability of the patients to make appropriate and optimistic decisions that will ultimately liberate their unique personalities. It is therefore subject to scrutiny by the physicians or psychiatrists that examine these patients. This makes this model of diagnosing Borderline Personality Disorders prone to alterations and bias, based on the individual’s relationship with the examining psychiatrist. Indeed, there have been cases of some biased psychiatrists applying the diagnosis of a Borderline Personality Disorder to patients they consider difficult or, so to say, a “pain in the ass”. This trend has mostly been established more frequently with female patients than male patients and perhaps this is best demonstrated by the use of the term “Male Borderline” when a male has been confirmed with Borderline Personality Disorder. Regardless of the model used, the only responsible way to apply the diagnosis of Borderline Personality Disorder to someone is by using the DSM-IV criteria established by the American Psychiatric Association or the international ICD diagnosis system (APA, 2000). Conclusion Both the general criteria for diagnosing personality disorders and the specific diagnostic criteria for Borderline Personality Disorder need to be taken into consideration in order to fulfill the conditions for making a diagnosis of Borderline Personality Disorder. This is because Borderline Personality Disorder may be a specific entity but its occurrence most certainly has a correlation with the factors that lead to general mental disorders. Never the less, one mental disorder can secondarily lead to the other either due to the extent of damage it has caused or in the course of its convalescence. For a very long time now, personality disorders have been considered difficult to treat. However, recent evidence-based therapies proved to be highly successful in treating individuals diagnosed with Borderline Personality Disorder (Oldham, 2009), but interestingly, only in situations where these conditions had a reasonable intellectual foundation and were carried out by reasonable people in a reasonably consistent manner. Works Cited APA (2000) Borderline personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) Gunderson, J.G. (2009). Borderline Personality Disorder: Ontogeny of a diagnosis: American Journal of Psychiatry, 166, 530-539 Herman, J. (2005) Is Borderline Personality Disorder a Disease' Trauma and Recover, MedPage Today Hoffman, P.D. (2007). Borderline Personality Disorder: A most misunderstood illness. National Education Alliance for Borderline Personality Disorder, NAMI Advocate Kernberg, OF & Michels, R. (2009) Borderline Personality Disorder: American Journal of Psychiatry, 166, 505-508 Meyerson D. (2009) Is Borderline Personality Disorder under diagnosed' American Psychiatric Association Oldham, J.M. (2009). Borderline Personality Disorder comes of age. American Journal of Psychiatry, 166, 509-511. Phend, C. (2009). APA: Borderline Personality Disorder often missed first time around. MedPage Today. Royal College of Psychiatrists (2001) Onset of Borderline personality traits: Journal of Psychology, RCP press