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Why I Want To Be Diagnosed With Bpd


Data

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And personally I don't think you have BPD although I would agree you have some form of personality disorder, just not that one.

I agree with roses. I don't think your diagnosis is BPD. You should speak to your psych and ask him/her

I thank you for your honesty and I am sure you both mean well. However, I find this highly triggering.

data, none of us can dx you, so dont worry too much over what other people think, we're not pdocs after all, we dont know your mental health like you or your t do, and the internet realy isnt the best place to judge anyways

i understand you want to have the answer that fits you best. having a dx that says something is real, concrete, definable and approachable, would feel hugely validating. but that doesnt mean your going to have a good experience of this, just like many have said often bpd dx is reason for prejudice and inadaquate treatment. that said, if your eyes are open to this and you still feel you want to pursue it then good luck. i get the impression from what iv seen through work situations that men with a bpd dx are not judged as harshly as women with the dx, so maybe it will not be as negative as others. however pls dont take that as fact, its only the impression iv got, and i dont no of anything research that woud make this likely.

however, despite the fact we cant dx you, i would like to say im quite positive you dont have npd, not as a full blown dx anyways, as the daughter of a npd m you certainly do not come across like that at all, i still find i can sniff people like her out a million miles away. you have far too much insite and empathy and consideration to be npd, and a huge amount of paitence these days also as this thread shows. you may have narsassitstic traits, but all people have some narsassistic traits, as well as some co narsisstic traits, even those who are mentally healthy.

with regards to your t, it is normal practise in some areas for a t to advise a pdoc on what they feel the dx is, this is much more common if a t is treating someone who had did, as pdocs are much less likely to see people with did, where as ts are. so your ts opinion, as long as he is someone educated and experienced, which i remember he is, is a valuable one, but not the defining one. theres also certain progress you definately seem to have made on here, im not sure how much of that translates into your rl, but if it all did then you might find you may not meet enough criteria or have a big enough 'problem' anymore with certain areas. i appriciate thats more likely in future once you have made more progress.

im glad to hear you're still working hard with t. best of luckx

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Two of the main criteria of BPD are suicide attempts and self harm.

Because you don't have these, you could get a diagnosis of something else. Another personality disorder or somewhere on the autistic spectrum. I understand you want a diagnosis, but why BPD? If your therapist has told you it is BPD I think he has been very unprofessional

Ruthie

x

I disagree with this Ruthie, sorry. The main characteristic of BPD is a history of unstable relationships.

I've never attempted suicide, and i haven't self harmed in over 7 years, that doesn't mean i no longer have BPD or suffer from the often debilitating symptoms and traits of BPD. I could go into what exactly being BPD means for me, as i don't consider myself 'typical BPD' but this isn't my thread to do so.

xx

PS. Just want to say, that just because someone isn't exhibiting 'typical' symptoms like constant crises, suicide attempts, threats or actual self harm doesn't mean a person doesn't have it. Every person in the world has some BPD traits, it just depends on how many they have and how they interfere in their lives as to whether it is diagnosable. Remember you only have to fit 5 of the 9 criteria to get a dx.

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Official DSM-IV Criteria for Borderline Personality Disorder

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

2) a pattern of unstable & intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

3) identity disturbance: markedly and persistent 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)

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 paranoia or severe dissociative symptoms

The suicidal and self harm parts make up only 1 of the criteria....there are 8 others that some seem to be forgetting about.

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I have read and been told impulsivity which can lead to suicide attempts is one of the main factors and seperates it from other other personality disorders. BPD has a much higher suicide rate than other PDs

Ruthie

x

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The following is the current DSM-IV-TR classification of Borderline Personality Disorder:

301.83 BORDERLINE PERSONALITY DISORDER

Diagnostic criteria for 301.83 Borderline Personality Disorder

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:

frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

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). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

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

Diagnostic Features

The essential feature of Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.

Individuals with Borderline Personality Disorder make frantic efforts to avoid real or imagined abandonment (Criterion 1). The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. These individuals are very sensitive to environmental circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g., sudden despair in reaction to a clinician's announcing the end of the hour; panic or fury when someone important to them is just a few minutes late or must cancel an appointment). They may believe that this "abandonment" implies they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors, which are described separately in Criterion 5.

Individuals with Borderline Personality Disorder have a pattern of unstable and intense relationships (Criterion 2). They may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not "there" enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will "be there" in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.

There may be an identity disturbance characterized by markedly and persistently unstable self-image or sense of self (Criterion 3). There are sudden and dramatic shifts in self-image, characterized by shifting goals, values, and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with this disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing, and support. These individuals may show worse performance in unstructured work or school situations.

Individuals with this disorder display impulsivity in at least two areas that are potentially self-damaging (Criterion 4). They may gamble, spend money irresponsibly, binge eat, abuse substances, engage in unsafe sex, or drive recklessly. Individuals with Borderline Personality Disorder display recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (Criterion 5). Completed suicide occurs in 8%–10% of such individuals, and self-mutilative acts (e.g., cutting or burning) and suicide threats and attempts are very common. Recurrent suicidality is often the reason that these individuals present for help. These self-destructive acts are usually precipitated by threats of separation or rejection or by expectations that they assume increased responsibility. Self-mutilation may occur during dissociative experiences and often brings relief by reaffirming the ability to feel or by expiating the individual's sense of being evil.

Individuals with Borderline Personality Disorder may display affective instability that is 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) (Criterion 6). The basic dysphoric mood of those with Borderline Personality Disorder is often disrupted by periods of anger, panic, or despair and is rarely relieved by periods of well-being or satisfaction. These episodes may reflect the individual's extreme reactivity to interpersonal stresses. Individuals with Borderline Personality Disorder may be troubled by chronic feelings of emptiness (Criterion 7). Easily bored, they may constantly seek something to do. Individuals with Borderline Personality Disorder frequently express inappropriate, intense anger or have difficulty controlling their anger (Criterion 8). They may display extreme sarcasm, enduring bitterness, or verbal outbursts. The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil. During periods of extreme stress, transient paranoid ideation or dissociative symptoms (e.g., depersonalization) may occur (Criterion 9), but these are generally of insufficient severity or duration to warrant an additional diagnosis. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient, lasting minutes or hours. The real or perceived return of the caregiver's nurturance may result in a remission of symptoms.

Associated Features and Disorders

Individuals with Borderline Personality Disorder may have a pattern of undermining themselves at the moment a goal is about to be realized (e.g., dropping out of school just before graduation; regressing severely after a discussion of how well therapy is going; destroying a good relationship just when it is clear that the relationship could last). Some individuals develop psychotic-like symptoms (e.g., hallucinations, body-image distortions, ideas of reference, and hypnagogic phenomena) during times of stress. Individuals with this disorder may feel more secure with transitional objects (i.e., a pet or inanimate possession) than in interpersonal relationships. Premature death from suicide may occur in individuals with this disorder, especially in those with co-occurring Mood Disorders or Substance-Related Disorders. Physical handicaps may result from self-inflicted abuse behaviors or failed suicide attempts. Recurrent job losses, interrupted education, and broken marriages are common. Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the childhood histories of those with Borderline Personality Disorder. Common co-occurring Axis I disorders include Mood Disorders, Substance-Related Disorders, Eating Disorders (notably Bulimia), Posttraumatic Stress Disorder, and Attention-Deficit/Hyperactivity Disorder. Borderline Personality Disorder also frequently co-occurs with the other Personality Disorders.

Specific Culture, Age, and Gender Features

The pattern of behavior seen in Borderline Personality Disorder has been identified in many settings around the world. Adolescents and young adults with identity problems (especially when accompanied by substance use) may transiently display behaviors that misleadingly give the impression of Borderline Personality Disorder. Such situations are characterized by emotional instability, "existential" dilemmas, uncertainty, anxiety-provoking choices, conflicts about sexual orientation, and competing social pressures to decide on careers. Borderline Personality Disorder is diagnosed predominantly (about 75%) in females.

Prevalence

The prevalence of Borderline Personality Disorder is estimated to be about 2% of the general population, about 10% among individuals seen in outpatient mental health clinics, and about 20% among psychiatric inpatients. It ranges from 30% to 60% among clinical populations with Personality Disorders.

Course

There is considerable variability in the course of Borderline Personality Disorder. The most common pattern is one of chronic instability in early adulthood, with episodes of serious affective and impulsive dyscontrol and high levels of use of health and mental health resources. The impairment from the disorder and the risk of suicide are greatest in the young-adult years and gradually wane with advancing age. Although the tendency toward intense emotions, impulsivity, and intensity in relationships is often lifelong, individuals who engage in therapeutic intervention often show improvement beginning sometime during the first year. During their 30s and 40s, the majority of individuals with this disorder attain greater stability in their relationships and vocational functioning. Follow-up studies of individuals identified through outpatient mental health clinics indicate that after about 10 years, as many as half of the individuals no longer have a pattern of behavior that meets full criteria for Borderline Personality Disorder.

Familial Pattern

Borderline Personality Disorder is about five times more common among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for Substance-Related Disorders, Antisocial Personality Disorder, and Mood Disorders.

Differential Diagnosis

Borderline Personality Disorder often co-occurs with Mood Disorders, and when criteria for both are met, both may be diagnosed. Because the cross-sectional presentation of Borderline Personality Disorder can be mimicked by an episode of Mood Disorder, the clinician should avoid giving an additional diagnosis of Borderline Personality Disorder based only on cross-sectional presentation without having documented that the pattern of behavior has an early onset and a long-standing course.

Other Personality Disorders may be confused with Borderline Personality Disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more Personality Disorders in addition to Borderline Personality Disorder, all can be diagnosed. Although Histrionic Personality Disorder can also be characterized by attention seeking, manipulative behavior, and rapidly shifting emotions, Borderline Personality Disorder is distinguished by self-destructiveness, angry disruptions in close relationships, and chronic feelings of deep emptiness and loneliness. Paranoid ideas or illusions may be present in both Borderline Personality Disorder and Schizotypal Personality Disorder, but these symptoms are more transient, interpersonally reactive, and responsive to external structuring in Borderline Personality Disorder. Although Paranoid Personality Disorder and Narcissistic Personality Disorder may also be characterized by an angry reaction to minor stimuli, the relative stability of self-image as well as the relative lack of self-destructiveness, impulsivity, and abandonment concerns distinguish these disorders from Borderline Personality Disorder. Although Antisocial Personality Disorder and Borderline Personality Disorder are both characterized by manipulative behavior, individuals with Antisocial Personality Disorder are manipulative to gain profit, power, or some other material gratification, whereas the goal in Borderline Personality Disorder is directed more toward gaining the concern of caretakers. Both Dependent Personality Disorder and Borderline Personality Disorder are characterized by fear of abandonment; however, the individual with Borderline Personality Disorder reacts to abandonment with feelings of emotional emptiness, rage, and demands, whereas the individual with Dependent Personality Disorder reacts with increasing appeasement and submissiveness and urgently seeks a replacement relationship to provide caregiving and support. Borderline Personality Disorder can further be distinguished from Dependent Personality Disorder by the typical pattern of unstable and intense relationships.

Borderline Personality Disorder must be distinguished from Personality Change Due to a General Medical Condition, in which the traits emerge due to the direct effects of a general medical condition on the central nervous system. It must also be distinguished from symptoms that may develop in association with chronic substance use (e.g., Cocaine-Related Disorder Not Otherwise Specified).

Borderline Personality Disorder should be distinguished from Identity Problem (see 313.82 Identity Problem), which is reserved for identity concerns related to a developmental phase (e.g., adolescence) and does not qualify as a mental disorder.

Notice the bolded bits. From reading that, suicidal attempts and self harm are not the distinguishing characteristics that separate it from other PD's.

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Thanks for that, Wobbles. I have heard these criteria a few times but not explained in this detail. It is like reading my life story!

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ok. i was wrong. its what i was told. i apologise

Ruthie

x

No need to apologise hun :) there is so much misinformation floating around, and unfortunately a lot of it comes from 'professionals' which is why having the diagnosis can be so detrimental.

I think it's important to keep informed with the current stuff and take from it what each of us individuals feel is relevant to us, knowledge is power :)

(Not that i think i'm particularly knowledgable...just realised how arrogant that could have sounded)

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  • 2 years later...

I know this is an old thread, but I came across it and wanted to add my bit.

I haven't read all the posts, I've only read the first page.

Data, I totally get where you are coming from, I think the problem people had was the fact that you said you wanted to be Dx with BPD. When in actual act you wanted an accurate diagnosis (this may well be BPD, and if you think it is then it is/was definitely worth talking about with your pdoc.)

I went through several years of not having a diagnosis, and not having one meant that I wasn't entitled to the help I needed and deserved. I've had problems since young childhood, yet at 23 I am only now getting the help I needed years ago. This is because I finally have a Dx.

I didn't want it to be BPD, I didn't want it to be anything, I just wanted a label, so when people kept asking what's wrong? Why don't you work? Why did you drop out of uni with 2 months to go? I can say I have a mental health problem. I can put a name to it, I an research the best treatments for it and what other people feel like.

I think that may have turned into a rant, it wasn't meant to be, I just wanted to say that I felt Like it too and that you weren't alone.

However, this topic is 2 years old. Just triggered something in me and had to write how I felt.

Nikki x

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Well this is a blast from the past! I had a quick look through the history of replies to this, and I wish I didn't. Some emotionally charged responses on both sides.

I am glad you are getting help now Nikki.

Update: for the record, the last psychiatrist I saw doesn't think I have BPD. She suggested I might have a complex personality disorder with features of autism. I now accept what she says because I have confidence in it.

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Hi Data,

Thanks for replying, sorry some of the posts brought back bad memories.

I'm glad you've got confidence in this Dx. I found it really helpful getting my Dx.

Thanks again,

Nikki x

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