Is Bpd Classed As A Mental Illness?

[CharcoalKiss]

Hey Icu. Thanks! (btw, the mental health and illness essay i did on PDs - i got a 1st)

Along the lines of the changing classifications of schizophrenia and depression, homosexuality and a woman's refusal to marry the man that got her pregnant used to be classified as 'psychosis'. Mental illness/disorder classifications are an ever changing field of study because not all of psychology can actually be measured. For instance, serotonin/dopamine levels in depression and schizophrenia can be measured... but psychologists find it difficult to measure the non-biological and internal factors of any mental illness/disorder. There are heredity aspects claimed in many, if not all, mental illnesses/disorders. For instance, depression appears to have a high rate of familial concordance. The problem with PDs, as freud (i think) put it, is that 'one cannot measure of change a personality.' whereas illness - in its biological forms - can be both measured, and altered through drug therapies.

I disagree that BPD should be a spectrum of Bipolar II. Granted, the two have co-morbidity values and can be closely linked through symptoms, but if BPD is a spectrum of BPII, then shouldn't the other PDs be reclassified as mental illnesses rather than PDs... like schizotypal being re-classified as a form of schizophrenia as it once was? As far as my understanding goes, PD classifications were generated because the patients behaviours could not be classified or treated through known means for psychosis, neurosis and mood disorders, so another category was researched and added - that of personality disorders - which through time has increased to include several 'sets' of PDs (for instance BPD and ASPD are classified as 'Dramatic PDS') There is also the treatability element. While mood disorders, psychosis and neurosis can be 'cured' through the use of a combination of drug therapy to 'cure' the physical symptoms (re-align hormone and neurotransmitter levels) and therapy to remove the underlying psycho-social factors, the focus with PDs has for a long time been 'management rather than cure' (although admittedly this arguement loses precedence in the face of recent breakthroughs in the treatment and cure of BPD).

I really have no idea where i am going with this.... except to say that while i am very interested in your views; Icu; my opinion differs. (although i am by NO means saying that you are wrong - my point is that noone really knows the answer, i just differ in my opinion) and i think you may be entirely right that in a few years BPD, along with other PDs will me moved in classification into the axis I disorders.

fucktheworld; Yes, i agree with you that the co-morbidity of PDs and 'mental illnesses' is quite high, although there isn't a huge amount of conclusive evidence to suggest that coping with the PD is the cause of the co-morbid illnesses. For instance, i live with BPD and Depression.... was the depression caused by coping with the BPD.... or as a result of heredity through my mother suffering from severe depression all of her adult life?

I like your comparison of NPD and BPD - that NPD is different because of the lack of true empathy. I agree with you there. Narsissus, the Greek God from which narcissism took its name, was as legend has it, incredibly self centred. Although i don't actually see NPD as being 'self-centered' as such, your insight into the apathy inherent in this PD is interesting. As far as i remember, the only PDs where an individual is entirely apathetic as NPD and ASPD, in all others, while the person may struggle to empathise, they are aware that they are limited in their empathy - while certainly those with ASPD as unconcerned; as far as they are concerned their behaviour is ok, despite the fact that ASPD has been termed 'dangerous' because of the lack of consideration and knowledge a peson with ASPD has over what is 'right' and 'wrong' behaviour - they have no concern for other people and engage in dangerous and reckless behaviour, presumably (according to biological psychology) to get a 'thrill' as it has been found that ASPDs have low base levels in adrenaline and norepinephrine so seek thrills to increase these levels unconsciously.

One of the primary concerns of the mental health system when it comes to PDs is treatability. The majority of PDs are not considered to be treatable through biological means, which apparently makes us all dangerous and 'uncontrollable'. I think uncontrollable is a more apt term than dangerous. Or, even better - uncontrolled. Biological treatments are designed to suppress, not cure, the physical symptoms of mental illness (such as neurotransmitter levels). Drug therapy has not thus far had a high success rate with any of the PDs.

Although, in spite of all of my opinions - the PD classification has had the least study of all mental illness/disorders, and the answers to all these questions will only be discovered through research. Thankfully psychology is 'taking a loook' at PDs at present, mainly BPD and ASPD i think.

xxx

Oh, ps. Some psychologists reckon that ASPD is caused by untreated ADHD... i don't know personally. Just because something is co-morbid with another something doesn't mean its a cause.

[icu_baby]

When I was diagnosed with BPD, I asked my psychiatrist whether it was classified as mental illness, he said yes, alsthough not all personality disorders are. My understanding is that all personality disorders bar anti-social personality are mental illness. BPD being a severe personality disorder. Interestingly, when I have been sectioned it has been for bi-polar depression. They can only section you for treatment, and I was told their is no treatment for personality disorder, so you cannot be sectioned for it. This is a load of rubbish, you can be treated, however, on their poxy forms they are not allowed to write it!

Fairy xxx

I think that is sad Fairy. Does that mean if you have a condition that is deemed untreatable and you are suicidal you should be ignored? I think regardless of whether you have a mental illness or not, if you are in crisis or need help AND want help you should not be helped, even if they believe you cannot be treated, it is not only their responsibility but their duty to prevent further deterioration at least. I think that is so unethical.

[CharcoalKiss]

When I was diagnosed with BPD, I asked my psychiatrist whether it was classified as mental illness, he said yes, alsthough not all personality disorders are. My understanding is that all personality disorders bar anti-social personality are mental illness. BPD being a severe personality disorder. Interestingly, when I have been sectioned it has been for bi-polar depression. They can only section you for treatment, and I was told their is no treatment for personality disorder, so you cannot be sectioned for it. This is a load of rubbish, you can be treated, however, on their poxy forms they are not allowed to write it!

Fairy xxx

I think that is sad Fairy. Does that mean if you have a condition that is deemed untreatable and you are suicidal you should be ignored? I think regardless of whether you have a mental illness or not, if you are in crisis or need help AND want help you should not be helped, even if they believe you cannot be treated, it is not only their responsibility but their duty to prevent further deterioration at least. I think that is so unethical.

I absolutely agree Icu!

[icu_baby]

Charcol, congradulations on your Ist, that must mean a high distinction, I knew it was an excellent essay.

this is just a quick note, because unlike you have to go back to writing my assignment due tomorrow, lol and its 10.30pm but I need a break and I find this topic more interesting than legal ethics...

I value your views too, its ok we don't agree. I still find BPD such an elusive disorder to understand. Some questions I am still struggling with is:

How can you differentiate personality disorders and mental illness (say schizophernia or bipolar II) on the basis that one is much more treatable then the other. There are some forms of schizophernia that are more treatable than others and some stay chronically schizophrenic

Also I don't think you can distinguish BPD and mental illness on the basis that one is a behavioural problem and another is not. People with bipolar an also be irritable, moody, agressive particularily if they are going through a dysthemic or cyclothemic disorder. Cognitive behaviour therapy also benefits them to learn better ways of coping with stress etc just as it can with BPD.

Also, not all people with BPD exhibit "borderline behaviour" (I hate that phrase). I might yell at my sister maybe once in a few months but I think that is normal. I know thought that I have BPD because I feel things much more intensely than other people and it takes me a longer time than most to stop thinking about it (eg where I see something traumatic on tv, some injustice etc) so I guess you can say I have emotional dysregulation/affective liability (not sure if they are the same thing). I think Dr Paul Markovitz said that he treats BPD as bipolar II except when he sees people with interpersonal issues and then he treats them for BPD. But then what about those that are high functioning BPD - how do you distinguish that from bipolar II for example

How do you distinguish rapid cycling bipolar II or ultra rapid cycling from high functioning BPD when you consider that one of the criteria for BPD is intense dysphoria for a few hours and rarely more than a day?

What is the difference between dysphoria and depression? I read somewhere that BPD and bipolar II is distinguished on that basis - BPD are not depressed by suffer from dysphoria and then I read in another source that dsyphoria is a common feature of biploar II?

So many questions, so little answers.

[sundries]

what i find odd is the idea that people with Bipolar disorder arent going to have relationship issues. the divorce rate for bipolars is one of the highest in all chronic illnesses. I mean, are all we really talking about is diangosis of bpd on the basis of whether your pdoc likes you? cos sometimes it really seems that way.

[CharcoalKiss]

Charcol, congradulations on your Ist, that must mean a high distinction, I knew it was an excellent essay.

Yeah, its the highest grade you can get on an assignment. Thanks

this is just a quick note, because unlike you have to go back to writing my assignment due tomorrow, lol and its 10.30pm but I need a break and I find this topic more interesting than legal ethics...

Oh yeah, i would too! lol. I have an exam at 6 tonight (its now nearly 3) so i should be re-revising.... but meh it;s occupational psychology, it'll be fine.

I value your views too, its ok we don't agree. I still find BPD such an elusive disorder to understand. Some questions I am still struggling with is:

How can you differentiate personality disorders and mental illness (say schizophernia or bipolar II) on the basis that one is much more treatable then the other. There are some forms of schizophernia that are more treatable than others and some stay chronically schizophrenic

I understand this thought entirely and have often stuggled with it myself. I don't know the answer tbh. But through my studies i have generated a quasi-opinion based on research that personality disorders have been differentiated because of the difficulty with changing the maladaptive cognitive processes compared with mental illness - it is much harder to change someones personality then it is to correct a dysfunction of cognition or biological predeterminant. The classifications of mental disorders (PDs, and mental illness) has increased each time the DSM has been revised. Schizophrenia used to be one illness with no variants, now there are variants such as 'paranoid' and 'chronic'. There is an active debate within psychology as to whether or not schizophrenia is an umbrella term for a variety of psychotic-type illnesses, or whether it is simply schizohrenia - one illness. I see BPD as having similar problems in classification and treatment as schizophrenia in that despite the diagnostic criteria both of these are extremely subject to variation depending on the individual. Whereas with disorders such as depression, the criteria are generally static across most patients. BPD is (as far as i know) the most difficult to determine and unknown of the personality disorders, so answers are yet to have been found.

Also I don't think you can distinguish BPD and mental illness on the basis that one is a behavioural problem and another is not. People with bipolar an also be irritable, moody, agressive particularily if they are going through a dysthemic or cyclothemic disorder. Cognitive behaviour therapy also benefits them to learn better ways of coping with stress etc just as it can with BPD.

I don't see BPD as a behavioural problem at all. In my view all behaviours are backed by cognitions - which is as i under stand it the basic theory behind cognitive-behavioural therapy.

Also, not all people with BPD exhibit "borderline behaviour" (I hate that phrase). Yeah so do i I might yell at my sister maybe once in a few months but I think that is normal. I agree. I do not yell at my little brother because i have BPD, i yell at him because he is my little brother and he pisses me off some times. I know thought that I have BPD because I feel things much more intensely than other people and it takes me a longer time than most to stop thinking about it (eg where I see something traumatic on tv, some injustice etc) so I guess you can say I have emotional dysregulation/affective liability (not sure if they are the same thing). I think Dr Paul Markovitz said that he treats BPD as bipolar II except when he sees people with interpersonal issues and then he treats them for BPD. But then what about those that are high functioning BPD - how do you distinguish that from bipolar II for example

I was originally dx with biploar II for that very reason. I could describe to my pdoc all of the things he needed to dx me as both bipolar II and BPD, but i didn't show any of it at the consultation. I am very good at 'keeping up a front' and hiding the turmoil within. Oddly enough, i now sit under the dx of BPD and Bipolar I. I concur with what you are saying about feeling things more intensely (emotional dysregulation = being unable to regulate your emotions at a stable level in response to a stimulus; Affective liability = taking on the emotions as a sense of blame in response to a stimulus). And i think therein lies the differing element of a PD and a mental illness. Mentall illness, in my view, is simlar to a physical illness in that it is something that people 'suffer from' (although i am fully aware that there is a definate element of suffering involved in PDs too), while PDs i see more as something that people 'live with' The nature of a personality disorder is that it is a disordered personality. It is part of who i am. While the bipolar is an illness that i have, and something that i would fix if i didn't hate the idea of having to take so many medications (BPD, bipolar, heart condition.... blah blah blah).

I am terribly conflicted on the debate about BPD as well as other mental disorders & illnesses, some things i see clearly as being definitively right or wrong, others i am really not sure on. And even of the things i am sure on, they conflict with each other. Which is probably what makes it so interesting to me.

How do you distinguish rapid cycling bipolar II or ultra rapid cycling from high functioning BPD when you consider that one of the criteria for BPD is intense dysphoria for a few hours and rarely more than a day?

I dont know. I've actually not given this much thought tbh. i will look in to it now though (well, not now - after my exams)

What is the difference between dysphoria and depression? I read somewhere that BPD and bipolar II is distinguished on that basis - BPD are not depressed by suffer from dysphoria and then I read in another source that dsyphoria is a common feature of biploar II?

As far as i understand it. Dysphoria is the opposite of euphoria - which is extreme elation. So dysphoria would be characterised by pretty negative emotions towards everyone and everything. Feeling like ther eis no point, like nothing will get better. Whereas Depression, although seemingly hugely similar to this, is a process of maladaptive 'Schema' (a behavioural term used to describe cognitions which we learn through experience and are applied to all situations and people). For instance, while a BPD person would believe that nothing will get better because they are feeling 'down', a depressive person would belive that nothing will get better because from past experience their schema's in this circumstance suggest that nothing ever has got better. As far as i understand depression can be more defeatest, while dysphoria is more a sense of disequilibrium that can be balanced and equilibrium restored.

I could well be wrong though.

So many questions, so little answers.

I know, and i'm sure my answers fall short of reality or actual truth, but they are my opinions as i see them now. They may change with further study or through the assimilation of other opinions. But this is my take on the questions you have presented. I hope that at least they provide you with a plateau from which to continue debating.

Good luck with your essay!!!

[CharcoalKiss]

what i find odd is the idea that people with Bipolar disorder arent going to have relationship issues. the divorce rate for bipolars is one of the highest in all chronic illnesses. I mean, are all we really talking about is diangosis of bpd on the basis of whether your pdoc likes you? cos sometimes it really seems that way.

I have to admit that in some cases you seem to be dead on with this assumption. I'm not saying that its true, just that as you said it seems to be.

From my experience there seems to be a definate element of personal opinion in the dx of all mentall illness/disorders. Afterall, the DSM gives a list of things to look out for, but its up to the individual psychiatrist to determine whether, for instance, a person's belief that one of their friends is plotting with another is a paranoid delusion, or in fact a subjective observation that these two friends have started making 'inside jokes' and spending a lot of time together to the exclusion of the person presenting to the psychiatrist.

All diagnosis not based in firm biological fact contain elements of subjectivity that can lead to misdiagnosis, rediagnosis etc. Until medical science can prove definitively that mental illness/disorder has a biological cause, and differentiate these causes for the illness/disorder, dx will ultimately be at the hands of the views of the person doing the diagnosing.

[icu_baby]

Ahha! This is the document I have been looking for:

Read this, it is about a notorious prisoner who had BPD and the judge, as a lay person, said that he had a mental illness because he severely mutilated his body (really gross stuff) while the psychiatrists disagreed and explained why it is classified as a PD. I would agree with the judge in the first instance. Though I think BPD is a mental illness but not APD because BPD should be seen as a mood disorder in my eyes.

Gary_David___mad_or_bad.doc

[icu_baby]

Wow sundries, you know alot and have provided me with plenty of amunition and will certainly come back to it after my essay, glad its due at 4.00pm tomorrow, still time to work on it.

Just one quick point though, dysphoria, which I think I have, and is about restoring the equilibrium, equilibrium of what? Doesn't dysphoria have a biological element then and some people with BPD might experience it a few hours a day for many months/years shouldn't that be enough to classify BPD as a mental illness just because dysphoria causes suffering just like depression.

Also, if depression is a cognitive distortion and thus a mental illness, why isn't BPD a mental illness since there are cognitive disortions in BPD too?

If BPD is a maladaptive copying style, then isn't depression also a maladaptive because they have a defeatest attitude and learned hopelessness element. Surely a depressed person can release that things were better before? Don't depressed people also feel like nothing will get better or have feelings of hopelessness, I thought that was what depression was?

[sundries]

Dysphoria includes anger,anxiety,depression - which is how it differs from depression.

I have my doubts about ultra rapid cycling bipolar

but

if i was to distinguish

i would say that the period of ultra rapid cycling would be part of a larger cycle ie 3 months of ultra rapid cycling and then fine for 3 months. Sometimes in bipolar ultra rapid cycling is also called a 'mixed state' (

(but mixed state can also refer to a state where you have symptoms of depressionand mania at same time (ie restless/pressure of speech but very negative feelings)(think it can also be called dysphoric mania/agitated depression when it is like this)

anyway,

described like that, BPD would be different because the 'rapid cycling' does nto have the long breaks in between.

Depression

I think a lot of people diagnosed with 'depression' simply have what if it was dispalyed by someone with BPD would be called a behavioural problem. That is why i am very sad they got rid of the distinction between endogenous and reactive depression. I think everyone should be helped, but i think refusing bpd help on the basis of its reactivity is very inconsistent.

Triggered by life events

(not talking about origin of illness eg abuse, more manifestation of it on yearly basis)

I think bipolar can be 'triggered' by life events/stressful situation in a different way from bpd.

In bipolar the relapse will be almsot a response to being underweather. eg if you are very stressed might get a cold, and once cold is there it has its own course

in bpd, the 'relapse' consists in the direct response to the situation, the relsapse IS the out of control behaviour.

so, for instance, with bipolar you might be trying to give the healthy response but not have the energy/not be able to because you are too exhausted by hte cold

but with bpd, you only know how to give the response you are giving eg you arent usually fit enough to run a mile and just held back by cold brought on by stress, you just arent fit enough full stop.

[icu_baby]

Wow, sundries, I can certainly see the distinction between the two and thank you so much for taking the time to explain the distinction to me, I still consider BPD as a separate mental illness.

I love the cold analogy, and I want to know what the relapse is for people with BPD who do not have out of control behaviour in response to a direct external stimuli, does that mean the person is just a sensitive person?

Also what is the significance of having BPD traits rather than the full blown disorder. I have seen both dx with BPD in my file and BPD traits. I would prefer the full disorder than the traits. I don't see the usefulness of writing has BPD traits because this means nothing to me. Just borrowing from you example, if I have a stomach ache that could be a trait of so many things such as irritable bowl syndrome, cancer, the flu, food poisoning. The GP would not tell me that I have food poisoning traits or flu traits so why is it that if I have emotional dysregulation they write BPD traits or BPD and not just emotional dysregulation. I mean you can only be diagnosed with the flue for example with other symptoms such as stomach ache, running noise, fluid in ear, sneezing etc and once you have a bundle of symptoms you can be diagnosed with the flu as apposed to another disease. I am just irritated because I still do not know what criteria I meet for BPD!