BPD Borderline Personality Disorder PYC4802

This essay aims to discuss, analyse and contrast the problems that Clinicians face when identifying and diagnosing Borderline Personality Disorder (BPD). The DSM-IV-TR Diagnostic criteria for Axis 1 and Axis 2 disorders will be defined to outline the Diagnostic criteria and the overlap that exists amongst these criteria. There exists large co-morbidity between, PTSD, the Mood disorders, Depression and the Impulse Control disorders. In addition to the aforementioned problems, the difficult client therapist relationship that is apparent with BPD patients, the surplus stigma attached to BPD (from psychologists and the general Public), the extensive under diagnosis of BPD, the prescription of many different medications for BPD (which have generally proved unsuccessful), the lack of research into BPD, the incorrect practices being used to identify and diagnose BPD and the ever changing nature of Psychology and Psychiatry. All create, amalgamate and form the large problems that Clinicians are facing when trying to identify and diagnose BPD. This essay aims to consider the factors that contribute to the under/misdiagnosis of BPD and demystify this disorder through the analysis of all factors that contribute to it’s under/misdiagnosis. 2. DSM-IV-TR Diagnostic criteria for Personality disorders and (BPD): Borderline Personality Disorder (BPD) is one of the 11 Personality disorders that are classified on the DSM-IV-TR, a personality disorder is characterised by a stable pattern of inner experience and behaviour that is inflexible and pervasive, deviating markedly from the expectations of the persons culture, is stable over time, has an onset in adolescence or early adulthood and leads to major suffering or impairment in significant areas of functioning (Tutorial letter 101. PYC4802). The specific Diagnostic criteria for BPD are characterised by frantic efforts to evade real or imagined abandonment, unstable and intense relationships, unrelenting and extreme unstable self image, impulsive behaviours that are potentially self damaging, recurrent suicidal behaviour, gestures, threats or self mutilating behaviour, affective instability due to a marked reactivity of mood, chronic feelings of emptiness, intense or inappropriate anger and transient stress related paranoid ideation and/or severe dissociative symptoms (Tutorial letter 101. PYC4802). To be able to diagnose Personality disorders, persons need to be assessed with regard to their long term patterns of functioning over time and across different situations and personality traits need to be separated from other symptoms that may have become apparent after certain stressors, transient mental states and traumatic events that have been experienced (Tutorial letter 101. PYC4802). More than one interview is needed for this process and both sets of criteria must be present to diagnose a specific personality disorder and the identification of a personality disorder requires that these relatively stable traits are consistent from adolescence into early adulthood (Tutorial letter 101. PYC4802). 3. The different ideas around what constitutes and causes BPD and the overlap of BPD and Mood disorders Diagnostic criteria: There exist two quite contrasting notions of what constitutes BPD, the older version goes back to the disorders earliest use in psychoanalytic literature and refers to a far reaching number of patients whose underlying Psychology does not have the disorganization, chaos and lack of reality testing that is coupled with psychotic disorders ( Kernberg, O. F. & R, Michels. 2009). However they possess the traits of lack of stable relationships and the lack of being able to regulate their affect which is associated with neurotic patients (Kernberg, O. F. & R, Michels. 2009). Therefore there exists a middle ground within these patients, this middle group of patients present symptoms between neurosis and psychosis, which is Diagnostically linked to more severe Personality disorders and unstable presentations of axis 1 disorders (Kernberg, O. F. & R, Michels. 2009). Therefore, these two contrasting notions of what constitutes BPD could be confusing psychologists when it comes to identifying BPD in patient’s (Kernberg, O. F. & R, Michels. 2009). The second meaning that BPD has been given and which is its official current psychiatric nosology, is known as a specific axis 2 cluster B disorder, and which encompasses many of the characteristics of the first meaning but more specifically as they appear in the histrionic personalities and which is defined by the surface phenomenology rather than the underlying psychological structure of the disorder (Kernberg, O. F. & R, Michels. 2009). In short all of the second type of Diagnostic symptoms would be included in the first type (Kernberg, O. F. & R, Michels. 2009). However a number of the first type symptoms would be classified in the DSM axis 2 system as histrionic, narcissistic and antisocial, located in cluster A or C , furthermore most American psychologists have a fuzzy notion of what in fact constitutes BPD (Kernberg, O. F. & R, Michels. 2009). Therefore, the blurred lines that constitute BPD create problems in identifying and diagnosing BPD because a patient could be presenting with symptoms where he/she could be diagnosed with an array of different Personality disorders (Kernberg, O. F. & R, Michels. 2009). When it comes to the causes of BPD, once again there are two distinct views, in short the development of the disorder is complicated and always involves nature as well as nurture, although one or the other may be predominant as the determinant of the cases and a mixture of both in extreme cases (Kernberg, O. F. & R, Michels. 2009). Lying within the parameters of BPD, relating to both the descriptive diagnosis and the broader psychodynamic concept are significant and undeniable problems with its classification and diagnostic criteria (Kernberg, O. F. & R, Michels. 2009). The descriptive criteria for BPD has a co morbidity of 60% with other severe Personality disorders, which points towards underlying common personality features between these Personality disorders, which therefore creates problems identifying as well as diagnosing BPD because of this overlap ( Kernberg, O. F. & R, Michels. 2009). The original psychodynamic definition, which was originally based on theories of early infancy and conflicts derived from early childhood have defied efforts to theorise a precise theoretical description of BPD which compounds the problems that clinicians face when trying to diagnose patients (Kernberg, O. F. & R, Michels. 2009). However, from a clinician’s viewpoint it is undeniable that similar personality traits correspond to different psychological meanings within the sphere of Psychiatry and the search for the relationship between surface features and underlying psychological and or Neurobiological structures lends itself to reductionist shortcuts that do not explain the complexity of psychopathological conditions (Kernberg, O. F. & R, Michels. 2009). In addition, the diagnosis has been officially challenged with the idea that it can be explained by other co morbid conditions, or as variants of axis 1 disorders, namely mood and impulse control disorders (Goodmam, M et al. 2009). However, increasing evidence points towards BPD as a valid diagnosis with relatively specific genetic and psychosocial, biological susceptibilities and specific responses to treatments and outcomes to those treatments (Goodmam, M et al. 2009). Therefore Psychology needs to come up with a more comprehensive and precise definition of the Diagnostic criteria for BPD to help psychologists make the correct identification and thus diagnosis of the disorder (Kernberg, O. F. & R, Michels. 2009). Furthermore, BPD has also been conceived as an impulse control disorder due to impulsive aggression in patients; however these symptoms arise in an interpersonal context