As such, the most obvious "symptom" of Borderline Personality Disorder is a lifelong pattern of instability in interpersonal relationships, self-image and emotions.


Why is Borderline Personality Disorder Difficult to Diagnose

Borderline Personality Disorder is a relatively recent addition to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization International Statistical Classification of Diseases and Related Health Problems (ICD). Accordingly, the majority of practicing mental health professionals graduating prior to 2000 have not been trained on the diagnosis and the treatment of this complex disorder as part of their professional curriculum.

Additionally, the clinical definition of Borderline Personality Disorder is very broad. It is defined in terms of nine criteria of which 5 or more are indicative of the disorder. This translates to 256 clusters of criteria, or constellations as they are known, any one of which is diagnostic for BPD. Within these constellations, there are high functioning borderlines that operate well in society and are not very obvious to new acquittances or the casual observer. In these constellations, there are the low functioning borderlines that are often more apparent as they can't hold jobs, and they self-harm (cutting). Suicidal attempts and ideation and anorexia/bulemia are some of the most serious aspects of this disorder - many with the disorder do not exhibit either.

Proper diagnosis and treatment of Borderline Personality Disorder is spotty at best with community health care providers, marriage counselors, family therapists. Most borderlines are undiagnosed or in treatment for other maladies such as depresion or PTSD. If your loved one needs care, it is best to use a specialist, preferably one associated with a University.

Test for Personality Disorders

Commonly used assesment tests includes include the Structured Clinical Interview (SCID-II), Personality Disorder Beliefs Questionnaire (PDBQ). There are rating tests such as the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD).

The questionairre that appears in the right column is a simple 50 question instrument. Many of our members have taken the test on their own behalf and on the behalf of a loved one. You are invited to take the test and join in a discussion with our members. Membership is free to anyone with a loved one with the disorder.

Structured Clinical Interview (SCID-II)

The Structured Clinical Interview (now SCID-II) was formulated in 1997 by First, Gibbon, Spitzer, Williams, and Benjamin. It closely follows the language of the DSM-IV Axis II Personality Disorders criteria. There are 12 groups of questions corresponding to the 12 personality disorders. The scoring is either the trait is absent, subthreshold, true, or there is "inadequate information to code". SCID-II can be self administered or administered by third parties (a spouse, an informant, a colleague) and yield decent indications of the disorder. The questionairre is available from the American Psychiatric Publishing ($60.00).

Personality Disorder Beliefs Questionnaire (PDBQ).

The Personality Disorder Beliefs Questionnaire (PDBQ) is a brief self administered test for Personality Disorder tendencies. A list of questions most often aswered as "yes" by people with Borderline Personality Disorder is available to members of BPDFamily.com.

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Below are characterization of the disorder by the National Institute of Health, The Mayo Clinic, and the American Psychiatric Association.

National Institute of Health Definition of Borderline Personality Disorder

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all.

Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

The Mayo Clinic Definition of Borderline Personality Disorder

People with BPD often have an unstable sense of who they are. That is, their self-image or sense of self often rapidly changes. They typically view themselves as evil or bad, and sometimes they may feel as if they don't exist at all. This unstable self-image can lead to frequent changes in jobs, friendships, goals, values and gender identity.

Relationships are usually in turmoil. People with BPD often experience a love-hate relationship with others. They may idealize someone one moment and then abruptly and dramatically shift to fury and hate over perceived slights or even misunderstandings. This is because people with the disorder have difficulty accepting gray areas — things are either black or white. For instance, in the eyes of a person with BPD, someone is either good or evil. And that same person may be good one day and evil the next.

In addition, people with BPD often engage in impulsive and risky behavior. This behavior often winds up hurting them, whether emotionally, financially or physically. For instance, they may drive recklessly, engage in unsafe sex, take illicit drugs or go on spending or gambling sprees. People with BPD also often engage in suicidal behavior or deliberately injure themselves for emotional relief.

Other signs and symptoms of borderline personality disorder may include:

* Strong emotions that wax and wane frequently
* Intense but short episodes of anxiety or depression
* Inappropriate anger, sometimes escalating into physical confrontations
* Difficulty controlling emotions or impulses
* Fear of being alone

The American Psychiatric Association Definition of Borderline Personality Disorder

Personality disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with borderline personality disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria note that people with BPD have a pattern of unstable relationships, self-image and mood, as well as impulsive behavior. These typically begin in early adulthood. This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

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:
Personality disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with borderline personality disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria note that people with BPD have a pattern of unstable relationships, self-image and mood, as well as impulsive behavior. These typically begin in early adulthood. This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

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:

References:

(1)BPDFamily Staff Production included anonymous members Elphaba, LAPDR, United for Now, ForeverDad, NewLifeForHGG, and Skip, community leaders with professions in healthcare, education, and business.

(2) Assumptions in borderline personality disorder: specificity, stability
and relationship with etiological factors. Arntz, A., Dietzel, R., & Dreessen, L. (1999). Behaviour Research and Therapy, 37, 545–557

(3) Stop Walking on Eggshells, Paul Mason,MS and Randi Kreger, New Harbinger Publications; 1st edition (July 1998), ISBN-10: 157224108X