Diagnosis: What are the new DSM-5.0 criteria for BPD?

[Skip]

It might be better to misdiagnose someone with bpd who might have bipolar or npd for example, because the treatment of DBT can be beneficial to all of these illnesses, whereas the medication treatments are generally much less effective on personality disroders.  Generally, there is much greater risk (side effects, suicide, depression, etc) associated with mistakenly giving someone heavy doses of various anti-psychotics, anti-depressants, and so forth than mistakenly giving them therapy.

I think the bias is for Bipolar over BPD because bipolar is so responsive to medication. If in doubt, most clinicians would treat for bipolar and look for short term improvement before pursuing BPD.  This make more sense to me than trying a two year course of DBT (with a reasonably high drop out rate) first.

[Noob]

Wow, someone has done their homework.

[jak33]

Wow, yes, interesting revisions.  What's interesting is that I can see some of this stuff in me!  

What is really helpful is the empathy thing.  Looking at him.  And looking at me.

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[jak33]

Just following on from my posts above about the "a or b" thing under "Impairments in interpersonal functioning" ("a" being to do with empathy and "b" being to do with intimacy), when it comes to the "a or b" under "Impairments in self functioning" here, "a" being to do with identity and "b" being to do with self-direction, I would say my H fits both of these, but with the identity issues fitting in a particularly strong way.

[iluminati]

I like this batch of criteria.  It's a lot simpler to explain, and the scales can help you tease out differences easier.  After all the controversy with the DSM 5, I like.

[qcarolr]

The new view seems much more straightforward with its clear definitions of each component. I will be interested to learn of the results of the clinical trials. It reconfirms for me the severity of my DD25's classification. It helps me understand her resistance to therapy - except that the prozac does help moderate her rage episods and panic attacks. I look forward to seeing more about this as the release date approaches.

Just think of all the books out there that will need new editions!

qcr

[victim15]

I think I may have misunderstood this, I initially thought it was to do with their level of intelligence but now think it is to do with how well they cope with everyday life.

Would welcome any further explanation please...

[RefugeeFromOz]

A high functioning pwBPD is generally successful in life outside of intimate relationships.  They can be smart, witty, attractive, accomplished, talented, high wager earners, etc.  They hide their dysfunction and dysregulation from all except those with whom they share close emotional relationships.

A very destructive characteristic of a relationship with a high functioning pwBPD is that you experience profound and intense destructive behaviors, and yet everyone else sees what appears to be a successful, well adjusted, and healthy person.

It is an isolating experience because it is difficult to find validation and support from people outside your relationship because no one believes what you claim is happening.  In my case, it even took a therapist almost two years to realize that the facade presented by my exw was completely false.

I'm sure others will contribute more on this topic.

[PDQuick]

Summing it up...

Good comments, all.  

In summing up what we have learned so far, here is how the pieces fit together.  To be BPD all three must be true.  Anything less is not BPD per se' but rather "BPD leanings, or BPD style, or subclinical BPD, or "high functioning BPD".

(1) A rating of mild impairment or greater on the Levels of Personality Functioning

(2) A “good match” or “very good match” to a Personality Disorder Type (see BPD type)  

(3) Relative stability of (1) and (2) across time and situations, and excludes culturally normative personality features and those due to the direct physiological effects of a substance or a general medical condition.

The DSM 5 makes this all more clear.  Clinically, BPD is about dysfunction.  What is "high functioning dysfunction"?  Probably similar to "intelligent mental retardation", which is low intelligence.

High functioning, or sub-clinical BPD means a lot of things. They are not as severe, are more responsive to therapy, and are more likely to self resolve. These are more obvious to the partners of the disorder sufferer, but not as obvious to others.

Because BPD and sub-clinical BPD are disorders of relationship instability, it makes sense that the problems are much more apparent to a relationship partner.

[Auspicious]

Clinically, BPD is about dysfunction.  What is "high functioning dysfunction"?  Probably similar to "intelligent mental retardation".

Yeah, but ...

There is something to the "high functioning" concept. You can have the same kind of black and white thinking, the history of dysfunctional relationships, the unstable self-image, etc., and as long as in you they don't manifest with suicide attempts, cutting, and so forth the odds of even you seeing that you have a disorder drop, big time.

It's still dysfunctional, still destructive to your life and those around you (granted, not quite as dysfunctional as directly trying to kill yourself), but much less likely to be identified and treated.

And much harder to measure the treatment outcomes. We can measure, for example - does DBT reduce the number of hospitalizations, suicide attempts, mortality, etc.? Much harder to measure (and is anyone even trying?) does DBT produce greater relationship stability, better work performance, better parenting?

[PDQuick]

"Almost" borderline  personality disorder, "almost" narcissistic personality disorder and "almost" Schizophrenic states can make for very difficult people. There is no question.

However, it's not "much harder" to measure improvements in relationship stability in subclinical BPD than it is in clinical BPD - it is the same.  It's hard to measure in both and clinical studies show that this particialr aspect of the disorder is harder to resolve than suicidal behavior, for example.  Relatively speaking, it is easier to resolve traits in subclinical BPD than it is to resolve traits in clinical BPD, just like it easier to heal a sprain than a compound fracture.

All that said, your point that subclinical can be extremely destructive is true.  I agree.  The DSM-5's point is that it's all a continuum. It is not a unique and special circumstance as it is sometimes portrayed.

[Auspicious]

I guess I wasn't being clear. I wasn't referring to "almost" or subclinical situations. It's possible to have clinical BPD, and not be (just for example) actively suicidal. It's just harder to diagnose.

The core traits of BPD can manifest in different ways, in different people. Some ways are easier to see clinically. Some ways are easier to see outside of close relationships. Some ways can get you - accurately - diagnosed, if you are forthcoming about them to the professional, but not if you aren't.

People can also move between different types of functioning (moving from "high" to "low" is sometimes called "decompensating"). My wife didn't "not have BPD" before she started a string of hospitalizations (and the actions that resulted in them) that got her that diagnosis. She had the same black and white thinking, the history of unstable relationships, the unstable self-image, etc. It just hadn't - yet - resulted in the kind of actions that get you identified and treated.

[bluebutterfly]

my partner has been diagnosed as having bpd personality traits with clusters b and c. Where would he fit into these categories. , does it mean that he doesnt have bpd . Or its just a nicer way to diagnose someone.

[GreenMango]

Bluebutterfly-the new criteria is supposed to be a more thorough look at the disorder and takes into account there is a continuum is severity that may manifest in a variety of behaviors.  Part of the new release trims out some of the other disorders and streamlined the possible diagnoses.  If your partner has the diagnosis now and you are seeing destructive behaviors that is the most pressing issue.

[Surnia]

This is very interesting.

What I do not understand, is that they will reduce the PDs. So what about NPD? If it is so, why? And what are the consequences about this? What do you think?

[SWLSR]

Surnia,

From what I have been told by my therapist, they have still not made all the decision on the DSM V so what I am hearing now can be changed.  I am not sure what is going to happen to NPD but it may be absored into BPD.  What I do know is they are discussing changes as to how to define BPD.  One of the things I have heard is they is going to be a stronger link to BPD and Bi-Polar.  How much of a link and what the details I am not sure.  They is also going to be some kind of disorder that is a mild case of BPD.  And the other thing I am hearing is BPD flair ups this is someone who has been in a bpd remission but has it return.  That is all I know for now but if I hear more I will let you know.

[jdcthunder14]

I think there will be a lot of failings in the revised criteria until the psychiatrists start listening to the families of the BPD. Until they do this, they simply won't get the real picture of what's happening with the BPD. All they are seeing is what presents in their office, or what presents for the studies.

I learned more about the illness from other adult children of a BPD when I found this place around five or six years ago. What shocked me was that one of us would open up a topic about something we thought could never have happened to another human being, and suddenly there would be an outpouring of 'Oh My God!  My BPD mother/father did exactly the same thing.'

It frustrates me that there's no mention of what goes wrong when they have children. The change - and by change I mean deterioration - in my uBPDsister's behaviour after she had children - was something to behold.

I know they're trying, but they've got a long way to go to understand this illness.  They won't get it until they listen to the families.   Too much happens behind closed doors that the BPD's therapists would never DREAM was going on.

I don_

[MWMan]

Is it on a scale of 1-10?

Is 8 and above the truly severe where they hurt themselves physically?

Would a 6 or 7 be where they just get mad weekly at little things and cause issues in the relationship?

I'm wondering how to classify my exgfBPD whom I'm pretty sure is in the middle ground. Not severe, but it impacts her relationships - at least it did ours.

[motherof1yearold]

I have just one simple comment and one simple question:

The comment is, I really wish they would change the name!  It's so misleading and confusing - one more barrier to acceptance by the sufferer.

The question is - and forgive me if this was explained already but I want to make sure I understand - by this system, would it be more likely that treatment would be covered by insurance?

Thanks!

Matt

I really wish they would change the name too! It is VERY misleading and doesn't help people understand or grasp the seriousness of this disorder and how it affects all who come into contact with them.

[truly amazed]

Hi,

Well I look at the new criteria and even the old and scratch my head. BPD and having had a partner who was described by my psychiatrist who is a Uni lecturer and has 30 years in the field as being 8 if not 9 of the old criteria, I always come up short seeing the criteria. Same too having a mother who also is BPD but a milder all be no less destructive form and again I come up short.

Both are unlikely to ever seek help. Both even if they did seek help are high functioning and despite for my ex partner having a very high score, she will always fall through the diagnosed criteria for the simple reason she is not a cutter only one who threatens it.

Whilst I now have zero doubt as does my psychiatrist about the BPD diagnosis in my ex, having been there and not being aware of it until post relationship, if my ex was presented to even very experienced people in the field as a high functioning one I suspect in a blind test about half of them would fail to diagnose or call it a mild impairment at best.

Diagnosis actually comes down to the non BPD's I suspect in many cases vs the actual sufferer in those that are high functioning. The high functioning BPD suffers who will never seek help will like my 80 plus year old mother remain undiagnosed. What actually tipped the scales for even my own psychiatrist was I actually taped a few rage sessions and he listened in rapture and went oh my that is her personality splitting and made comments as the tirade was replayed to him over the course of a 30 minute attack. I didn't really remember my own actions until it was replayed but I didn't swear or abuse or even yell just asked she leave me alone whilst it went from bad to worse.

Unfortunately diagnosis for even very experienced health care professionals at times is impossible. I look at this criteria and even the new one and whilst my ex may have had relationships which have lasted 20 or more years with friends, post relationship with me she shredded those and discarded them at will. They were of course superficial and like me those discarded scratched their heads and wondered what had happened. They like myself were disposable. It may have appeared if asked my ex had long standing relationships but they were are as always sadly disposable. Even friends of such a long time who gave gifts to my ex's children every year for the past 15 years whilst any test might have had them disproving a BPD type personality, they too went out the window of late. How disposable are these people in their lives ? It was of course an enabling relationship they had where it was one sided on the main.

I do wonder after reading the new criteria and my own experiences with BPD what the real percentage of BPD suffers is out there vs those diagnosed ?

Many thanks for the great thread and discussion as always