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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: Diagnosis: DSM-5.0 | Alternate Model for Personality Disorders  (Read 58150 times)
sandpiper
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« Reply #10 on: March 10, 2010, 01:28:16 AM »

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.

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« Reply #11 on: March 10, 2010, 07:57:45 AM »

These are interesting thoughts, SaNPDiper.

Most diseases don't have victims!  Doctors focus on helping their patients, and medical researchers often have that focus too;  you don't examine a family member to figure out what's wrong with someone's leg, or lungs.  You examine the patient.  But for BPD a reasearcher would have to be part doctor and part sociologist - not psychologist - because to understand it fully you have to look at the interactions between family members (or others close to the BPD sufferer), and I think that may be outside the scope of most medical researchers.
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« Reply #12 on: March 10, 2010, 09:42:04 AM »

These are interesting thoughts, SaNPDiper.

Most diseases don't have victims!  Doctors focus on helping their patients, and medical researchers often have that focus too;  you don't examine a family member to figure out what's wrong with someone's leg, or lungs.  You examine the patient.  But for BPD a reasearcher would have to be part doctor and part sociologist - not psychologist - because to understand it fully you have to look at the interactions between family members (or others close to the BPD sufferer), and I think that may be outside the scope of most medical researchers.

That's interesting. I think there are some parallels here with conditions such as schizophrenia (which my Dad has; my mother is uNPD/BPD) where the patient's family can be left in a situation where they are living with a person whose symptoms are too severe for them to cope with. There were phases where my Dad was unable to be an effective parent (although he  never harmed us) and could not be left alone with us as children.

I think there are child protection implications when a parent has any kind of severe mental health condition. I hope the new DSM document recognises that when an adult is diagnosed with a PD, there is a significant risk that their children will be abused and/or neglected. Especially because so many adults with PDs seem to have a sadistic streak.

Annie xoxo
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« Reply #13 on: March 10, 2010, 10:29:28 AM »

Just a small point   smiley

The DSM is published by the American Psychiatric Association.

It provides definitions, symptoms and characteristics for mental disorders that are recognized by clinicians from around the world.  

It's simply a classification system.  The equivalent of "a heart attack is defined as" or "stroke is defined as".  This is really important for research, for example, so that a study of people with BiPolar I disorder at Harvard is looking at the same type of patients that a study of of BiPolar I at UCLA is.  This way the findings can be compared by clinicians and used by future researchers to design more advanced analysis.

The DSM does not discuss diagnostic methods per se', there is no discussion, for example, about the use of the SCIDII questionairre.  The DSM does not discuss treatment, social implications, the impact on families, etc.  All very important things - just not the charter of the DSM.

In this next addition, it appears that they want to simplify things - that maybe the 10 Axis II categories were too hard to work on a practical level - or there was too much overlap - and that appears to be what they have done.
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« Reply #14 on: March 10, 2010, 10:38:20 AM »

The DSM-IV uses, if I remember right, nine criteria for BPD.  It's these criteria that are being discussed here, I think...

That is, the DSM defines disorders according to observable behaviors;  but the current criteria include some that aren't directly observable, but depend on the patients description of his or her feelings, state of mind, etc.  Maybe that's impossible to avoid in this field.

What I think is being suggested here - and I agree with it, I think - is that, as a scientist, the psychologist has access to other information, which may be as reliable, or more so, than the patient's description of his or her behavior and what's going on in their head.  In another scientific field, the scientist would look at any reliable information available to understand the phenomenon.  Because this is a medical field, and there is a strong tradition - and maybe considerations of "ethics" - in the way of the doctor talking openly with family members and others whose inputs might be meaningful - that make it tough for doctors to get it right.
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« Reply #15 on: March 10, 2010, 10:52:46 AM »

Clinical Practices: There is nothing in the DSM that discusses how the information is to be gathered.   There is nothing in the DSM that precludes asking family member, co-workers, or friends.  And depending on the situation and the clinician this is often done.  Family therapy is not uncommon.  Nor are parent meetings with their child's clinician uncommon.  

Research Studies: Most research studies rely on patient surveys to determine the disorder. This is a significant aspect what psychology research - building of reliable diagnostic questionairres.  The questionairres themselves are tested against populations that have been diagnosed by in detail psychoanalysis to determine there accuracy.  Eventually, they find the right questions that can accurately reproduce what an detailed patient analysis can do (more or less).

This is why it is called the Diagnostic and Statistical Manual.  

Hope this helps  smiley
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« Reply #16 on: March 10, 2010, 11:01:26 AM »

There's nothing in the DSM preventing doctors from gathering information in a variety of ways.  My (minimal) observation suggests that there are traditions and role-definitions that can interfere with it though.  (So that's outside the scope of the DSM discussion per se, but related because the DSM definitions are in terms of behaviors which aren't entirely observable from testing or talking with the patient alone.)

Example:  The therapist views her role as helping the patient.  A diagnosis of BPD may not be in the patient's interest, because the patient is likely to reject the diagnosis and cease therapy.  So the therapist avoids objective testing and looks for ways to help the patient without fully understanding the disorder.  Meantime, family members are hurt by the patient's behavior, but have nothing solid to use to change the family situation - no diagnosis or clear input from the therapist.  By defining her role as "helping the patient" not "helping the kids" or "helping the family", the scientist comes to a different, or a more vague, conclusion and takes actions which may be less effective.  (This is a real example, by the way, not made up.)

I'm not condemning the DSM or saying it should be different - I really don't know - only building on some of the comments here that somehow the way BPD is diagnosed just simply doesn't always work in the real world.
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« Reply #17 on: March 15, 2010, 11:18:36 PM »

Great points raised by all-

I was told recently by a psycho analyst that they were considering changing the name from borderline to "emotional affect regulatory disorder" It's a mouthful but it is certainly more descriptive than "Borderline". I find it frightening that they are telling doctoral candidates( at least a few here in California ) to not code anyone as Axis II not only because of the potential stigma but because insurance won't pay for treatment. This throws the whole data collection  process and resulting statistics ( you know, 2-4% borderlines.3-5 % narcisssists,etc..)out the window. Without proper stats,we will never know the true scope of the problem. As many of you probably know or suspect , there are a lot more Axis II sufferers amongst us than the literature would have us believe and...no..I'm not paranoid  smiley       
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« Reply #18 on: May 03, 2010, 12:56:32 PM »

By defining her role as "helping the patient" not "helping the kids" or "helping the family", the scientist comes to a different, or a more vague, conclusion and takes actions which may be less effective.

The latest trend in BPD treatment is to involve the family more and more.  The NEA-BPD Family Connections program is all about treating the BPD family and the BPD environment.
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Randi Kreger
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« Reply #19 on: May 04, 2010, 06:49:24 AM »

Great points raised by all-I was told recently by a psycho analyst that they were considering changing the name from borderline to "emotional affect regulatory disorder" I find it frightening that they are telling doctoral candidates( at least a few here in California ) to not code anyone as Axis II not only because of the potential stigma but because insurance won't pay for treatment. This throws the whole data collection  process and resulting statistics ( you know, 2-4% borderlines.3-5 % narcisssists,etc..)out the window.  

Strangely, I have heard no wails from the typical people about the fact the name wasn't changed. I think people were too happy and the axis l and ll merger and the new stats.But I disagree with the popular new name propositions that stress emotional dysregulation.  It would make it even harder for average folks to understand the difference between bipolar and BPD and that comes up in so many interviews I do. If we picked just one BPD trait it could just as well be identity disorder or fear of abandonment disorder.The latest figures that raised the percentage of BPs from 2% to 5.9% were done by looking at large scale surveys, not hospital data. But the figures about BPD as a percentage of outpatients and inpatients ARE affected. Once wonders.Randi KregerAuthor, "The Essential Family Guide to Borderline Personality Disorder "
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