Home page of BPDFamily.com, online relationship supportMember registration here
November 15, 2018, 12:50:52 AM *
Welcome, Guest. Please login or register.

Login with username, password and session length
Board Admins: Harley Quinn, Harri, Once Removed, Radcliffwendydarling
Senior Ambassadors: Flourdust, Mutt, Turkish, Woolspinner2000
Ambassadors: BeagleGirl, bluek9, Cat Familiar, CryWolf, Enabler, Feeling Better, formflier, Insom, JNChell, Merlot, Mustbeabetterway, RolandOfEld, spero, zachira
  Help!   Groups   Please Donate Login to Post New?--Register to post Here  
PSYCHOLOGY: Help us build this database.
26
Pages: 1 [2] 3  All   Go Down
  Print  
Author Topic: DIAGNOSIS: DSM-5.0 | Alternate Model for Personality Disorders  (Read 6460 times)
Indigo Sky
******
Offline Offline

Gender: Male
Posts: 848


« Reply #25 on: July 09, 2010, 06:15:34 AM »

I am having hard time understanding the new designations (etc) and I am a bit of a slow learner as well, but I was wondering, is there any way the changes could effect funding for people who need help? Is there a chance that this is change can be used to cut back funding or coverage to others who suffer from not just BPD but other disorders?

Is this a good thing or a bad thing regarding the changes. Is this like a con man who uses misdirection. Yes we may think it is a good thing but latter find out otherwise.

I guess I have always been a sceptic when ever these things happen. I remember when they said regulating the electrical industry would reduce costs, my first reaction was laughter, add in a middle man and the costs go down...the laughter lasted until the power bills arrived...

Could the changes effect the amount of money be put aside for research?

I have limited experience as being part of a union executive (lower position thank goodness) and was always shocked how we would go over management changes reguested at bargining, try and look at all future impacts and fail to miss at how management used those changes in the future, it was really quite scary.

Logged


UKannie
*******
Offline Offline

Gender: Female
Person in your life: Parent
Posts: 1029


« Reply #26 on: July 09, 2010, 10:22:37 AM »

Is this a good thing or a bad thing regarding the changes. Is this like a con man who uses misdirection. Yes we may think it is a good thing but latter find out otherwise.

I guess I have always been a sceptic when ever these things happen

Yeah I'm inclined to think the same way. What's in it for the drug companies when disorders get re-classified? What's in it for medical practitioners and therapists? What about medical textbooks and self-help books, I guess they make money out of publishing a whole new edition with updated diagnostic criteria.

Am I correct in interpreting that the changes are leaning in the general direction towards BPD being viewed as a spectrum disorder? If so, that's interesting because my experience is that these individuals slide up and down the scale constantly, and assume aspects of other personality disorders as and when it suits them. How do you even begin to diagnose someone who constantly varies in severity and type of symptoms?

My own feeling is that they should be graded according to their level of toxicity   A bit like radioactive material.

Sorry, just thinking aloud. Hope I'm not being inappropriate or OT

Annie
Logged
Skip
Site Director
***
Offline Offline

Person in your life: Ex-romantic partner
Posts: 7923


« Reply #27 on: July 10, 2010, 03:04:22 PM »

Am I correct in interpreting that the changes are leaning in the general direction towards BPD being viewed as a spectrum disorder? If so, that's interesting because my experience is that these individuals slide up and down the scale constantly, and assume aspects of other personality disorders as and when it suits them. How do you even begin to diagnose someone who constantly varies in severity and type of symptoms?

They are suggesting that there is a spectrum of severity of the traits and defining, at some level, what is severe enogh to be a clinical disorder vs "borderline leanings","style", etc.

In its current iteration, ratings from three assessments combine to comprise the essential criteria for a personality disorder:

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

(2)  A rating of

  • a “good match” or “very good match” to a Personality Disorder Type (see BPD type


    - or -

  • “quite a bit” or “extremely” descriptive on one or more of six Personality Trait Domains


(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.
Logged

Randi Kreger
DSA Recipient
*****
Offline Offline

Gender: Female
Person in your life: Parent
Posts: 620

Author of the 'Essential Family Guide to BPD"


« Reply #28 on: July 10, 2010, 03:11:21 PM »

Yeah I'm inclined to think the same way. What's in it for the drug companies when disorders get re-classified? What's in it for medical practitioners and therapists? What about medical textbooks and self-help books, I guess they make money out of publishing a whole new edition with updated diagnostic criteria.

1, No effect for drug companies. No drugs have ever even been tested on people with PDs. All drugs are given off-label.2. With fewer PDs and the addition of a way to "measure" the traits, it should be easier for practitioners to diagnose.3. An update for the DSM is LONG overdue. These days everything is going e-book.
Logged
Indigo Sky
******
Offline Offline

Gender: Male
Posts: 848


« Reply #29 on: July 11, 2010, 12:42:35 AM »

Excerpt
No effect for drug companies. No drugs have ever even been tested on people with PDs. All drugs are given off-label

Randi, IF there were drugs available for PD's right now, would this change benefit them? It sounds like there is a lot of research going on, they are tieing the PD's to the brain not functioning correctly, so if they come up with a drug in the future, does this change benefit the drug companies? Or is there a potential benefit?
Logged
Auspicious
Retired Staff
*
Offline Offline

Gender: Male
Posts: 8447



« Reply #30 on: July 11, 2010, 05:51:35 AM »

Excerpt
No effect for drug companies. No drugs have ever even been tested on people with PDs. All drugs are given off-label

Randi, IF there were drugs available for PD's right now, would this change benefit them? It sounds like there is a lot of research going on, they are tieing the PD's to the brain not functioning correctly, so if they come up with a drug in the future, does this change benefit the drug companies? Or is there a potential benefit?

I would gladly make some drug company very rich if they came up with an effective drug treatment for BPD. They would deserve to be rich.
Logged

Have you read the Lessons?
Skip
Site Director
***
Offline Offline

Person in your life: Ex-romantic partner
Posts: 7923


« Reply #31 on: July 11, 2010, 08:08:14 AM »

there has been talk of eliminating the category as the psychiatrists behind the DSM are trying to knock down 10 PDs into 5.

This is the current list of 6.  

Antisocial/Psychopathic Type

Avoidant Type

Borderline Type

Narcissistic Type

Obsessive-Compulsive Type

Schizotypal Type

Severe PD types, such as schizotypal and borderline, have been found to have significantly more impairment at work, in social relationships, and at leisure than patients with less severe types, such as obsessive-compulsive disorder, or with major depressive disorder in the absence of personality disorder.

And they plan to define all of these using constellations of these 6 criteria:

  • Negative Emotionality: Experiences a wide range of negative emotions (e.g., anxiety, depression, guilt/ shame, worry, etc.), and the behavioral and interpersonal manifestations of those experiences

    Trait facets:  Emotional lability, anxiousness, submissiveness, separation insecurity, pessimism, low self-esteem, guilt/ shame, self-harm, depressivity, suspiciousness


  • Introversion: Withdrawal from other people, ranging from intimate relationships to the world at large; restricted affective experience and expression; limited hedonic capacity

    Trait facets:  Social withdrawal, social detachment, restricted affectivity, anhedonia, intimacy avoidance


  • Antagonism: Exhibits diverse manifestations of antipathy toward others, and a correspondingly exaggerated sense of self-importance

    Trait facets:  Callousness, manipulativeness, narcissism, histrionism, hostility, aggression, oppositionality, deceitfulness


  • Disinhibition: Diverse manifestations of being present- (vs. future- or past-) oriented, so that behavior is driven by current internal and external stimuli, rather than by past learning and consideration of future consequences

    Trait facets:  Impulsivity, distractibility, recklessness, irresponsibility


  • Compulsivity: The tendency to think and act according to a narrowly defined and unchanging ideal, and the expectation that this ideal  should be adhered to by everyone

    Trait facets:  Perfectionism, perseveration, rigidity, orderliness, risk aversion


  • Schizotypy: Exhibits a range of odd or unusual behaviors and cognitions, including both process (e.g., perception) and content (e.g., beliefs)

    Trait facets:  Unusual perceptions, unusual beliefs, eccentricity, cognitive dysregulation, dissociation proneness


The other PDs will be in a general category - Paranoid Personality Disorder, Schizoid Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder, Dependent Personality Disorder
Logged

Blossom
****
Offline Offline

Posts: 253


« Reply #32 on: July 11, 2010, 09:41:06 AM »

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.

I'm new to this thread, but finding it interesting. Thoughts like that above though, do concern me. Like UKannie, my father has schizophrenia; my husband has BPD. I would hate to see this raised as a child protection issue though; it undermines nons and would put an immense stress and pressure on families that are already trying to do their best to avoid stress and pressure. Of course growing up with a mentally ill parent is different to having two 'normal' parents, but that doesn't warrant interference from social services where there is no indication of abuse other than the 'possibility' presented by a mental illness; it feels like a slippery slope.
Logged
Skip
Site Director
***
Offline Offline

Person in your life: Ex-romantic partner
Posts: 7923


« Reply #33 on: October 18, 2010, 01:43:04 AM »

The underlying research on this work can be found here:

Research led by Michigan State University psychologist Christopher Hopwood proposes a new way to classify personality disorders.

EAST LANSING, Mich. — Research led by a Michigan State University psychologist is playing a key role in the effort to change the way mental health clinicians classify personality disorders. The study by Christopher Hopwood and colleagues calls for a more scientific and practical method of categorizing personality disorders – a proposal that ultimately could improve treatment, Hopwood said.  Hopwood and colleagues propose a new three-stage strategy for diagnosing personality disorders:

  • Stage One: Consider a patient's normal personality traits, such as introversion/extroversion. "If a person is depressed and I'm a clinician, it might make a difference if I think they're extroverted depressive rather than introverted depressive," Hopwood said. "It may dictate the type of recommendations I make for them." These normal personality traits also may indicate patient strengths that could help in overcoming psychiatric difficulties; such strengths are not assessed in the current DSM.


  • Stage Two: Create a numerical score to represent severity of the disorder. "We're arguing that one single score can represent that severity, so clinicians can easily communicate with one another about how severe a patient is," Hopwood said. "That may indicate decisions such as whether this person should be hospitalized or treated with outpatient care."


  • Stage Three: Condense the list of 10 personality disorder categories to five dimensional ratings. Under this proposal, clinicians would diagnose how many symptoms of each disorder a patient has, rather than whether they have one or more of 10 disorders as in the current system. Hopwood said this is more reliable, valid and specific than the current system. He added that research has not sufficiently supported the validity of several current personality disorders. The proposed dimensional ratings are:

    Peculiarity. The defining characteristic here is oddness in thought or behavior. This dimension includes the diagnoses of paranoid, schizotypal and schizoid.

    Withdrawal. This includes avoidant personalities. "This may have to do with not wanting to leave the house," Hopwood said.

    Fearfulness. This combines disorders with opposite extremes of harm avoidance, such as antisocial (which involves fearlessness) and dependant or avoidant (which involves fearfulness).

    Unstable. This is similar to the diagnosis of borderline in DSM-IV. The defining characteristic is instability, such as with relationships, identity or emotional experience.

    Deliberate. This includes obsessive-compulsive disorder and other disorders defined by overly methodical behavior. "It's having a rigid sense of how life should happen – how I should behave and how other people should behave," Hopwood said.


"We're proposing a different way of thinking about personality and personality disorders," said Hopwood, MSU assistant professor of psychology and an experienced clinician. "There's widespread agreement among personality disorder researchers that the current way to conceptualize personality disorders is not working."

The study is being cited by the team of experts that currently is developing criteria for the manual used to diagnose personality disorders – the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, slated to come out in 2013.

The study is being considered for inclusion in the DSM-5. The DSM, published by the American Psychiatric Association, is considered the bible of the U.S. mental health industry and is used by insurance companies as the basis for treatment approval and payment. The study also will appear in an upcoming issue of the Journal of Personality Disorders.

The current method of classifying personality disorders, as spelled out in the fourth edition of the DSM, or DSM-IV, breaks personality disorders into 10 categories, Hopwood said. That system is flawed, he said, because it does not take into account severity of personality disorders in an efficient manner and often leads to overlapping diagnoses.

"It's just not true that there are 10 types of personalities disorders, and that they're all categorical – that you either have this personality disorder or you don't," Hopwood said. "Scientifically, it's just not true."

Ultimately, Hopwood said, the proposal could improve both the system for diagnosing personality disorders as well as the outcome. "Presumably, if this leads to better clinical efficiency it could lead to better clinical care, and that's in everybody's interest," he said.



Co-authors of the proposal include Andrew Skodol of the Sunbelt Collaborative, New York State Psychiatric Institute and Columbia Medical School, and Leslie Morey of Texas A&M University.


Skodol is chairperson and Morey is a member of the committee that will determine the criteria for diagnosing personality disorders in the upcoming DSM.[/size]
Logged

PotentiallyKevin
Formerly "Mobocracy"
*****
Offline Offline

Gender: Male
Posts: 663


WWW
« Reply #34 on: October 18, 2010, 05:13:32 PM »

"Stage One: Consider a patient's normal personality traits, such as introversion/extroversion. "If a person is depressed and I'm a clinician, it might make a difference if I think they're extroverted depressive rather than introverted depressive," Hopwood said. "It may dictate the type of recommendations I make for them." These normal personality traits also may indicate patient strengths that could help in overcoming psychiatric difficulties; such strengths are not assessed in the current DSM."

I  absolutely agree with this, personality definitely needs to be taken into consideration. We, as individuals, have different priorities, strengths and weaknesses that are innate and unique to our personality types. It is just not logical to treat an extrovert with depression the same way you treat an introvert with depression - their triggers and responses are usually opposite.

Stage two makes sense as well, but stage three is confusing...
Logged

po·ten·tial  adj.
1. Capable of being but not yet in existence; latent: a potential greatness.
2. Having possibility, capability, or power.
3. The inherent ability or capacity for growth, development, or coming into being.
4. Something possessing the capacity for growth or development.
Skip
Site Director
***
Offline Offline

Person in your life: Ex-romantic partner
Posts: 7923


« Reply #35 on: November 02, 2010, 03:10:14 PM »

DSM-5 Field Trials Begin: Proposed Diagnostic Criteria Put to the Test

October 19, 2010 — The American Psychiatric Association (APA) has announced that standardized field trials have now started in preparation for the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The trials were created to assess the practical use of proposed DSM-5 diagnostic criteria in real-world clinical settings before the manual is published in 2013.

Dr. David Kupfer

"The process for developing DSM-5 continues to be deliberative, thoughtful, and inclusive," said Darrel Regier, MD, MPH, vice chair of the DSM-5 Task Force and APA research director, in a release.

"Large-scale field trials are the next critical phase in this important process and will give us the information we need to ensure the diagnostic criteria are both useful and accurate," he added.

More than 8000 comments by clinicians, researchers, and advocates submitted on the DSM-5 Website regarding the draft criteria were reviewed by the DSM-5 Work Groups. The new field trials will reflect criteria adjustments based on these comments — and will have 2 separate study designs, depending on type of clinical setting.

Although all field trial clinicians will assess new and existing patients at different stages of treatment using the proposed DSM-5 diagnostic criteria and measures, academic and other large clinical settings will use one design, whereas individual practitioners and smaller clinical practices will follow the other.

"It is important that the proposed criteria are subjected to rigorous and empirically sound field trials," David Kupfer, MD, chair of the DSM-5 Task Force, said in the same release. "The 2 field trial designs will allow us to better understand how the proposed revisions affect clinicians' practices and, most importantly, patient care."

11 Large Centers

Of approximately 60 academic or large centers that responded to the APA's call for proposal, 11 pediatric and adult sites were selected. These include the following:

   * Baystate Medical Center in Springfield, Massachusetts;

   * Child Psychiatry Division, Columbia University/New York State Psychiatric Institute in New York City;

   * Lucile Packard Children's Hospital at Stanford University in Palo Alto, California;

   * The Children's Hospital in Aurora, Colorado;

   * Centre for Addiction and Mental Health in Toronto, Ontario, Canada;

   * Dallas Veterans Affairs Medical Center in Texas;

   * DeBakey Veterans Affairs Medical Center and Menniger Clinic, Baylor College of Medicine in Houston, Texas;

   * Mayo Clinic in Rochester, Minnesota;

   * University of California, Los Angeles;

   * University of Pennsylvania in Philadelphia; and

   * University of Texas Health Science Center in San Antonio

Field trial patient evaluations in these settings will start with a baseline assessment by a clinician followed by a second assessment 4 hours to 2 weeks later by a different clinicianto test the reliability of the proposed diagnostic criteria. At 4- to 12-week follow-up, the assessment will be repeated.

Clinicians in these larger settings will also be allowed to conduct videotaped evaluations for a small subset of patients.

In an article published in the October 15 issue of Psychiatric News, Dr. Kupfer writes that it is important that draft criteria are examined in sizable, diverse populations.

"These large settings provide an ideal backdrop for recruiting high volumes of psychiatric patients who represent a wide array of characteristics, including various ages, cultures and ethnicities, socioeconomic backgrounds, and potential diagnoses," he adds.

It is estimated that 2500 to 3000 patients will be recruited to participate in this setting.

Smaller Settings

A total of 3900 mental health professionals, including 1400 psychiatrists from a randomly selected sample of those registered with the American Medical Association Masterfile and 2500 volunteer clinicians (including psychiatrists, psychologists, social workers, and nurses), will participate in the field trials scheduled to be conducted in smaller, routine clinical settings.

Recruitment for these smaller settings will continue through October and November. Those selected will need to complete Web-based training before participating and will then recruit and evaluate 2 patients each.

"Having practitioners, such as solo clinicians and those in independent group practices, test proposed revisions is important for examining DSM-5 in the context of its everyday use," writes Dr. Kupfer.

The main difference between the 2 study designs is that the routine clinical settings will use just 2 evaluation visits for patients compared with 3 for the larger institutions.

"Although the use of 2 field-trial designs increases the complexity of this project, the tradeoff is a more precise understanding of how the future of psychiatric diagnosis might impact patients and clinicians," Dr. Kupfer adds.

Evaluation Measures

The DSM-5 Task Force reports that results from all field trials will address several important measures regarding the diagnostic criteria, including the following:

   * Feasibility: are the proposed criteria easy for clinicians to understand and use?

   * Clinical utility: do they help in describing psychiatric problems and in making treatment plan decisions?

   * Validity: how accurate are they in reflecting the mental disorders they are designed to describe? and

   * Reliability: are the same conclusions reached when the criteria are used by different doctors?

Severity measures, through the use of questionnaires and other tools to help assess patient symptom severity on a rating scale, will also be examined during the field trials, as will "cross-cutting dimensional measures." These are tools for "assessing symptoms that occur across a wide range of diagnoses, such as anxiety or sleep problems."

This first phase of field trials is scheduled to run through the end of March 2011, after which the results will be presented in scientific meeting presentations and in articles in scientific journals and DSM-5 source books.

After these initial field trials, another period of public comments through the DSM-5 Website, and more draft criteria adjustments by the Work Groups, a second set of field trials is scheduled to take place later in 2011 and in 2012.

Logged



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).

Totoro13
**
Offline Offline

Gender: Female
Posts: 87


« Reply #36 on: November 02, 2010, 03:27:31 PM »

"Stage One: Consider a patient's normal personality traits, such as introversion/extroversion. "If a person is depressed and I'm a clinician, it might make a difference if I think they're extroverted depressive rather than introverted depressive," Hopwood said. "It may dictate the type of recommendations I make for them." These normal personality traits also may indicate patient strengths that could help in overcoming psychiatric difficulties; such strengths are not assessed in the current DSM."

I  absolutely agree with this, personality definitely needs to be taken into consideration. We, as individuals, have different priorities, strengths and weaknesses that are innate and unique to our personality types. It is just not logical to treat an extrovert with depression the same way you treat an introvert with depression - their triggers and responses are usually opposite.

Stage two makes sense as well, but stage three is confusing...

Stage 3 sounds interesting...  It seems to be focusing on the behaviors instead of a label.  When looking at some of the PDs I think my ex has, there are many overlaps and that made it difficult for me to decided exactly which PD best fits him. 
Logged
RowJimmy
**
Offline Offline

Gender: Male
Posts: 89


« Reply #37 on: November 02, 2010, 04:38:04 PM »

If I could just throw my layman's 2 cents in here. 

It seems to me that the biggest problem we have today is that psychiatrists and psychotherapists are unable, and/or unwilling to make a diagnosis of BPD today, in part because 1) it is extremely difficult to make such a diagnosis with the current DSM criteria, and 2) because of the stigma attached with the term "Borderline Personality Disorder."

The new criteria listed in the OP seem to be even more confusing and tend to leave out what I have come to understand as some of the defining and distinctive behavior patterns, such as splitting, mirroring, projection, tendency to abuse those in close relationships, etc.  What is desperately needed by both BPD's and their loved ones, is EASIER diagnosis, not more complex.

My concern is that no only is the name not changing, but it is now going to be even HARDER to diagnose, which is going to lead to a lot more people coming on her with undiagnosed loved ones than there already is.  It has been noted that there are more people with BPD than bipolar and schizophrenia combined, yet psychiatrists seem to diagnose Bipolar like they are giving out candy while ignoring BPD for the most part.  And because recovery rates have been reported as fairly good with techniques like DBT, I think it is critical that the psychiatric community both make an effort to remove the stigma associated with the word borderline AND make diagnosis simpler and NOT more complex. 

Mistakes are inevitable, but my feeling is that it is much better to err on the side of the disease that afflicts more people.  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.
Logged
ThursdayNext
******
Offline Offline

Gender: Female
Posts: 869



WWW
« Reply #38 on: November 25, 2010, 05:25:33 PM »

Have to say I think I agree with RowJimmy, that more pwPDs are likely to slip through the diagnostic net with this.

I think my (appearance of) high-functioning uNPD father would be hard to diagnose under the current criteria and there is no way he would score sufficiently highly using the new diagnostic criteria. Yet just from description of his behaviour and listening to a letter from him that I read aloud, my T was able to say, 'I think your father has NPD'. (I'd already worked that out through internet diagnosis!)

My point is that with the new criteria I think that both families and patients are possibily disadvantaged - patients because there are more who will not 'fit the criteria' sufficiently for diagnosis and families because their pwPD is 'missed'. I've seen this happen in the education system when they change criteria and it's almost always related to funding - they want to cut funding for support, so the criteria are made more general or changed so that fewer can be identified as needing the funding/support. Result: less treatment, not more.

Nothing we can do about it, of course, but I am seriously concerned.
Logged

Give sorrow words; the grief that does not speak whispers the o'er-fraught heart and bids it break.  ~William Shakespeare
Skip
Site Director
***
Offline Offline

Person in your life: Ex-romantic partner
Posts: 7923


« Reply #39 on: July 20, 2011, 10:49:49 AM »

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.
Logged

jak33
***
Offline Offline

Gender: Female
Posts: 100


« Reply #40 on: July 20, 2011, 12:34:04 PM »

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.
Logged
jak33
***
Offline Offline

Gender: Female
Posts: 100


« Reply #41 on: July 20, 2011, 01:18:11 PM »

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.
Logged
iluminati
********
Offline Offline

Gender: Male
Person in your life: Ex-romantic partner
Posts: 1546



WWW
« Reply #42 on: March 14, 2012, 06:45:35 PM »

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.
Logged

He causes his sun to rise on the evil and the good, and sends rain on the righteous and the unrighteous.~ Matthew 5:45
qcarolr
Distinguished Member
*
Offline Offline

Gender: Female
Person in your life: Child
Posts: 4930



WWW
« Reply #43 on: March 21, 2012, 10:26:13 PM »

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
Logged

The best criticism of the bad is the practice of the better. (Dom Helder)
victim15
**
Offline Offline

Posts: 67


« Reply #44 on: April 18, 2012, 03:07:24 AM »

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...
Logged
RefugeeFromOz
***
Offline Offline

Gender: Male
Posts: 171


« Reply #45 on: April 19, 2012, 07:03:11 AM »

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.
Logged


PDQuick
Retired Staff
*
Offline Offline

Gender: Male
Person in your life: Ex-romantic partner
Posts: 5746


Don't look outside for the answers within.


« Reply #46 on: April 19, 2012, 10:04:08 AM »

Summing it up...

Good comments, all.  Smiling (click to insert in post)

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.
« Last Edit: April 19, 2012, 10:16:48 AM by PDQuick » Logged


Auspicious
Retired Staff
*
Offline Offline

Gender: Male
Posts: 8447



« Reply #47 on: April 19, 2012, 10:17:56 AM »

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

Yeah, but ... Smiling (click to insert in post)

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?
Logged

Have you read the Lessons?
PDQuick
Retired Staff
*
Offline Offline

Gender: Male
Person in your life: Ex-romantic partner
Posts: 5746


Don't look outside for the answers within.


« Reply #48 on: April 19, 2012, 11:05:01 AM »

"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.
Logged


Auspicious
Retired Staff
*
Offline Offline

Gender: Male
Posts: 8447



« Reply #49 on: April 19, 2012, 11:15:05 AM »

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.
Logged

Have you read the Lessons?
Links and Information
CLINICAL INFORMATION
The Big Picture
5 Dimensions of Personality
BPD? How can I know?
Get Someone into Therapy
Treatment of BPD
Full Clinical Definition
Top 50 Questions

EDITORIAL DEPARTMENTS
My Child has BPD
My Parent/Sibling has BPD
My Significant Other has BPD
Recovering a Breakup
My Failing Romance
Endorsed Books
Archived Articles

RELATIONSHIP TOOLS
How to Stop Reacting
Ending Cycle of Conflict
Listen with Empathy
Don't Be Invalidating
Values and Boundaries
On-Line CBT Program
>> More Tools

MESSAGEBOARD GENERAL
Membership Eligibility
Messageboard Guidelines
Directory
Suicidal Ideation
Domestic Violence
ABOUT US
Mission
Policy and Disclaimers
Professional Endorsements
Wikipedia
Facebook

BPDFamily.org

Your Account
Settings

Moderation Appeal
Become a Sponsor
Sponsorship Account


Pages: 1 [2] 3  All   Go Up
  Print  
 
Jump to:  

Powered by MySQL Powered by PHP Powered by SMF 1.1.21 | SMF © 2006-2018, Simple Machines Valid XHTML 1.0! Valid CSS!