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Author Topic: Diagnosis: DSM-5.0 | Alternate Model for Personality Disorders  (Read 60167 times)

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« Reply #50 on: June 24, 2012, 07:54:38 PM »

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.

stay happy!

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« Reply #51 on: June 25, 2012, 01:04:03 PM »

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.


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« Reply #52 on: June 26, 2012, 04:42:11 AM »

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?


“Don’t shrink. Don’t puff up. Stand on your sacred ground.”  Brené Brown
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« Reply #53 on: July 12, 2012, 10:22:29 AM »


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.

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« Reply #54 on: October 02, 2012, 10:27:14 PM »

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.
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« Reply #55 on: October 29, 2012, 01:36:24 PM »

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?



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
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« Reply #56 on: October 29, 2012, 04:40:11 PM »


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   

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« Reply #57 on: October 29, 2012, 11:13:51 PM »

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.

The new scale is a 0 to 4.  0 being healthy and 4 severly impaired.  There needs to be at least a 2 in one from each category of criteria Self (identity or self direction) and Interpersonal (intimacy or empathy) along with the other factors listed impulsivity, hostility, mood lability, etc for clinical diagnosis with a longstanding pervasive pattern.  The more severe the more likely the behavior is to affect a larger number of relationships and to see more severe emotional reactions outside of just romantic/family...like work or acquaintances.

It could be a weekly thing, it could be monthly, daily.  It probably depends on if the person is triggered and by whom.  If you see an impaired relationships pattern because of the behavior its a pretty good indication that there is an impairment but it may not be a 2.

Most of the members partners don't qualify for clinical diagnosis but have traits.  These traits can still make the relationship very difficult with a lot of conflict.

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« Reply #58 on: December 02, 2012, 06:39:06 AM »

DSM-5 Wins APA Board Approval

Published: December 01, 2012

The American Psychiatric Association's board of trustees has approved the fifth edition of its influential diagnostic manual, named DSM-5.0, the group announced Saturday.

The board vote is the last step before the manual is formally released at the APA's annual meeting next May. The association's Diagnostic and Statistical Manual of Mental Disorders was last revised in 1994; that edition is known colloquially as DSM-IV.

According to an APA statement, changes include an end to the system of "axes" used to class diagnoses into broad groups, and an associated restructuring of diagnostic groups to bring disorders thought to be biologically related under the same headings.

Also, many of the diagnostic criteria will now include so-called dimensional assessments to indicate severity of symptoms.

Specific language in DSM-5 was not immediately released, and probably won't be until the formal unveiling in May. Detailed criteria that had been published on the APA's DSM5.org website for public review and comment have now been removed.

However, the statement released Saturday indicated that the manual will include many of the most controversial of the proposed changes from DSM-IV.

They included removal of the "bereavement exclusion" in the major depression section. In DSM-IV, a diagnosis of depression could not be made in patients who had suffered the death of a loved one until two months had elapsed. Under DSM-5, such patients may be called clinically depressed sooner, although the criteria will include advice to clinicians about distinguishing normal grief from depression that should be treated.

DSM-5 will also add a diagnosis of "disruptive mood dysregulation disorder" for children older than 6 who show frequent bursts of anger along with chronic irritability.

In fact, it appeared from the statement announcing the approval that most of the changes from DSM-IV discussed at the APA's 2012 meeting were ratified by the board.

One outside interest group lost no time in reacting to the APA's announcement.

In a statement issued barely an hour after the APA's release, the chief science officer for Autism Speaks, Geraldine Dawson, PhD, said the group remained "concerned about the impact of the new DSM-5 criteria when they are used in real world settings. The field trials are somewhat reassuring that the criteria are working well, but these trials are based on a relatively small number of children. We still have very little information about the impact of the DSM-5 on diagnosis of autism spectrum disorder in young children and adults."

Dawson said the group believes it is "crucial" that diagnosis and access to services be monitored once DSM-5 is in use. "We want to make sure that no one is excluded from obtaining a diagnosis and accessing services who needs them."

In fact, some of the changes proposed for DSM-5 would loosen the criteria, as the head of the APA's work group on autism spectrum disorders explained at the 2012 APA meeting.

Susan Swedo, MD, of the National Institute of Mental Health, noted that the work group was seeking to drop an age-based exclusion in the DSM-IV criteria.

The other major change proposed for DSM-5 was a reorganization that would collapse a number of autism-related conditions treated as separate disorders in DSM-IV into a single "autism spectrum disorder" category.

Those changes were blasted by some in the autism advocacy community, but Swedo argued that the criticisms were unfounded.

In announcing the APA board's action, James H. Scully, MD, medical director and chief executive officer of APA, said, "At every step of development, we have worked to make the process as open and independent as possible. The level of transparency we have strived for is not seen in any other area of medicine."

The group also noted that more than 160 clinicians and researchers had worked to develop DSM-5, with help from hundreds of other clinical investigators as well as thousands of comments from health professionals and the general public offered during open-comment periods.

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« Reply #59 on: December 03, 2012, 04:36:41 PM »

Personality disorder revamp ends in 'horrible waste'

A planned overhaul of the way in which personality disorders are diagnosed will not now appear in the manual dubbed "the bible of psychiatry".

The failure to agree a workable system for the next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, known as DSM-5 is bad news for people with serious personality difficulties, who are frequently misdiagnosed.

"It's a horrible wasted opportunity," says Jonathan Shedler of the University of Colorado School of Medicine in Denver, one of the fiercest critics of the rejected new system.

Personality disorders revolve around difficulties in relating to other people, but can manifest in different ways. Experts agree that the system in the current DSM, which dates from 1994, is seriously flawed. It features a bewildering set of symptoms and checklists that attempts to match patients to one of 10 disorders.

Symptoms, not cause

The problem is that patients may end up being diagnosed with several disorders at the same time, while others with seriously disturbed personalities don't clearly meet any of the diagnoses. Add this confusion to the commonly held but outdated view that personality disorders can't be treated, and many patients never get the help they need.

Rather than receiving intensive psychotherapy, which can be effective, patients with personality disorders often get treated for the anxiety and depression that can be triggered by their difficulties with social interaction. Others get misdiagnosed as suffering from attention-deficit hyperactivity disorder or even post-traumatic stress disorder.

"They go from therapist to therapist and don't get any help," says Valerie Porr, president of the non-profit organisation Treatment and Research Advancements Association for Personality Disorder in New York City.

Five traits

The DSM-5 personality disorders work group developed a system that recognised that personalities don't come in black and white, but instead operate in shades of grey. It proposed two scales of "personality functioning" based on people's interpersonal interactions and sense of self, and said that patients should also be rated for five pathological personality traits, including antagonism and impulsivity.

The proposed system got even more complicated when the task force overseeing the entire DSM-5 revision asked the group to try and map the existing disorders onto the new framework – which was done for six of the 10 disorders.

The resulting hybrid was criticised for being too complex for use by busy doctors, and was given the thumbs down by two expert committees, asked to review the scientific basis and clinical value of all of the DSM-5 proposals.

As a result, when the APA's Board of Trustees on Saturday approved what should go into the final volume, due to be published in May 2013, the section on personality disorders was the main casualty. The board backed a recommendation to exclude it from the main text and instead publish it in a section describing diagnoses requiring further study.

Andrew Skodol of the University of Arizona in Tucson, who headed the work group responsible for the proposal, hopes that it may be shifted into the main DSM text after further research. "It's already being studied and ultimately I have faith the people will see its scientific soundness and clinical utility," he says.

Top priority

David Kupfer of the University of Pittsburgh, who chairs the APA task force overseeing the development of DSM-5, says that further research to test the value of the new proposals will be top priority: "We really want them to be high on the agenda."

However, the main focus of attention will now shift to a group headed by Peter Tyrer of Imperial College London, which is working on a new system of diagnosing personality disorders for the next edition of the World Health Organization's International Classification of Diseases (ICD), due out in 2015. Although it holds less sway over psychiatry, particularly in the US, than the DSM, the ICD is the main system used for medical diagnosis across the globe.

Tyrer's group has also devised a system that rates the scale of patients' personality problems – but its proposal is simpler. It is based on a four-point scale rating people's problems relating to others, running from "personality difficulties" through mild, moderate and severe personality disorder.

This would be supported by ratings for "domains" of personality, linked to extremes on four of the "big five" personality traits recognised by psychologists: extraversion, agreeableness, conscientiousness, neuroticism and openness to experience. For example, patients who currently meet criteria for borderline personality disorder, whose relationships may swing between adulation and outbursts of anger, would be rated as having problems on a scale of negative emotion, linked to the trait of neuroticism.

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