Simple test for BPD - Mark Zimmerman, MD

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Mark Zimmerman, M.D., is the director of outpatient psychiatry at Rhode Island Hospital and his fellow researchers published a study last week with the following finding:

We recommend that clinicians screen for BPD in the same way that they screen for other psychiatric disorders: by enquiring about a single feature of the disorder (i.e. affective instability), the presence of which identifies most patients with the disorder (92.8% accurate) and the absence of which rules out the disorder (99% accurate).
https://www.ncbi.nlm.nih.gov/pubmed/27908898?dopt=Abstract

What is "affective instability"?
Answer: Its a history rapid cycling in and out of elevated levels of anger, panic, or despair (not to be confused with moodiness) typically associated with an event or stimulus - disproportionate response.

[flourdust]

This is very interesting. I've read the full article. The screen was done using two structured interviews designed for DSM-IV criteria and administered by multiple trained raters to a large sample over a long period of time.

The study results essentially say that in 99% of cases, someone who does not test positive for affective instability can be ruled out for BPD. The positive finding is bit more nuanced -- around 38% of people with affective instability were later diagnosed (using a more in-depth diagnostic procedure) with BPD.

None of the other BPD characteristics were as powerful in ruling out a diagnosis.

[flourdust]

I guess a simpler way of putting this would be -- if s/he doesn't have "affective instability," it's almost certainly not BPD. If s/he has "affective instability," it might be BPD. (So, the title of this thread is a bit misleading.)

[Skip]

For our purposes does this get us past the threads/thinking that there are 100 red flags of BPD (I think members have collectively posted thousands of indicators) and the "BPD can be hidden behind any wonderful appearing person" fear and focus us down to one primary, first level

No affective instability, probably not BPD.
Affective instability, best indicator of BPD or BPD traits (what most of us heave dealt with).

So, the title of this thread is a bit misleading.

Technically not.    Rule out is the most important aspect of some tests. For example, the most used tests for HIV, or Syphilis are far better as rule outs than rule in.

Great comment. Thanks for reading and reporting on the study detail.

[Sunfl0wer]

Curious how one determines "affective instability" via "inquiring."

Many I know with PTSD, or cPTSD, or Bipolar, or depression, or Huntington's, etc, other PD also may present or self report symptoms of affective instability depending on how this info is gathered. Yet, IMO, the difference of (c)PTSD without BPD and BPD is the lack of ability for consistent stable self insight and consistent stable/reliable theory of mind. 

Also, a pwPD is likely to report only the area of personality/schema mode they are presenting to the evaluator, which is often not at all the dynamic whole personality.

Idk really, just am literally curious.

[flourdust]

Curious how one determines "affective instability" via "inquiring."

Many I know with PTSD, or cPTSD, or Bipolar, or depression, or Huntington's, etc, other PD also may present or self report symptoms of affective instability depending on how this info is gathered. Yet, IMO, the difference of (c)PTSD without BPD and BPD is the lack of ability for consistent stable self insight and consistent stable/reliable theory of mind. 

Also, a pwPD is likely to report only the area of personality/schema mode they are presenting to the evaluator, which is often not at all the dynamic whole personality.

Idk really, just am literally curious.

Well, the procedure is known as a "structured interview," which means the questions being asked are predetermined and responses are coded based on established criteria. It's a difficult examination technique to master, which is why there's pretty extensive training required in order to be certified, and research using these interviews includes reliability analysis and multiple raters to ensure that the scoring is consistent. Unfortunately, I don't think you can see the actual questions unless you purchase the exam (the cheapest version available is around $50, which is actually really cheap for a psychological exam), but it's not very useful without training guides and recorded interviews, which could add up to several hundred dollars. Plus the cost of a graduate degree. 

[Skip]

It would seem to me that the take home is that there is one area to hone in on when trying to figure out BPD.

I think if you spend any time with someone, you can ask subtle questions and you can observe their behavior with others and with yourself.

What you say about research questionnaires is true however they are designed to be low contact/high efficiency tools. When we deal with individuals, we are high contact - we can spends hours/days, not minutes.

When I was dating after my last relationship, I was amazed at what questions people would respond to and the level of honesty/sincerity in their responses. This is not something terribly difficult "tell" to uncover if you are highly alert to its importance:
Its a history rapid cycling in and out of elevated levels of anger, panic, or despair (not to be confused with moodiness) typically associated with an event or stimulus - disproportionate response.

The alternative, often looks like this:

I am not so sure that I want to be head-over-heels for someone. I've been in long term (years) relationships with two people that I was completely attracted to. All it left me was feeling overwhelmed with love, worry, and loss.

Good comments.

[TyroneWiggums]

I had to google affective instability; my ex was "emotionally labile," but that appears to be the same thing (right?).

For some reason, I can't access the article itself, but wow, what an eye-opener.  It explains a LOT behind what made her dBPD:

Her blurting out "will you marry me?" two months into our relationship after an especially good evening.
Her deciding her best friend hated her because the birthday card came a few days late.
Her relationship to her parents vacillating between "greatest family ever" to screaming matches followed by months of silence, often occurring within the same weekend.
Her telling me I was the love of her life on the same day she dropped me on my head.

Question for me is, this was the first (and last, so far) and only relationship I've ever been with where I didn't know with these types of mood swings, especially at the end, so why did I put up with it?  I guess because the good times were the best ever?  Still working that out on my own.  That said, the bad times were also the worst... .

[VitaminC]

Not having read the full article or given sufficient thought to how the data was gathered and evaluated (all very important parts of this ), my overwhelming feeling is: yes.

I recently explained to someone that the easiest way to understand BPD was to think of Bipolar mood swings happening dozens or more times per day, sometimes due to outside forces and sometimes due to invisible chemical reactions in the brain. The point is, it happens many many times per day. 

Add impulsivity and shame and you have a pretty volatile mix that gives rise to many of the behaviours we witness and find extremely confusing.

[Circle]

Interesting thread, thanks for sharing. Makes sense. Thankyou for posting:)

[Portent]

Pretty much there is another thread about a study just out that says that the sudden mood changes are the #1 sign. If you have such you might be BPD. If you dont then you are not.

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The reliability of these symptoms for predicting "BPD" was assessed based on interviews of 3,674 people.

• Avoid abandonment
  
• Unstable relationships
• Identity disturbance
• Impulsively
• Suicidality/self-injury
• Affective instability
• Emptiness
• Anger
• Stress-induced paranoia/dissociation

Affective Instability was the most reliable factor

Results -------------------- All Patients (n=3674) PV = Predictive Value

Sensitivity ---------------- 92.8%

Specificity ---------------- 81.9%

Positive PV ---------------- 37.9%

Negative PV ---------------- 99.0%

https://www.youtube.com/watch?v=B26TFXnmI7k

[jhkbuzz]

Not sure what the difference is between "affective instability" and "moodiness"?... .

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I believe we are talking about mood instability (mood instability = affective instability). This would difffer from moodiness in terms of frequency of change and extremeness.

Technically, the  dimensions of Affective Instability are:

• Frequency of Mood Change
• Amplitude of Mood  Change
• Temporal Dependency – Sequencing of Mood Changes (e.g. does anxiety tend to follow depression

DSM 5 Marked reactivity of mood such as intense episodic dysphoria [the opposite of euphoria], irritability, or anxiety usually lasting a few hours.  The basic dysphoric mood of those with Borderline Personality Disorder is often disrupted by anger, panic, despair and is rarely relieved by periods of well-being or satisfaction.

[flourdust]

I had to google affective instability; my ex was "emotionally labile," but that appears to be the same thing (right?).

For some reason, I can't access the article itself, but wow, what an eye-opener.  It explains a LOT behind what made her dBPD:

They're very similar concepts. I believe emotional lability is more strictly diagnosed as having an organic component (i.e., due to brain damage), but I've seen it used more casually.

I work for a university, so I have access to most of the full-text research databases -- the full article might not be available to some folks.

[jhkbuzz]

Results -------------------- All Patients (n=3674) PV = Predictive Value

Sensitivity ---------------- 92.8%

Specificity ---------------- 81.9%

Positive PV ---------------- 37.9%

Negative PV ---------------- 99.0%

Since I don't have access to the article, I'm not sure what this means... .I'd like to know. What/why "test models"?

[heartandwhole]

Very interesting. In my relatively short and long-distance experience with pwBPD (diagnosed), he exhibited the symptoms below:

• Avoid abandonment
  
• Identity disturbance
• Impulsively
• Affective instability
• Emptiness
• Anger
• Stress-induced paranoia/dissociation

The cycles of emotional instability were often several times a day. It was sometimes excruciating to witness the overwhelm he experienced on a regular basis. At least there were highs as well as lows.

heartandwhole