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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: Is it really BPD? Could it be multiple comorbid personality disorders?  (Read 52824 times)
Almost_Nobody
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« on: May 27, 2007, 04:39:21 AM »

I have a question.

I read somewhere that BPD often coexist with other personality disorders like NPD, or ASPD.

Is this true?

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Skip
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« Reply #1 on: September 21, 2007, 10:40:40 AM »

Analyzing comorbidity data is a complex matter that probably exceeds most of our laymen skills   smiley  

In medicine, comorbidity describes the effect of all other diseases an individual patient might have other than the primary disease of interest.

In psychiatry it is a bit different.  In psychology and mental health counseling comorbidity refers to the presence of more than one diagnosis occurring in an individual at the same time. However, in psychiatric classification, comorbidity does not necessarily imply the presence of multiple diseases, but instead can reflect our current inability to supply a single diagnosis that accounts for all symptoms. The term comorbidity was first used in psychiatry in 1970's.

The current DSM-IV definitions have so much overlap, just about everyone with a personalty disorder has a co-morbidity with another mental conditions.  The Amercican Psychiatric Association is trying to reduce this up in a revised version of the DSM (DSM-5) due to be published in 2013.

In a study of 34,653 people in the general population by the Laboratory of Epidemiology and Biometry, National Institutes of Health (NIH), Bethesda, MD, USA the incidence of comordibities with BPD were very high.  

Comorbidity with another personality disorder (Axis II) was very high at 74% (77% for men, 72% for women) and as such, the PD are being redefined.





Comorbid w/BPD---------

Paranoid

Schizoid

Schizotypal

Antisocial

Histrionic

Narcissistic

Avoidant

Dependent

OCD
Men-----------

17%

11%

39%

19%

10%

47%

11%

2%

22%
Women-------

25%

14%

35%

9%

10%

32%

16%

4%

24%


But even with the changes in the DSM-5, co-morbidity is real with Axis I disorders.

In the NIH study comorbidity with mood disorders was very high at 75% as was anxiety disorders 74%.



Comorbid w/BPD---------

Anxiety Disorder (Axis I )

-Posttraumatic stress

-Panic with agoraphobia

-Panic w/o agoraphobia

-Social phobia

-Specific phobia

-General anxiety

Mood Disorder (Axis I )

-Major depressive

-Dysthymia

-Bipolar I

-Bipolar II
Men---------

-

30%

8%

16%

25%

27%

27%

-

27%

7%

31%

7%

Women------

-

47%

15%

21%

33%

47%

42%

-

37%

12%

33%

9%



Male and female borderline patients were also found to be significantly different comorbidities in the areas of substance use disorders and eating disorders (Axis I).





Comorbid w/BPD---------

Alcohol abuse

Drug abuse

Anorexia*

Bulimia*
Men----

52%

22%

7%

10%
Women----

33%

14%

25%

30%


* From a separate study of 515 inpatients at McLean Hospital (Harvard University)

Looking at all this comorbidity, it's easy to see why a therapist might initially focus on the more "treatable" and episodic Axis I disorders (e.g., depression, anxiety disorders, bipolar disorder, ADHD, anorexia nervosa, bulimia nervosa) before diagnosing and tackling the more difficult to treat and stigmatized borderline personality disorder (Axis II).  In many ways, this makes sense.


Please note:  This soon to be published study data is provided to give a general idea of the magnitude of comorbidity. I selected this study because it was comprehensive and the data are easy to understand and because it was a general population study -- a representative sample of the civilian population, 18 years and older, residing in households and group quarters in the United States. There are (and will be) numerous other studies that update and further refine these findings.
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JoannaK
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« Reply #2 on: September 21, 2007, 10:50:44 AM »

Some members here reported that they are dealing with loved ones with some NPD or ASPD traits... these people may be harder to diagnose and treat than someone with "simple" BPD.  

Those with NPD and ASPD tend to refuse to accept that they have any problems.  

They tend to "ride above" the chaos.  Those with BPD are a bit more involved with and cognizant of the chaos.
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Abigail
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« Reply #3 on: September 21, 2007, 10:54:02 AM »

Good points, Skip! Sometimes there is a tendency to attribute every undesirable or problematic trait to BPD.  It is important to distinguish what is caused by BPD and what is attributable to another disorder or factor.  Otherwise, we may miss other disorders that need to be treated also.  Each of these separate disorders can influence the other.

 

One fairly common example would be substance abuse/addiction and BPD.  If one treats the substance abuse but neglects to treat the BPD, the chances of relapse are much greater.  Drug abuse and alcohol can make the BPD worse.  In particular, withdrawal from alcohol (12 to 72 hours after drinking) can bring on dysphoria.  Seeking release from the dysphoria, they are apt to drink again.  

And the cycle continues.

 

Abigail
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« Reply #4 on: September 24, 2007, 10:31:33 PM »

Keeping it in Perspective

When asking differential questions about multiple personality disorders, it is important to understand why you are asking the question and how you intend to use the information. Without this perspective and focus, the data may be overwhelming, confusing and misleading.  For example...

~ if your child is not responding to therapy, it makes sense to look more carefully into the possibility that the wrong personality disorder was diagnosed or whether there are comorbid (multiple) personality disorders at play.

~ If you are trying to get along better with your wife, it's not as important to pinpoint the specific disorder or analyze the comorbidity as it is to recognize and fully understand the problem behaviors and how to constructively deal with them.  

~ If you are recovering from a failed relationship, the important thing is often to understand which behaviors were pathologic (mental illness) and which were just the normal run of the mill problems common to failing/failed relationships - there is often a bias to assign too much to the "pathology" and not enough to common relationship problems, or the issues we created by our own behaviors.

Some helpful hints for sorting through this.

  • General and Specific There are definitions for "personality disorder" as a category and then there are definitions for the subcategories (i.e., borderline, narcissistic, antisocial, etc.).  Start with the broader definition first.  Keep in mind that to be a personality disorder, symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder - - the history of symptoms can be traced back to adolescence or at least early adulthood - - the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control


  • Spectrum Disorders  An extremely important aspect of understanding mental disorders is understanding that there is a spectrum of severity. A spectrum is comprised of relatively "severe" mental disorders as well as relatively "mild and nonclinical deficits".  Some people with BPD traits cannot work, are hospitalized or incarcerated, and even kill themselves.  On the other hand, some fall below the threshold for clinical diagnosis and are simply very immature and self centered and difficult in intimate relationships.


  • Comorbidity Borderline patients often present for evaluation or treatment with one or more comorbid axis I disorders (e.g.,depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa). It is not unusual for symptoms of these other disorders to mask the underlying borderline psychopathology, impeding accurate diagnosis and making treatment planning difficult. In some cases, it isn’t until treatment for other disorders fails that BPD is diagnosed.  Complicating this, additional axis I disorders may also develop over time.  Because of the frequency with which these clinically difficult situations occur, a substantial amount of research concerning the axis I comorbidity of borderline personality disorder has been conducted. A lot is based on small sample sizes so the numbers vary.  Be careful to look at the sample in any study -- comorbidity rates can differ significantly depending on whether the study population is treatment seeking individuals or random individuals in the community.  Also be aware that comorbidity rates  are generally lower in less severe cases of borderline personality disorder.


  • Multi-axial Diagnosis  In the DSM-IV-TR system, technically, an individual should be diagnosed on all five different domains, or "axes." The clinician looks across a large number of afflictions and tries to find the best fit.  Using a single axis approach, which we often do as laymen, can be misleading -- looking at 1 or 2 metal illness and saying "that's it" -- if you look at 20 of these things, you may find yourself saying "thats it" a lot.   smiley  A note in the DSM-IV-TR states that appropriate use of the diagnostic criteria is said to require extensive clinical training, and its contents “cannot simply be applied in a cookbook fashion”.


  • Don't become an Amateur Psychologist or Neurosurgeon  While awareness is a very good thing, if one suspects a mental disorder in the family it is best to see a mental health professional for an informed opinion and for some direction - even more so if you are emotionally distressed yourself and not at the top of your game. 


I hope this helps keep it in perspective.   smiley

Skippy




Additional discussions...

Personality Disorders

Borderline and Paranoid Personality Disorder

Borderline and Schzoid/Schizotypal Personality Disorder

Borderline and Antisocial Personality Disorder

Borderline and Histrionic Personality Disorder

Borderline and Narcissistic Personality Disorder

Borderline and Avoidant Personality Disorder

Borderline and Dependent Personality Disorder

Borderline and Obsessive Compulsive Personality Disorder

Borderline and Depressive Personality Disorder

Borderline and Passive Aggressive Personality Disorder

Borderline and Sadistic Personality Disorder

Borderline and Self Defeating Personality Disorder

Other

Borderline PD and Alcohol Dependence

Borderline PD and Aspergers

Borderline PD and Attention Deficit Hyperactivity Disorder

Borderline PD and BiPolar Disorder

Borderline PD and Dissociative Identity Disorder

Borderline PD and P.T.S.D.

Borderline PD and Reactive Attachment Disorder (RAD)

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jalk
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« Reply #5 on: August 07, 2009, 09:34:59 AM »

Something I read online. The most co morbid diagnosis with BPD's is eating disorders. How many of you folks here on this message board know if your ex BPD has an eating disorder. Mine does. In fact she has had it ever since she was in her 20's and she is now 49 yrs old. She was able to keep it from me for 8 years by staying up later than me, binging, then she would go and vomit. Once in awhile I would hear her vomit and she would say that something did not agree with her. I took it at face value, being the naive trusting person that I am.
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FloatOn
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« Reply #6 on: August 07, 2009, 11:22:16 AM »

Mine had anorexia and bulimia. She would basically binge for periods and then starve herself to compensate. I knew she had it from the beginning basically, she was in therapy and told me all about it. I thought no biggie, she's getting treated for it and she seems to be doing fine now right? Like a month before we broke up she started to have problems with food again, one time telling me "I just have a really strong desire to starve myself right now". She would wake up in the middle of the night and not be able to sleep because she was so hungry. All this from gaining 15 pounds from the night we met 4 years prior (she was still thin and really hot) and thinking she was fat and ugly.
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Matyr
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« Reply #7 on: March 10, 2011, 11:47:52 PM »

My SO is also diagnosed as Bi Polar, & having Major Depressive Syndrome. I'm currently trying to figure out whether or not the Bi Polar diagnosis has any bearing on her mood swings (or phasing as I've come to call it). I'm documenting her moods on a daily basis, so I may look back & see if there is a pattern. Also she is on Sertraline (Brand name: Zoloft), which seems to take the edge off, but certainly does not prevent her mood swings, hostility & occasional dis associative aggression.

Any comments or advice would be greatly appreciated.

PS   I'm also trying to subtly suggest that she may be happier if she returns to DBT (I'll let you know how that one goes lol)
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artman.1
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« Reply #8 on: March 11, 2011, 12:14:07 AM »

My UBPDW for the last 42 years, has been diagnosed as Bi-Polar about 15 years ago when she had a nervous breakdown.  She was assigned Therapy at that time and was given Lithium which was the med of Bi-Polar choice at that time.  

I just recently discovered that her mood swings do not match Bi-Polar behavior, and does match BPD behavior.  

Well, how can we get her to seek treatment?  We cannot do this or control this.  We must only help ourself.  That is what I am doing, and learning the skills to set boundaries and enforce them, which, surprisingly helps with her behavior.  

Read the lessons and read the lessons, and you will begin to see.


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Matyr
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« Reply #9 on: March 11, 2011, 12:57:40 AM »

42 Years...Man oh Man !

I commend you sir. You must have a Masters Degree in dealing with BPD by now !. Thank you for your input regarding mood swings, & naturally you are correct in recommending the lessons. I am finding both the workshops & the forums very helpful & informative. I'm finding that a lot of the material is pretty subjective, & at the moment I'm finding it easier to cope by detaching emotionally, hence my desire to make sense of this all in an empirical manner. I am relatively new to this having only been in my relationship for 5 years, during which time my efforts to help her have basically involved getting her involved with case management & calling them when she gets violent, to leaving for 9 months. Like most people who share their lives with BPD"s, I'm just trying to make sense of it all. I realize the only person I can help is myself, but at least by learning as much about this disorder as I can, perhaps I can circumvent & maybe prevent some of the more extreme symptoms. We have a young child, so I feel obligated to see this through.

 
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