"Why is a BPD diagnosis not given out more often?
" It's at the root of a great insecurity many have... is the person in my life "ill" or is it me?
What does it all mean when a person in our life fits many of the criteria of BPD or BPD traits (but not the obvious tangible criteria sch as cutting, suicide)and have seen a therapists and not been diagnosed or treated.lasagna
points out insurer issues. Lincoln
points out that at certain types care providers do not have the education and background to diagnose these disorders. lasagna points out the potential negative impact on the therapy... that patients often don't return (as a dx is telling an insecure, hypersensitive person that they are their own problem. geroldmodel
point out that the "diagnosis" can't be made by a social worker, or non-MD therapist. All good points.
But it is also important to consider that even in the case of skilled, specialized psychiatrists, they don't have the equivalent of the low cost technical tools like blood tests and x-rays to diagnose patients like other doctors have.
1. Clinical Process
Psychiatrists are limited to what the patient tells them. This communication is a function of time (appointments are under an hour), communication skills of the patient (remember, people often see a therapists when they are in crisis), patient self awareness and honesty, and patient follow up (coming in for additional appointments, reporting progress).
My understanding is that many clinicians work through a hierarchy of diagnosis and treatment - treating the more episodic, pharmaceutical responsive, and lower cost conditions first - they go after the "low hanging fruit". Many of the Axis I disorders fall into this category. If this does not resolve the problems, they dig deeper. The process is a little like peeling back an onion and dealing with each new layer. If the patients heals or stop coming in, the pealing process stops. Insurance company reimbursement policies tend to encourage this approach.
Axis II disorders are far more expensive, complex treatments. And they are often obscured by other comorbid conditions.
In a hospital setting, there is more time to analyze and diagnose a patient. Outpatient treatment, however, is often very time limited.
Right now with the current medications and therapies that are available, a diagnosis of BPD (except in cases of suicidal ideation, or cutting) is likely to come later (rather than earlier)... the diagnosis of "high functioning" BPD is not obvious and straight forward.
The discussion also raises an obvious suggestion that many of the partners, parents, children here aren't "BPD" by the clinical definition... they have some traits, or many traits, but not enough, or severe enough to be diagnosed. They are extremely difficult people, nonetheless. In many ways, the same tools, options, and thought processes are valid in subclinical situations... maybe even being more effective.
Anyway... "General BPD Topics and Questions" is an information exchange board... for me, this was a good exchange of information we have gathered. Thanks.