The Borderline personality disorder is a mental illness marked by an ongoing pattern of varying moods, self-image, and behavior.
The evaluation and diagnosis of personality disorders is a very complicated task that requires considering multiple aspects of the life of the individual and not merely the complaints or problems that the person presents.
The “borderline” term for borderline personality disorder does not refer to a certain level of intelligence.
Once people understand this little fact, they should note that there is an objective difficulty in establishing the diagnosis, due to the high variability of symptoms that each person can display and the changes that manifest over time.
The term borderline to refer to the disorder is widespread, even outside the Anglo-Saxon world.
The reasons are of a historical nature due to the popularization of the concept in psychiatry by CH Hughes and subsequent adoption by the psychoanalyst Adolph Stern in 1938 to characterize psychiatric conditions that surpassed neurosis but did not reach psychosis (many authors describe the symptoms of BPD as Pseudo psychotics).
Under this conception, a gradual continuum was established between the two extremes, with the disorder at the “limit.”
The formal concept of borderline personality disorder is relatively new in the field of psychopathology.
It did not appear in the Diagnostic Manual of Mental Disorders (DSM) published by the American Psychiatric Association until 1980 (DSM-III).
It is from there, once achieved the official status of “personality disorder,” when interest in this pathology triggers. Experts recognized this following significant controversies and disputes initiated in the 1970s.
Official terminology and diagnostic criteria were agreed through compromises between different models and attending to empirical-descriptive data.
With this definition, the previous idea of the condition was definitively left behind as a phenomenon that fluctuated between neurosis and psychosis to constitute a picture with its entity and not a limit of a continuum between two others.
Thus, at a given time, a person can come to consultation because of a problem of access of anger, that is, a hypersensitivity that causes him to explode in the form of violence.
On another occasion, this same person may demand help to overcome a romantic breakup, which has ended abruptly despite significant efforts to maintain that relationship.
Later on, these symptoms present themselves, accumulating a seemingly confused and disjointed clinical history.
This range of possible symptoms that can be shown by the patient makes it difficult to diagnose the borderline personality disorder.
Since some of these can come from other pathologies, such as bipolar disorder – where there is an alternation of moods, although their symptoms are or attention-deficit hyperactivity disorder.
In which there are hypersensitivity and impulsivity, and which also leads to poor academic performance, in this case, due to a lack of attention rather than a continuous change of interest.
The task of the specialist, in the first place, will be to determine if it is a borderline personality disorder, distinguishing the symptoms that are specific to it and, if people perceive other symptoms, they have to find out if there are also other concomitant disorders.
Among the most common that occur at the same time is significant depression, narcissistic disorder, and eating disorders, also complicated in many cases with addictions and substance abuse, which only make the clinical picture worse and complicate its recovery.
The clinical interview is undoubtedly the best way to assess the presence of a personality disorder
The professionals who perform the meeting must know in depth not only the various diagnostic criteria of the manuals but also how to address them, what kind of questions should be asked to assess their presence and importance and have the necessary resources and skills as a professional.
In this sense, people should consider that standardized test instruments and structured or semi-structured interviews can help to explore some aspects that in the course of the diagnostic conversation are not explicitly addressed (primarily).
Also, it can help to provide additional information to seniors but in no case can they be used as the sole or primary evaluation resource.
Also, it should be noted that many of the standardized instruments give rise to false diagnoses (both positive and negative).
False diagnoses (positives): it is possible to diagnose as existing a disorder that is not such. Such thing happens because many of the elements typical to the diagnostic criteria (DSM IV and ICD-10) appeal to personality traits that are present in many people with no apparent problems at low-intensity levels.
False diagnosis (negative): it is possible because the absence of disease awareness of people with BPD is persistent.
That leads them to respond negatively to indicators of pathology in which they do not feel reflected or with which they are not identified (Consciously or unconsciously).
The following are the criteria for the diagnosis of BPD according to DSM IV (Diagnostic and Statistical Manual of Mental Disorders).
The presence of 5 or more can indicate the existence of this disorder:
- Frantic efforts to avoid a real or imagined abandonment.
- A pattern of unstable and intense interpersonal relations characterized by the alternation between the extremes of idealization and devaluation.
- Alteration of identity: self-image or sense of self-accused and persistently unstable.
- Impulsivity in at least two areas that are potentially harmful to self (e.g., expenses, sex, substance abuse, reckless driving, and binge eating)
- Intense behaviors or recurrent suicidal threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (e.g., episodes of intense dysphoria, irritability or anxiety, which usually last a few hours and rarely a few days).
- The chronic feelings of emptiness.
- Inappropriate and intense anger or difficulties in controlling violence (e.g., many signs of bad temper, constant anger, recurring physical fights).
- Transient paranoid ideation related to stress or severe dissociative symptoms.
Keep in mind that to a certain extent, we all have these characteristics, especially teenagers. These components must be long lasting (years), persistent and intense so that this disorder can get diagnosed.
It is important to remember that you have to be careful when making your diagnoses or to other people.
No person should base such determination on the contents of an information booklet, a website or a book. If you think you or someone you know may have this disorder, it is best to talk to a qualified therapist.
Many people with this disorder may have additional problems or concerns such as depression, eating disorders, substance abuse, etc. and it may be difficult to isolate what the BPD is from other diseases.