Borderline Personality Disorder Presentation given in Psychopathology II class.
Summer 2010 Argosy University San Francisco
By Lucia Merino, Psychology Doctor Candidate
21. Differential Diagnosis BORDERLINE PERSONALITY DISORDER Schizotypal Paranoid Mood Disorder Episode Axis I = Mood Disorder Axis II = Personality Disorders Antisocial Histrionic Identity Problem Substances Medical Condition Dependent Narcissistic
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25. Differential Diagnosis Borderline Vs. Antisocial BPD Manipulation to gain concern/nurturance caregiver/lover Antisocial Manipulation for profit, power or material gain Common feature: Manipulation
Talk about the stigma associated with this diagnosis because of their labile affect, reactive emotionality, sense of entitlement, blaming others for their predicament. Making you feel that you have to give them something. Their anger and manipulation. They are labeled as “difficult patients” Name of “borderline” came to be because first there was this classification of normal, psychotic and neurotic. There was a group of people that would not fall into any of these categories, so they created the borderline because it was between the neurotic and the psychotic.
This patient live in continuous inner turmoil.
International Classification of Disease calls it Emotionally Unstable Personality Disorder because it is a disorder of emotional dysregulation and intense emotionality. These people are very sensitive to emotions and get too engrossed in them. They don’t have enough tolerance for distress.
Must have 5 + to meet criteria
“ The Great Impersonator” because it looks like other diagnosis. Read from book about BPD being as Syphilis: manifests in many other areas of the body.
But Bipolar Disorder is characterized by Inflated Self-Esteem, Grandiosity, Racing Thoughts, Talkativeness, decreased need for sleep, etc. The major distinction is that they are not afraid of rejection or engage in these behaviors as a frantic effort to avoid being abandoned like the Borderline Personality client. The impulsivity in during the episode not like BPD that is continuous, long standing, not episodic.
Give Picture with translation-
This is Mixame first psychiatric hospitalization. She was suicidal and her boyfriend brought her in. She has been depressed for the last months, disassociates, feels guilty, empty and afraid or her thoughts when she sees a knife in the kitchen.
Marsha Lineham, PhD –founder of DBT. Professor at the University of Washington at Seattle.
Lack of boundaries: SWF –not even after 2 weeks of having moved in, she undresses and shows her naked body to roommate.
Refer to handout –and explain the PRAISE mnemonic. Go to Statistics.
BPD is very often confused with Bipolar disorder because its presentation is similar in symptomatology.
She keeps reading and finds out about other personality disorders and finds that she meets some of the criteria for those also. She gets very confused.
Other PD can be confused with BPD b/c they have common features. Therefore, must distinguish them based in their differences. Look at the differences in their characteristic features. Can diagnose more than one if it meets criteria. BPD and HPD both share attention seeking behavior, but BPD have other flavor. For instance, Attention seeking through suicidal gestures, notes, self-mutilation. Manipulation through angry disruption in relationships, for instance, getting up in the middle of a romantic dinner because not getting her way in a discussion. Mood swings with a flawor of emptiness, guilt and utter feelings of being bad/evil. Mostly related to stress with caregiver or lover.
BPD related to relationships. For instance, in the movie White Single Female, Hedra thinks they want to get rid of her.
BPD the stimuli is real or imagined abandonment. Becomes self-destructive (the paranoid or narcissistic don’t).
Both characterized by fear of Abandonment. Key difference is that BPD has unstable relationships.
Identity concerns related to a developmental phase (e.g. adolescence) do not qualify for a mental disorder.
BPD often co-occurs with Mood Disorders, and when criteria for both are met, both may be diagnosed. Because of the cross-sectional presentation of BDP can mimicked by an episode of Mood Disorder, the clinician should avoid giving an additional diagnosis of BDP based only on cross-sectional presentation without having documented that he patter of behavior has an early onset and a long-standing course.
She has been reading about mental disorders and identifies with Borderline and Bipolar. She thinks she is bipolar.