Discuss the problems related with identifying and diagnosing Borderline Personality Disorder.

To identify this disorder we use the DSM-IV-TR diagnostic criteria which we will look at further on. Six of the nine symptoms of the disorder are “1. fears of abandonment; 2. intense mood shifts; 3. impulsivity; 4. problems with anger; 5. recurrent suicidal behaviours or self-injurious behaviours; and 6. patterns of unstable and intense relationships” (Hoffman, 2007). As one can see, there are many complex symptoms and these have to be prevalent in the long term and will be dated back to adolescence or early adulthood.

The DSM-IV-TR uses the following diagnostic criteria for Borderline Personality Disorder, “A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and a marked impulsivity beginning in early adulthood and present in a variety of contexts, as indicated by five or more of the following [symptoms]” (APA, 2000. p. 710). Six of the Diagnostic criteria were previously mentioned and the DSM-IV-TR makes mention of three others. “(3) Identifying disturbance: markedly and persistently unstable self-image or sense of self. (7) Chronic feelings of emptiness. (9) Transient, stress-related paranoid ideation or severe dissociative symptoms” (APA, 2000. p.710)

Identifying Borderline Personality Disorder can be difficult for any professional. It is so complex and has nine symptoms which may be present. There are many combinations of these symptoms you would take into account and therefore over 200 constellations. “There are many reasons for the confusion. With the nine possible symptoms there exist over 200 different ways for the disorder to present itself, and this heterogeneity is further complicated by the fact that BPD rarely stands alone” (Hoffman, 2007). This disorder is also said to be co-morbid, which means it may exist with other disorders at the same time. “A high rate of co-occurrence exists with other disorders, which typically include major depression, bi-polar disorder, substance abuse, eating disorders, and anxiety disorders” (Hoffman, 2007). Borderline Personality Disorder shares symptoms with many other disorders and this is why it becomes difficult to identify. Depression is a disorder which has similar symptoms to that of BPD. Some of the symptoms which occur across both would be anxiety, suicidal tendencies, aggression and feelings of worthlessness about oneself. When you look at a number of other disorders, there are common criteria between them. Borderline personality disorder is said to be a brain disorder and “can be identified by brain imaging techniques” (Oldham, 2009). Offhand though, without this technique, this disorder often goes undiagnosed as it is so difficult to identify.

Diagnosing Borderline Personality Disorder is also a difficult task. Due to the fact that it is difficult to identify, it becomes complicated to diagnose. The diagnosis of this disorder is received with mixed reviews. Some professionals are very skeptical as it presents itself similarly to other disorders. “The diagnosis has been challenged with the notion that it can be explained by other comorbid conditions, or as a variant of axis I disorders such as mood or impulse control disorders” (Goodman, 2007). The idea of overlapping symptoms is shared by many psychologists and psychiatrists. “[I]n theory, two individuals could present with only one overlapping symptom and both meet the criteria for BPD” (Meyerson, 200). There are a number of symptoms which also makes it difficult to diagnose this disorder as people are not likely to present similar symptoms. There also needs to be evidence of this disorder being present over an extended period of time. Patients suffering BPD are not comfortable in relationships and often chase other people away. This makes it difficult to gather information on the patient’s history if the patient is not forthcoming with information. BPD is a fairly new disorder which was identified and classified into the DSM-III. As it is so new there is not an abundance of literature on this subject. We know it affects many lives as people have written down their experiences for other people to read. It has also been said that BPD is diagnosed after the age of eighteen only. This means that people may have suffered with it for many years before it is diagnosed.

There are many reasons why Borderline Personality Disorder is difficult to identify and diagnose. It has a large number of criteria specified by the DSM-IV-TR which overlap with a number of other disorders. The symptoms have to be present for a lengthy period of time and so a detailed history of the patient is needed. Not everyone is in agreement as to what the symptoms are and some feel they should be changed with some wanting other criteria added. It is a complex and misunderstood diagnosis and still has many years of research to come.

Reference List

Barlow, D.H., Durand, V.M., (2005). Abnormal Psychology (4th ed.). USA: Thomson Wadsworth.

Goodman, M., Hazlett, E.A., New, A.S., Koeningsig, H.W., Siever, L. (2009). Quieting to affective storm of Borderline Personality Disorder. American Journal of Psychiatry, 166, 522-528.

Gunderson, J.G. (2009). Borderline Personality Disorder: Ontogeny f a diagnosis. American Journal of Psychiatry, 166, 530-539.

Hoffman, P.D. (2007) Borderline Personality Disorder: A most misunderstood illness. National education Alliance for Borderline Personality Disorder, NAMI Advocate, winter 2007.

Meyerson, D. (2009). Is Borderline Personality Disorder under diagnosed? APA 2009, in C. Phend (2009). APA: Borderline Personality Disorder often missed first time around. Medpage Today.

Oldham, J.M. (2009). Borderline Personality Disorder comes of age. American Journal of Psychiatry, 166, 509-511.