Changes to the DSM – Diagnostic and Statistical Manual,
often referred to as the “bible” for psychiatrists and other mental health professionals and the subject of much recent controversy, affect several diagnoses, including that of Borderline Personality Disorder (BPD).” Changes to the BPD diagnosis in the new DSM-5 involve
radical changes that fundamentally amend a definition of BPD that has survived with minimal changes since it entered the DSM system 30 years ago. Because a BPD diagnosis is currently greatly underutilized, most clinicians lack the training that is needed to treat patients with BPD, and because of this lack of training, they are hesitant to work with this population. Show Changes within the DSM-5 may encourage doctors to make a BPD diagnosis more frequently than before. The diagnosis will be more visible and accessible, possibly (and hopefully) leading to the creation of much-needed training programs for clinicians. In the DSM-III and IV, placing BPD under the parent class of Personality Disorders may have encouraged excessive use of the residual category, PDNOS (Personality Disorders Not Otherwise Specified). Hopefully, the changes in the DSM-5, which make the criteria more specific will diminish both BPD’s overlaps and its heterogeneity. Below are the changes we will see, starting with the current DSM-IV-TR and moving into the DSM-5: The DSM-IV-TR (2000) criteria for Borderline Personality Disorder is as follows:Borderline Personality Disorder A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
The DSM-5 (2013) diagnostic criteria for Borderline Personality Disorder:Borderline Personality Disorder The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose borderline personality disorder, the following criteria must be met: A) Significant impairments in personality functioning manifest by:
APA Rationale for Revised A Criteria for Personality Disorders and the Levels of Personality Functioning B) Pathological personality traits in the following domains:
APA Rationale for Criteria B and the Proposed Trait System C) The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations. D) The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment. E) The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g. substances of abuse or medication) or a general medical condition (e.g. severe brain injury). What are the DSM 5 diagnostic criteria for BPD?Diagnostic criteria (DSM-5)
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. Identity disturbance - Markedly and persistently unstable self-image or sense of self.
What are the 3 C's in BPD?Remember the 3 C's: I didn't cause it, I can't control it, I can't cure it.
How do you diagnose BPD clinically?Personality disorders, including borderline personality disorder, are diagnosed based on a:. Detailed interview with your doctor or mental health provider.. Psychological evaluation that may include completing questionnaires.. Medical history and exam.. Discussion of your signs and symptoms.. How many criteria must be met for BPD?Symptoms in borderline personality disorder occur in 4 domains: affectivity, interpersonal functioning, impulse control and cognitive. The diagnosis requires that at least 5 of 9 specific criteria be met (Box 2).
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