Posted by Else on August 3, 2001, at 18:48:13
In reply to Re: Borderline Personality Disorder, posted by Elizabeth on August 3, 2001, at 18:19:40
Elizabeth, you rule! Keep up the good work. I am so very impressed by how calm and knowledgeable you are. It's wonderful.
> [MM:]
> > > Don't know if anyone's still reading this thread, but I also was wondering about the symptom of chronic emptiness in BPD. Isn't that a symptom of just regular depression too?
>
> I was never clear on what "emptiness" is supposed to mean anyway. I guess that it might be something like boredom or inability to feel okay/comfortable/at ease/fulfilled. This might contribute to the impulsive sensation-seeking that is commonly seen in BPD -- an attempt to fill the void.
>
> [Mitch:]
> > Yes, I would think so. I mean can someone more clearly define what "chronic emptiness" is? Sure sounds like depression to me.
>
> The overlap is substantial. I think that BPD probably does exist as a distinct entity (one that's prevalent, in particular, in women who were abused as children), but it's way overdiagnosed in people (especially women) who might really have ADHD, PTSD, bipolar disorder, atypical depression, substance dependence, etc., without first ruling out these disorders. And a primary diagnosis of personality disorder often prevents people from getting adequate medical treatment, since there's a general feeling that "personality disorders" don't respond to medication.
>
> In fact, a variety of medications have been employed successfully in BPD: antidepressants (but not tricyclics), antipsychotics (mainly in low doses), anticonvulsants, lithium, psychostimulants, etc. This doesn't prove that these patients "really" have an axis I (or III) disorder and not BPD (for example, response to Depakote doesn't mean that a person is really suffering from bipolar disorder or temporal lobe epilepsy), but it does mean that pharmacotherapy should at least be considered. People with this disorder suffer a great deal, and their treaters often make it worse by getting irritated with them and labelling them with derogatory adjectives such as "manipulative," "attention-seeking," "immature," "demanding," etc., and by assuming that medication will not help.
>
> Marsha Linehan (a psychologist who designed a modified form of cognitive-behavioural therapy specifically for BPD) thinks that one causative factor can be invalidation of a person's feelings and experiences in childhood. Reexperiencing that invalidation in the treatment setting can hardly be expected to help.
>
> > I wouldn't be surprised that in the future it gets eliminated from the DSM.
>
> I think it might be assimilated into the mood disorders category, perhaps as "affective reactivity disorder" or something like that. IMO, the primary feature of BPD is excessive sensitivity or mood reactivity.
>
> > Nearly any person with clear-cut uncomplicated bipolar disorder already will have some of the "traits".
>
> The difference is that in a personality disorder, they're enduring traits, not symptoms of a manic, depressive, or mixed episode. When you get into mixed mania, rapid cycling, and "soft" bipolar disorders (cyclothymia and bipolar II), though, the waters become muddy.
>
> > And if you have one or more of the anxiety disorders you will have some of those "traits" as well.
>
> Yes. I think the criteria should be more restrictive. Clinicians are often hasty to diagnose an Axis II condition based on a person's behaviour during a brief hospital stay. I think this is a serious problem. They seem to forget the general rule that personality disorders have to be enduring -- trait, not state -- and that the signs and symptoms must present in a variety of contexts (not just, for example, in the hospital). I also suspect that a lot of adolescent girls are diagnosed with BPD when in fact they're just going through the usual stuff that teenagers have to deal with.
>
> > I think it is just a "catch-all" for something that pdocs have trouble treating.
>
> Well, it's a way of blaming the patient for failing to get better, rather than blaming the doctor for failing to cure the patient. I don't think it's especially helpful in most cases, and it's quite stigmatising.
>
> > In my opinion, it is either/both a subset of ADHD patients, or a subset of bipolar patients with "mixed" symptoms.
>
> I think that is probably true in many cases.
>
> -elizabeth
poster:Else
thread:71466
URL: http://www.dr-bob.org/babble/20010731/msgs/73415.html