Yesterday I posted about the DSM IV criteria that had been used to diagnose BPD in myself in 2008. With the new DSM V coming out eventually some time this year (I’m glad those in the mental health community and services are putting up a massive fuss about it, WOOT) there will be new criteria to meet in order to be diagnosed as Borderline.
The DSM 5 website has this handy dandy side-by-side comparison chart that looks at the changes in personality disorder and the changes in the individuals disorders.
My analysis is that the criteria has expanded but that is because they’ve gone into detail and broken down the current criteria. Borderline criteria in the DSM IV is, I guess, fairly vague. I may actually like this new version (ugh I don’t want to say that).
Borderline Personality Disorder, DSM V
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:
1. Impairments in self functioning (a or b):
a. Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress.
b. Self-direction: Instability in goals, aspirations, values, or career plans.
2. Impairments in interpersonal functioning (a or b):
a. Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.
b. Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.
B. Pathological personality traits in the following domains:
1. Negative Affectivity, characterized by:
a. Emotional lability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.
b. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.
c. Separation insecurity: Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.
d. Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.
2. Disinhibition, characterized by:
a. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.
b. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.
3. Antagonism, characterized by:
a. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.
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., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
What do you think?
I want to continue spreading the awareness of BPD during this month of May and I can think of nothing better to talk about than the criteria to be diagnosed with BPD.
I was diagnosed using the DSM IV so those are the criteria I will use (we can talk about the new DSM V criteria tomorrow).
There are 9 criteria for Borderline Personality Disorder. They are:
(1) Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms
When I was first diagnosed in 2008 I identified with 8 of the 9 criteria, not identifying with criteria 9. This was probably because I was in a horrible relationship.
I can see how being in a more positive relationship has helped me improve but I have also changed criteria.
I now currently identify with 6 of the criteria. What’s changed?
I no longer identify with:
- Criteria 3- unstable self image. My self image is fairly stable and would not be labeled persistent.
- Criteria 4- impulsivity. I am not impulsive although I do fear this and avoid situations that may cause impulsive behaviour or thoughts to occur.
- Criteria 7- chronic feelings of emptiness. I do not feel this way often.
What was added:
- Criteria 9- stress related paranoia. Due to my previous horrible experiences with relationships I can become very paranoid when in stressful situations involving my current close relationships.
This is progress if I’ve ever seen it
I hope people can begin to understand what BPD is and that with the right support, time and effective treatment (although I haven’t pursued it until recently) BPD can be managed or completely recovered from!