Wednesday, 5 December 2012

New BPD Diagnostic Criteria

I couldn't resist posting my thoughts on the newly announced updates to the diagnostic criteria for Borderline Personality Disorder.

Alicia Paz runs a very excellent and informative BPD blog, where she has recently posted the Borderline Changes for DSM-5. It has gone from a list of nine criteria of which five must be met, to a list of key areas with sub-categories of symptoms.

To summarise in basic terms, the areas of BPD diagnosis were previously listed as:
  • Avoiding Abandonment
  • Intense/Unstable Relationships
  • Identity Disturbance
  • Impulsivity
  • Suicidal Behaviour
  • Affective Instability
  • Emptiness
  • Anger
  • Dissociation/Paranoia

To summarise in basic terms, the areas of BPD diagnosis will now be organised as:

A: Significant Impairments in Personality Functioning
     1. Self
         a. Identity
         b. Self-Direction
     2. Interpersonal
         a. Empathy
         b. Intimacy

B: Pathological Personality Traits
     1. Negative Affectivity
         a. Emotional Lability
         b. Anxiousness
         c. Separation Insecurity
         d. Depressivity
     2. Disinhibition
         a. Impulsivity
         b. Risk-Taking
     3. Antagonism
         a. Hostility

(Obviously the criteria - new and old - go into much further specifics than that, but to me I find it most helpful to understand these changes by starting with general summaries as above.)

In my (humble) opinion, I think the new diagnostic criteria provides clarity for some of these symptoms by including more details, even if this means more scientific terminology in parts.

Less emphasis on Emptiness does seem useful as although this is a persistent feeling for me it's better explained by listing it as part of a lack of identity and self-direction, rather than the other way around.

Specific thought processes that are outlined in the new criteria, like "worry about the negative effects of past unpleasant experiences" and "feeling threatened by uncertainty" and "denial of the reality of personal danger", seem especially accurate to me.

Dropping the description "difficulty controlling anger" and instead having "persistent... angry feelings" is less helpful in my view. I easily identified with the original definition on this one.

And lastly, even though this is probably just semantics, I am not thrilled about the word "Pathological" being used to describe anything about me.. but, in it's technical use, it does apply.

Overall I think the new criteria explains BPD just as well as the previous criteria.

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