 - Last login: 8 hours agoElle-ba
- elle is a 41 year old woman from Scotland, UK.
- Likes 4,123 pages, 17 videos, 296 photos • 1,079 fans • Received 235 reviews
- Member since Dec 03, 2004
Treat every person with kindness and respect, even those who are rude to you. Remember that you show compassion to others not because of who they are but because of who you are.
~ Andrew T. Somers ~
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NHP: Is it difficult to diagnose?
ALC: BPD can sometimes be difficult to diagnose, especially because some of the symptoms of BPD look a lot like some of the symptoms of other psychiatric disorders. For instance, the intense mood swings of BPD can look a bit like bipolar disorder, making it difficult for the diagnostician to determine whether the individual has BPD or some kind of rapid cycling bipolar disorder. Often, people with BPD have experienced traumatic life events, so it can sometimes be difficult to determine whether the individual has BPD or post-traumatic stress disorder. The best way to diagnose BPD is to use a combination of well-established structured interviews, self-report questionnaires, interviews and discussions with the patient about her or his life, and possibly, interviews with family members or others in the person's social network. BPD is supposed to be a chronic, long-standing disorder; thus, the diagnostician often looks for patterns of difficulties that have been present for a long time.
NHP: Is BPD ever diagnosed in children?
ALC: BPD is not officially diagnosable in children. As with all personality disorders, it is only appropriate to diagnose BPD once a person has reached adulthood. Some of the individual symptoms of BPD, such as emotional ups and downs, impulsive behaviors, and identity problems, are actually somewhat common among adolescents. Therefore, most researchers believe that you should wait until adulthood to diagnose BPD, in order to make sure that these problems are long-lasting and more than simply "typical adolescence." Now, on the one hand, we agree that it would be a mistake to diagnose someone with BPD when their difficulties may simply resolve over time. It's not helpful to receive a diagnosis that isn't accurate. On the other hand, because BPD is such a painful disorder, the best thing to do is to catch it early so that people can get the help they need as soon as possible. And, research has found that some people with BPD struggled with some of these symptoms for many years before they were diagnosed - even in childhood. Therefore, we believe that it is important not to ignore or dismiss possible BPD symptoms simply because the person is not an adult, as some of these symptoms (e.g., interpersonal problems, self-harm or suicidal behaviors, and emotional difficulties) may be the early signs of BPD. Basically, the best approach is to balance taking distressing symptoms seriously while not assuming that they are a guarantee that the person is going to develop BPD.
NHP: What are the treatment options for those with BPD? What is the most successful of these?
ALC: The good news is that BPD is actually very treatable. One treatment option that has been found to be particularly helpful is psychological treatment. Psychological treatments basically involve helping people make important changes in their lives, in terms of their emotions, thinking, and behaviors. The psychological treatment with the best scientific evidence thus far is Dialectical Behavior Therapy (DBT), developed by Dr. Marsha Linehan at the University of Washington. In DBT, the patient normally attends weekly individual therapy sessions and weekly group therapy sessions, and the therapist is available to be contacted in-between sessions if the patient needs help or is in a crisis. DBT is aimed at helping people reduce serious, self-damaging behaviors (self-harm, suicide attempts), learn useful life skills for managing emotions and relationships, and get motivated to move forward in life directions that are important to them. Recently, a small number of studies has shown that other psychological treatments have had promising effects for BPD, including Mentalization Based Treatment (developed by Drs. Peter Fonagy and Anthony Bateman), Schema-Focused Therapy (developed by Dr. Jeffrey Young), and Transference-Focused Psychotherapy (developed by Dr. Otto Kernberg).
Another treatment option is medication. The important thing to remember here is that there is no "anti-BPD" medication. Some medications seem to help with some of the symptoms of BPD, and interestingly, many different types of medications (antipsychotic medications, antidepressant medications, mood stabilizing medications) seem to have very similar effects. The medications with the best evidence and the fewest troubling side effects are a specific type of antidepressant - selective serotonin reuptake inhibitors (SSRIs, such as Prozac). Most experts agree that medication treatment alone is not advisable for BPD. So far, psychological treatments have the best evidence for their efficacy, and if a person is on medication, it is generally recommended that she or he also be in a psychological treatment.
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