April 15, Accepted: May 12, Published: May 15, Citation: Int J Ment Health Psychiatry 1:
Whatever the purported underlying psychological structures, the cluster of symptoms and behaviour associated with borderline personality were becoming more widely recognised, and included striking fluctuations from periods of confidence to times of absolute despair, markedly unstable self-image, rapid changes in mood, with fears of abandonment and rejection, and a strong tendency towards suicidal thinking and self-harm.
Transient psychotic symptoms, including brief delusions and hallucinations, may also be present. The characteristics that now define borderline personality disorder were described by Gunderson and Kolb in and have since been incorporated into contemporary psychiatric classifications see Section 2.
An overlap with psychotic disorders can also be considerable. In extreme cases people can experience both visual and auditory hallucinations and clear delusions, but these are usually brief and linked to times of extreme emotional instability, and thereby can be distinguished from the core symptoms of schizophrenia and other related disorders Links et al.
Because of this considerable overlap with other disorders, many have suggested that borderline personality disorder should not be classified as a personality disorder; rather it should be classified with the mood disorders or with disorders of identity.
Despite these concerns, borderline personality disorder is a more uniform category than other personality disorders and is probably the most widely researched of the personality disorders.
While some people with borderline personality disorder come from stable and caring families, deprivation and instability in relationships are likely to promote borderline personality development and should be the focus of preventive strategies.
The course of borderline personality disorder is very variable. Most people show symptoms in late adolescence or early adult life, although some may not come to the attention of psychiatric services until much later. It is not known to what extent this is a consequence of treatment — evidence suggests that a significant proportion of improvement is spontaneous and accompanied by greater maturity and self-reflection.
There is some controversy over the possible age of onset of borderline personality disorder. Many believe that it cannot, or perhaps should not, be diagnosed in people under 18 years of age while the personality is still forming although diagnosis is possible in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition [ DSM-IV ; APA, ] based on the same criteria as adults with additional caveats.
Nevertheless, borderline symptoms and characteristics are often identifiable at a much earlier age, and sometimes early in adolescence Bradley et al. More attention is now being paid to its early manifestations in adolescent groups see Section 2. Borderline personality disorder is associated with significant impairment, especially in relation to the capacity to sustain stable relationships as a result of personal and emotional instability.
For many the severity of symptoms and behaviours that characterise borderline personality disorder correlate with the severity of personal, social and occupational impairments.
However, this is not always the case, and some people with what appears to be, in other ways, marked borderline personality disorder may be able to function at very high levels in their careers Stone, Many, but not all, people with borderline personality disorder recurrently harm themselves, usually to provide relief from intolerable distress, which for many can lead to significant physical impairment and disability.
Although the prognosis of borderline personality disorder is relatively good, with most people not meeting the criteria for diagnosis after 5 years, it is important to note that a minority of people have persistent symptoms until late in life. Recurrent self-harm may occasionally be a problem in the elderly and the possibility that this may be because of borderline personality disorder should be considered in such circumstances.
However, the prevalence of the condition in the elderly is much lower than in the young and one of the encouraging features about remission from the condition is that it is much less often followed by relapse than is the case with most other psychiatric disorders.
Comorbidities Borderline personality disorder is a heterogeneous condition and its symptoms overlap considerably with depressive, schizophrenic, impulsive, dissociative and identity disorders. This overlap is also linked to comorbidity and in clinical practice it is sometimes difficult to determine if the presenting symptoms are those of borderline personality disorder or a related comorbid condition.
The main differences between the core symptoms of borderline personality disorder and other conditions are that the symptoms of borderline personality disorder undergo greater fluctuation and variability: For each of the equivalent comorbid disorders there is much greater consistency of these symptoms.
The reliability and validity of the diagnostic criteria have been criticised, and the utility of the construct itself has been called into question Tyrer, Moreover, it is unclear how satisfactorily clinical or research diagnoses actually capture the experiences of people identified as personality disordered Ramon et al.
The extent of overlap in research studies is particularly great with other so-called cluster B personality disorders histrionic, narcissistic and antisocial. In addition, there is considerable overlap between borderline personality disorder and mood and anxiety disorders Tyrer et al.
According to DSM-IV, the key features of borderline personality disorder are instability of interpersonal relationships, self-image and affect, combined with marked impulsivity beginning in early adulthood. Comparisons of DSM and ICD criteria when applied to the same group of patients have shown that there is little agreement between the two systems.
For example, in a study of 52 outpatients diagnosed using both systems, less than a third of participants received the same primary personality disorder diagnosis Zimmerman, Further modifications in the ICD and DSM are required to promote convergence between the two classifications, although greater convergence is unlikely to resolve the problems inherent in the current concept of personality disorder.
The reliability of diagnostic assessment for personality disorder has been considerably improved by the introduction of standardised interview schedules. The main instruments available for assessing borderline personality disorder are listed in Table 2. When used by a properly trained rater, all of the schedules allow for a reliable diagnosis of borderline personality disorder to be made.
Nevertheless, the level of agreement between interview schedules remains at best moderate Zimmerman, In addition, clinical and research methods for diagnosing personality disorders diverge.
Westen has found that although current instruments primarily rely on direct questions derived from DSM-IVclinicians tend to find direct questions only marginally useful when assessing for the presence of personality disorders.
Instead, clinicians are inclined to arrive at the diagnosis of personality disorder by listening to patients describe interpersonal interactions and observing their behaviour Westen, Table 2 The main instruments available for the assessment of borderline personality disorder.
Currently, outside specialist treatment settings, there is still a heavy reliance on the diagnosis of borderline personality disorder being made following an unstructured clinical assessment. However, there are potential pitfalls in this approach.Not all patients with post-traumatic stress disorder (PTSD) respond to cognitive behavioural therapy (CBT).
Literature suggests group music therapy might be beneficial in treating PTSD.
However, feasibility and effectiveness have not been assessed. includes a demographic description of the client, the presenting problem, the goal of treatment, any legal, ethical, or safety issues, the treatment plan, the interventions being employed, what stage of treatment the client is in, and the provisional diagnosis--which is always subject to change.
Anxiety disorders are different, though. They are a group of mental illnesses, and the distress they cause can keep you from carrying on with your life normally.
For people who have one, worry and. Co-occurring disorders were previously referred to as dual diagnoses. According to SAMHSA’s National Survey on Drug Use and Health (NSDUH) (PDF | MB), approximately million adults in the United States had co-occurring disorders in THE NEUROLOGY OF MUSIC IN PTSD TREATMENT!!
2! Acknowledgements A special thanks goes out to my chair, Lance Peterson, for being patient, supportive, and encouraging throughout this process. Stuttering can also negatively influence job performance and opportunities, and treatment can come at a high financial cost.
Symptoms of stuttering can vary significantly throughout a person’s day. In general, speaking before a group or talking on the telephone may make a person’s stuttering more severe, while singing, reading, or speaking.