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Sunday, January 11, 2009

Are we becoming borderlines?

Andy Alt has left me a link to this article "The Mystery of Borderline Personality Disorder", Times Mag, Jan. 08, 2009 by John Cloud.
I'm puzzled by the reasons borderline diagnose is increasing and scary about what is going to happen with symptoms.
I have nothing more to say. We were anxious and turned depressed. Then bipolarity age appeared strangely enough without mania. What now? Are we borderlines? Are we going to commit suicide under which diagnosis?
I'm getting more and more confused but it's good to know that Harvard claims that some patients improve in a year and to spice things up it's the disease Winonar Ryder played in Girl, Interrupted.


"Borderlines are the patients psychologists fear most. As many as 75% hurt themselves, and approximately 10% commit suicide--an extraordinarily high suicide rate (by comparison, the suicide rate for mood disorders is about 6%). Borderline patients seem to have no internal governor; they are capable of deep love and profound rage almost simultaneously. They are powerfully connected to the people close to them and terrified by the possibility of losing them--yet attack those people so unexpectedly that they often ensure the very abandonment they fear. When they want to hold, they claw instead. Many therapists have no clue how to treat borderlines. And yet diagnosis of the condition appears to be on the rise."

"A 2008 study of nearly 35,000 adults in the Journal of Clinical Psychiatry found that 5.9%--which would translate into 18 million Americans--had been given a BPD diagnosis. As recently as 2000, the American Psychiatric Association believed that only 2% had BPD. (In contrast, clinicians diagnose bipolar disorder and schizophrenia in about 1% of the population.) BPD has long been regarded as an illness disproportionately affecting women, but the latest research shows no difference in prevalence rates for men and women. Regardless of gender, people in their 20s are at higher risk for BPD than those older or younger.

There are several theories about why the number of borderline diagnoses may be rising. A parsimonious explanation is that because of advances in treating common mood problems like short-term depression, more health-care resources are available to identify difficult disorders like BPD. Another explanation is hopeful: BPD treatment has improved dramatically in the past few years. Until recently, a diagnosis of borderline personality disorder was seen as a "death sentence," as Dr. Kenneth Silk of the University of Michigan wrote in the April 2008 issue of the American Journal of Psychiatry. Clinicians often avoided naming the illness and instead told patients they had a less stigmatizing disorder.

Therapeutic advances have changed the landscape. Since 1991, as Dr. Joel Paris points out in his 2008 book, Treatment of Borderline Personality Disorder, researchers have conducted at least 17 randomized trials of various psychotherapies for borderline illness, and most have shown encouraging results. According to a big Harvard project called the McLean Study of Adult Development, 88% of those who received a diagnosis of BPD no longer meet the criteria for the disorder a decade after starting treatment. Most show some improvement within a year."

6 comments:

Andy A said...

Ana, you're right to be confused and you asked a good question in your other comment: "Why are more people being diagnosed?"

And then you quoted this part:
"A 2008 study of nearly 35,000 adults in the Journal of Clinical Psychiatry found that 5.9%--which would translate into 18 million Americans--had been given a BPD diagnosis. As recently as 2000, the American Psychiatric Association believed that only 2% had BPD. (In contrast, clinicians diagnose bipolar disorder and schizophrenia in about 1% of the population.) BPD has long been regarded as an illness disproportionately affecting women, but the latest research shows no difference in prevalence rates for men and women. Regardless of gender, people in their 20s are at higher risk for BPD than those older or younger."

Some of the questions we have to ask would be: 1.) What criteria did they use when they selected the individuals to participate in the study? 2.) In 2000, how did the APA come up with the 2%?

I'd say, Ana, that you are right to be skeptical or confused. There are still questions to be asked and answers to be given.

Ana said...

It seems to me that they are shuffling it all.
I don't know what a person who is diagnosed bipolar suffers any longer.
I knew very well what was "maniac-depressive psychosis", yes a terrible name but at least it said something.
Now we have a plethora of letters:

ADHD, ADD, OCD, BPD, PTSD, MDD,

I don't know.
It makes less and less sense to me.
It's alarming!

Ana said...

Criteria!
Yes!
It seems they change every year.

Dano MacNamarrah said...

Hello!

I was having trouble posting a comment, but look out NOW!

I always liked the Manic-Depressive term. It was to the point. I don't like Bipolar, because it make me think of polar bear s in twos.

I also have a Borderline Traits diagnoses, maybe because I SI? When I told my p-doc, he smiled and nodded.

Turns out, the BPD came about in the 60's, when kids like Suzanne (Girl, Interrupted) we're not behaving like their parents wanted them to.

He says it's a catch-all phrase, like Irritable Bowl. That it's applied when nothing else will.

Too many docs needing to name behavior that has always been around. Bad manners and parenting are now diagnosable.

Ana said...

I'm so glad you're here, Dano!
They don't know what to do with SI.
Polar bears in twos!
lol
Love,
Ana

Tormented said...

Maybe someday there will be a test using DNA or MRI brain scans to look for the presence of BPD.

TIME's article didn't discuss much about the genetic basis for BPD. But such research is being conducted. Some of it is suggesting that at least part of the development of BPD is caused by genes on chromosomes 1, 4, 9, and 18.

Links to the studies and other biological research on BPD are mentioned in a blog posting BPD Linked to Human Chromosome 9 .

Also, I've read previously that some researchers found that functional MRI scans show distinct differences in brain structures in people who have BPD versus those who don't.