The Hidden Diagnosis: "Though It Is Considered to Be Two to Three Times More Common Than Bipolar Disorder or Schizophrenia, [Borderline Personality Disorder] Is Far Less Understood and Grossly under Recognized."

By Gershon, Judy | USA TODAY, May 2007 | Go to article overview

The Hidden Diagnosis: "Though It Is Considered to Be Two to Three Times More Common Than Bipolar Disorder or Schizophrenia, [Borderline Personality Disorder] Is Far Less Understood and Grossly under Recognized."


Gershon, Judy, USA TODAY


BORDERLINE Personality Disorder is a mental health condition that affects roughly 10,000,000 Americans, or more than three percent of the general population. Though it is considered to be two to three times more common than bipolar disorder or schizophrenia, it is far less understood and grossly under recognized. This can be attributed, in large part, to the heavy and cruel stigma that so often misrepresents people suffering from BPD as being manipulative and untreatable. As a result, there is little education about BPD and many patients are not properly diagnosed. In fact, they usually go undiagnosed or are misdiagnosed (often as being bipolar), leading to inappropriate and ineffective treatment protocols. The tragedy is that 10% of those with BPD die by suicide, most 'likely due to lack of information and silence surrounding the disorder. There is effective treatment for BPD, but people need to be educated, informed, and unafraid to access the correct therapy.

According to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, BPD is characterized by a pervasive pattern of instability of interpersonal relationships and self-image, as well as a marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

* Frantic efforts to avoid real or imagined abandonment.

* A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation--something called "splitting."

* Identity disturbance: markedly and persistently unstable self-image or sense of self.

* Impulsivity in at least two areas that potentially are self damaging--spending, sexual activity, substance abuse, reckless driving, and binge eating.

* Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

* Affective instability due to a marked reactivity of mood--intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days.

* Chronic feelings of emptiness.

* Inappropriate, intense anger or difficulty controlling anger--engaging in physical fights frequently.

* Transient, stress-related paranoid ideation or severe dissociative symptoms.

While about 75% of those diagnosed with BPD are women, it is believed there are many more men with it who have not been diagnosed properly. The character portrait of an individual who meets the above criteria would be one who is caught in a storm of extreme emotional swings, in many instances leading to self-destructive and reckless behavior, such as substance abuse and self-mutilation. "Cutting" is one of the more notorious behaviors of a person with BPD--though not everyone with BPD cuts--the purpose of which would be to provide relief from the intensity of the emotions by focusing momentarily on a physical sensation.

Those with BPD are described as "emotional burn victims"--they do not have the "thick skin" or protective mental screen to temper the effects of slights or rejections, which leads to feelings of excruciating and un-abated pain, while others in a similar situation simply would shrug it off. Individuals with BPD lead painful, tormented, and unstable existences; he or she has precious tittle chance to build a strong inner sense of identity or a stable life with lasting meaningful relationships.

The history of the BPD diagnosis dates back to the early 1900s when then-current psychoanalytic perspectives viewed those with mental illnesses either as psychotic or neurotic. The patients who did not fit into either of these categories easily were termed "borderline," as their condition was seen as lying somewhere on the border between psychosis and neurosis. While current therapeutic understanding disputes this perspective, the label "borderline" nevertheless has stuck, and perhaps is a contributing factor in the persistent stigma that plagues the BPD diagnosis. …

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