Bipolar 2.

[Stagg737]

I had a couple of cases recently that brought up this BPAD/BPD/CPTSD issue and I had also run into some reasonable clinicians (a psychologist at work, the Ghaemi book that several people had recommended in another thread recently) that advocated an approach different than the relatively prevailing take in this thread.

I'm curious about peoples' thoughts regarding patients who largely meet BPD criteria but specifically do not report intense/unstable relationships and frantic efforts to avoid abandonment? Are those necessary defining features (rule out) of BPD for you or do we just lack a good alternative diagnostic label for patients where chronic baseline/non-episodic mood lability/impulsivity/anger/identity challenges are an issue?

And apologies for the necrobump. Felt like this thread was good context for my question.

I think this is where the alternative/dimensional model becomes far superior to our current categorical model of diagnosing personality disorders. It's not impossible, but when you chip away at things those patients often do have other significant traits that mask the unstable relationships or fear of abandonment. I've had plenty of patients deny those symptoms because they don't let themselves get close others. Imo, the more important thing to look for is if there is a significant identity and interpersonal disturbance (Criterion A of the alternative model). If these aren't present, then there's minimal need for further exploration.

Interestingly to me, ICD 11 has basically gotten rid of all personality disorder diagnoses and their new model is basically "personality disorder, severity, with disturbance of (insert trait domain here". They basically just look at level of dysfunction, and if dysfunction is present then what personality trait/domain is the cause of the disturbance. I like the direction because it allows for a more targeted approach to therapy and symptom management than just diagnosing BPD.

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[clausewitz2]

I think you're talking about a factor analysis of the diagnostic criteria, which ones are essential, which ones are more sensitive/specific in BPD. Gunderson likes to say that an intolerance of aloneness is one of the defining criteria for the diagnosis of BPD. It's tough to see because it's an interpersonal phenomenon rather than an individual symptom.

This is a good paper on this, which says there are three domains/components to BPD diagnosis: disturbed relatedness, affect dysregulation, and behavioral dysregulation. The symptoms that scored the highest were affective instability, inapprorpiate anger, and impulsivity. Avoidance of abandonment was the 2nd lowest symptom that came up clinically, 1st being suicidal or self-injurious behaviors.

Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: findings from the collaborative longitudinal personality disorders study - PubMed

The diagnostic criteria for borderline personality disorder appear to reflect a statistically coherent construct. Three homogeneous components were supported empirically, lending conceptual clarity to different classes of the criteria for borderline personality disorder.

pubmed.ncbi.nlm.nih.gov

Liked, unfortunately, RIP