Borderline on the outs in DMSV...

[DebDynamite]

One of the residents here relayed a rumor to me that Borderline PD will not be in the DSMV (or, maybe fall into PD NOS). Anyone heard about this?

If so, what will I diagnose my sister with?

 

[strangeglove]

I'm guessing that they are not planning on doing away with the diagnosis altogether, but instead are giving it a name that gets away from historical psychosis/neurosis distinctions and is more descriptive of the symptomatology. Something like "Emotional Intensity Disorder."

 

[Anasazi23]

One of the residents here relayed a rumor to me that Borderline PD will not be in the DSMV (or, maybe fall into PD NOS). Anyone heard about this?

If so, what will I diagnose my sister with?

Unfortunately, it's a lot more complicated than this. According to "A Reseaerch Agenda for DSM-V," by Kupfer, First, and Regier, the entire personality disorder characterization is undergoing major review.

They point out that personality disorders have existed in every edition of the DSM, but were given increased prominence starting with DSM-III (1980), with the addition of the separate axis system, in order to bring closer attention to it as a treatment focus. The basic tenants of the disorders, however have not changed (i.e. they are maladaptive patterns, lifelong, deeply ingrained, etc.).

This purported system, however, is also not without its faults. Alternate dimension models, for example, have difficulty distinguishing between normal and abnormal personality or "living" patterns per se.

All this is to say nothing of the now-on-the-verge biological markers that may also contribute to the formation of personality disorders. They go on to cite an example of Coccaro's literature on the remarkably consistent low 5-hydroxytryptamine activity across personality disordered samples.

They go on further to elucidate other aspects of interest in the nomenclature and development of what will eventually be DSM-V personality disorders.

To make a long story longer, they cite:
Childhood development assessment
Physical health
Treatment
Personality Traits/Disorders and their Relation to Axis I disorders
Personality Traits as a function of Axis I Spectrum Condition (they cite specifically two important subcategories: Schizophrenia spectrum and Mood disorder spectrum disorders)
Cross-Cultural and Gender issues
Relational disorders (a huge area of future research and likely inclusion into DSM-V) i.e. "Marital Conflict Disorder without Violence"

Then, some of these above categories are further subdivided into research and inclusion areas...i.e. Cultural attitues toward relational disorders

I really enjoy seeing the evolution of the DSMs, and those on the board for a while know I value my copy of the DSM-I with my life. Still the best one in my opinion....

Those interested should pick up the above mentioned book. It's good with a bottle of Merlot when you're bored. Or a good Belgium beer for that matter.
Still polishing off the cases of Seasonal Sam Adams people brought for me this Winter.....
/ circumstantiality


Since that time, there has been criticism directed toward the classification of such disorders, and indeed, only two of the PDs were empirically validated across samples prior to inclusion in the DSM. This is not to say, however, that these patterns of personality maladaptation do not exist, but that the "statistical" part of the Diagnostic and Statistical Manual, was essentially lacking.

This criticism led to what many on the DSM-V taskforce are strongly considering....a spectrum or dimensional approach to personality disorders, using supposedly validated assessment instruments. The examples they cite include the Five Factor Model (FFM), the Tridimensional Character Inventory (TCI), the Dimensional Assessment of Personality Psychopathology-Basic Questionnaire (DAPP-BQ), and the Schedule for Nonadaptive and Adaptive Personality (SNAP).

 

[toby jones]

Has anyone seen the Psychodynamic Diagnostic Manual (PDM) that came out last year? I didn't think it was so good on the majority of disorders (just piggybacked on the DSM) but I thought the section on personality disorders was interesting.

I think a dimensional approach is a good idea. Of course there are arbitrary cut offs with respect to when we want to regard something to be a 'disorder' but oh well, such is life. However many standard deviations from the mean and there you go.

 

[whopper]

Aside from the borderline like traits such as talking about a rumor which might not be true....

Borderline is a commonly diagnosed and well accepted dx that is very reproducible in studies (at least from what I understand. For example DBT has been verified as effective in studies and for that to be possible BPD had to be verifiable in studies. Someone correct me if I'm wrong.) (http://nyspi.org/ar2000/Research/PersonalityStudies.html States that personality disorder dx show as very reliable in studies).

If Borderline will be removed from DSM V, there probably will be a better diagnosis that incorporates the condition that Borderline patients have, that has some improvements and updates that hopefully will lead to better practice.

now-on-the-verge biological markers that may also contribute to the formation of personality disorders

Been reading up on that too. Very cool data.

 

[toby jones]

I'm not sure that inter-rater reliability tells us much about whether we have found a category in nature or not.

People could agree that these people are witches and these people aren't, but of course there is no such natural category as witch. People could agree as to whether something is super-lunary or sub-lunary, but of course there is no such natural category as super-lunary object. People could agree that these people have a cough disorder and these other people don't, but of course there is no such natural category as cough disorder. Etc etc.

And of course we can develop questionares and surveys and rating scales to make the whole thing seem more scientific. Internal consistency and inter-rater reliability are no guarantee of our having found a category in nature, however. We might have a consistent concept but (as in the above cases) so what?

Borderline Personality Disorder has an interesting history...

I'm not sure what will happen to it in future. I like the idea of a dimensional classification system for the personality disorders (where traits are distributed across the population and personality disorders are diagnosed when people present with extreme traits).

I quite like Linehan's notion of Borderline Personality Disorder as a disorder of emotion dysregulation rather than the current name which originally had wider application to cover a range of conditions where people initially seemed neurotic (amenable to free association) but then regressed / fragmented to a psychotic state during a course of analysis...

 

[DebDynamite]

Thanks for all of the thoughtful responses to this post. Personality disorders fascinate me. When I was studying for Step1, one of my instructors pointed out that no matter where you go, they seem to persist globally- then he listed a ton of developed nations that all seem to have about a 10% prevalence of PD's.

Since then, I have always wondered if in fact "we" as a society, enable them. For instance, lots of antisocials may have been thrown to the lions during the Roman empire, Schizotypals would have been burned at the stake 500 years ago, (Whopper, I'm MUCH more schizotypal than borderline ), borderlines & histrionics ostracized to the point that they might remit a LOT faster in a more impoverished culture, etc.... Not that I'm advocating burning myself at the stake or throwing all the hustlers to the lions.... Actually I'm looking for a program that has really strong DBT & CBT...

I have looked at the local used book store for a DMS1 & indeed they are rare & hard to find. If I ever obtain more than one copy, I'm selling it on Ebay.

 

[cleareyedguy]

They've debated merging axis I and II, but BPD ain't going away