For many years, borderline personality disorder was considered a mental illness only associated with adults above age 18, however in recent years mental health professionals have begun to consider the possibility of Borderline Personality Disorder being diagnosed in adolescents. Borderline personality disorder is characterized by extreme patterns of impulsivity such as promiscuous sex, spending sprees, reckless drinking or abusing substances, unstable and intense personal relationships and an unstable self-image, amongst a few other symptoms. It is important to remember when making a diagnosis of Borderline personality disorder that quite often some of the symptoms associated with this illness are experienced by many people from time to time, however people with borderline personality disorder experience these symptoms severely and consistently over a long period of time. The characteristic symptoms of this illness make it difficult to diagnose it in adolescents because the symptoms are often similar to other disorders such as conduct disorder and attention deficit hyperactivity disorder.
1. CLASSIFICATION OF PERSONALITY DISORDERS ACCORDING TO THE DSM-IV:
The DSM-IV-TR classifies a personality disorder as a lasting pattern of inner experience and behaviour that deviates markedly from expectations of an individuals cultural, that is pervasive and inflexible and has an onset from early childhood or adolescence. It should be stable over a period of time and lead to distress or impairment of functioning.
ter>Sam Vaknin's Psychology, Philosophy, Economics and Foreign Affairs Web Sites Patients suffering from eating disorders binge on food and sometimes are both Anorectic and Bulimic. This is an impulsive behaviour as defined by the DSM (particularly in the case of BPD and to a lesser extent of Cluster B disorders in general). Some patients adopt these disorders as their way of self mutilating. ...
The development of personality disorders is mainly regarded as deriving from immature and distorted patterns of personality functioning, which has resulted in inappropriate and maladaptive ways of interacting with and perceiving others.
The DSM-IV identifies 10 personality disorders:
1) Paranoid Personality Disorder, which is characterized by patterns of distrust and suspiciousness that others are motivated to harm them.
2) Schizoid Personality Disorder, which is characterized by patterns of detachment from social relationships and a marked lack of emotional expression.
3) Schizopyal Personality Disorder, which is characterized by severe discomfort in personal relationships, cognitive and perceptual distortions and eccentricities of behaviour.
4) Antisocial Personality Disorder, which is characterized by disregarding and violating the rights of others.
5) Borderline Personality Disorder, which is characterized by patterns of unstable relationships with others, marked impulsivity and unstable self-image and affect.
6) Histrionic Personality Disorder, which is characterized by extreme and excessive emotionality and attention seeking behaviours.
7) Narcissistic Personality Disorder, which is characterized by displays of grandiosity, a lack of empathy and an extreme need for respect and approval.
8) Avoidant Personality Disorder, which is characterized by social inhibition, severe feelings of inadequacy and heightened sensitivity to criticism.
9) Dependent Personality Disorder, which is characterized by an excessive need to be cared for and loved, often resulting in submissive and clingy behaviour patterns.
10) Obsessive-Compulsive Personality Disorder, which is characterized by preoccupation with perfectionism and tidiness.
The DSM-IV has general diagnostic criteria for a Personality disorder:
“A) An enduring pattern of inner experience and behaviour that deviated markedly from the expectations of the individual’s culture. This pattern is manifested in two (r more) of the following areas:
Antisocial Personality Disorder Antisocial Personality Disorder (APD) is perhaps the most frightening of all personality disorders, as well as one of the most difficult to diagnose. Personality disorders in general are defined as inflexible, maladaptive, personality traits that cause personal distress or an inability to get along with others. APD specifically is characterized by deceitfulness, ...
1) Cognition (i.e. ways of perceiving and interpreting self, other people and events)
2) Affectivity (i.e. the range, intensity, liability and appropriateness of emotional response)
3) Interpersonal functioning
4) Impulse control
B) The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
C) The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning.
D) The pattern is stable and of long duration, its onset can be traced back at least to adolescence or early adulthood.
E) The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.
F) The enduring pattern is not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g. head trauma)”
These disorders can have a serious effect on an individual’s quality of life. Personality disorders have a far-reaching affect, not only affecting the individuals themselves, but also their families and loved ones and their work colleagues.
2. DEFINING BORDERLINE PERSONALITY DISORDER:
Borderline Personality Disorder is characterized by a number of different symptoms, most markedly with severe patterns of impulsivity, instability in interpersonal relationships, self-image and affect. There are a number of other symptoms associated with this disorder, such as:
•Suicidal thoughts and behaviours •Heightened and extreme fear of abandonment and rejection, which result in intense emotions from this fear •Intense emotional pain often resulting in Self harming behaviours to reduce the intense pain •Partaking in ‘distortion campaigns’ •Difficult in regulating emotions •Intense feelings of anger and/or emptiness •Stress related changed in thinking, which can result in paranoid thoughts •“Splitting”
Very often individuals with this disorder will experience extreme degrees of emotional pain, which will quite often lead to suicidal thoughts or attempts as they attempt to rid themselves of this intense pain. This pain is perpetuated through their extreme sensitivity to rejection and abandonment often leading to predictions or assumptions of abandonment or rejection, more often than not unprovoked which tends to cause disharmony within personal relationships.
"Multiple Personality Disorders" Sometimes people undergo traumatic experiences in their lives that are either physical or mental and maybe even a combination of both. If the experience was so intense, and so horrible, that the mind didn't want to remember it, or possibly didn't know how to deal or cope with it, then that one experience has the power to split a person's mind into "another ...
This often leads the individual to be unbalanced with in their personal relationships often swiftly swinging between extremes of idealization or absolute hatred. Individuals with Borderline Personality Disorder often use another defence mechanism known as “splitting” which is a form of dichotomous (black and white) thinking. This way of thinking adds to the distress within relationships as the individual struggles to come to terms with the swaying thoughts and feelings one minute being positive and the next tending towards the negative. The intense emotional pain these individuals are often in, tend to result in self-harming and self-injuring behaviours such as head banging and cutting. These behaviours can lead to suicide, however it is not always the intent of an individual self-harming to commit or attempt to commit suicide.
An individual with Borderline Personality Disorder has difficulty regulating their emotions. They often experience extreme emotions, and many feelings of anger. Under stress these individuals often experience in change in thinking patterns – generally leading towards paranoid thoughts that others are purposefully out to harm them. The perceived notion that individuals are out to harm them sometimes results in these individuals taking part in distortion campaigns where by they purposefully go about damaging the reputation or cause disruption and chaos in the life of the person perceived to have caused them harm.
These individuals are often very sensitive to the way they are treated by others, often having a very strong reaction to perceived criticism or hurtfulness. This is another reason why their interpersonal relationships are quite often so unstable. Individuals with Borderline Personality Disorder tend to have an unstable self-image or sense of self, often swinging from feeling positive about their self-image to feeling negative about their self-image in a short period of time. All these feelings seem to culminate and have a knock on effect:
In today's society, we are faced with or placed in many unpredictable and stressful situations. However, many of us manage to properly analyze the situations and maintain our sanity, experiencing only a mild form of depression, if any. Others may encounter similar situations and become mentally depressed. Some reasons for being depressed are normal, such as, a death of a family member, parents ...
Emotional pain, fear of abandonment or rejection appears to cause the individual to behave or react in inappropriate ways within their personal relationships, often leading to disharmony, perpetuating a negative self image, leading to more emotional pain as the poor individual struggles to regulate the emotions, causing self harm as a form of relief from that deep emotional pain they so badly seek.
3. CLASSIFICATION OF BORDERLINE PERSONALITY DISORDER ACCORDING TO THE DSM-IV:
The diagnostic criteria for Borderline Personality Disorder according to the DSM-IV is classified as:
“ A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and a marked impulsivity beginning in early adulthood and present in a variety of contexts, as indicated by five or more of the following:
1) Frantic efforts to avoid real or imagined abandonment: NOTE: Do not include suicidal or self-mutilating behaviour covered in criterion 5. 2) A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation. 3) Identity disturbance: markedly and persistently unstable self-image or sense of self. 4) Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating).
NOTE: Do not include suicidal or self-mutilating behaviour covered in criterion 5.) 5) Recurrent suicidal behaviour, gestures, threats, or self-mutilating behaviour. 6) Affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7) Chronic feelings of emptiness. 8) Inappropriate, intense anger or difficulty controlling anger 9) Transient, stress-related paranoid ideation or severe dissociative symptoms.”
It is now possible to consider diagnosing individuals under the age of 18 with Borderline Personality Disorder. The DSM-IV states the following: “To diagnose a personality disorder in an individual under 18 years old, the features must have been present for at least 1 year”.
4. DIAGNOSING PERSONALITY DISORDERS:
Diagnosing individuals with a personality disorder can be a difficult task. Many of the symptoms of the different disorders can often overlap other disorders, which can make the assessment of an individual difficult.
Multiple Personality Disorder (MPD) Dissociative Identity Disorder (DID) Multiple Personality Disorder (MPD), which is now called Dissociative Identity Disorder (DID), is a Dissociative Disorder. This disorder is when a person has two or more distinct personalities that often control the person's behavior. This disorder has many controversies because of the fact that it is not scientifically ...
‘Normal’ individuals often experience many symptoms described in various disorders from time to time, making a specific diagnosis of a disorder tough. This had lead to the requirement that the symptoms of a disorder be prevalent for a specific period of time.
One needs an effective plan for assessment. Clinical assessments use systematic approach often using strategies including an assessment of the individuals emotional, behavioural and cognitive functioning as well as the role of the environmental factors. One needs to take into consideration many factors when making a diagnosis, such as the individual’s age, gender, history and culture. This is especially important when making a diagnosis of young persons or adolescents.
When making a diagnosis of personality disorders the personality traits of individuals need to be separated from other symptoms that may have appeared – especially in the event of any stressors or traumatic experiences, which are usually diagnosed on AXIS 1. Clinician’s should avoid limiting an assessment to one interview due to stability over a period of time being a crucial feature for making a diagnosis. Clinician’s should try more than one interview as well as enhancing that information by other informants as well, for e.g. that the diagnostic criteria for Personality Disorder as well as at least 5 specific diagnostic criteria for e.g. for Borderline Personality Disorder, should be taken into account before making a diagnosis.
5. DIFFICULTIES DIAGNOSING 16-20 YEAR OLDS WITH BORDERLINE PERSONALITY DISORDER:
Making an accurate diagnosis of Borderline Personality disorder in an adolescent can be difficult. Differentiating between normal teenage behaviour and a disorder can be especially challenging due to the fact that the symptoms of Borderline Personality Disorder often over lap other common teen problems such as:
•Body image •Self image •Rivalry amongst peers and siblings •Teenage sex •Drugs and Alcohol abuse •Weight issues •Bullying •Emotional instability due to hormones or external causes (difficulties at school, home, bullying etc.)
In addition to the above mentioned problems teenagers encounter, there are also many common teenage mental health issues such as:
They are your neighbors. They are your friends. Maybe they are even your family. You talk with them often, and have even had them over for dinner on occasion. Perhaps your children play in the same playground or spend time in the same social group. Although you have noticed some quirks and idiosyncrasies, you would never know the difference, and you would never expect the worst. After something ...
•Anxiety disorders •Post traumatic stress disorder •Mood disorders •Eating disorders
All of these factors have to be taken into account when taking on the challenging task of diagnosing an adolescent with Borderline Personality Disorder, however it is important to take note that a teenager with Borderline Personality disorder will engage in extreme behaviours and more often, than the average teenager would resulting in severe disruption and impairment to their school lives, social lives and working lives if they have any.
A diagnosis of Borderline Personality Disorder can often be missed if the clinician does not take all the symptoms and the context in which those symptoms occur into account. There is a commonly held belief that a personality is still developing in late adolescence thus sometimes leading to reluctance on a clinicians part to diagnose an adolescent with Borderline Personality Disorder, however diagnosing an adolescent correctly early enough could have positive effects resulting in the young person may being able to enjoy a life free of the distress caused by such a debilitating mental illness. It is important also, that the clinician takes into account the adolescent’s previous history; their family back ground and their culture when making a diagnosis and takes all steps necessary to avoid ‘labelling’ the adolescent.
6. MISUNDERSTANDINGS SURROUNDING BORDERLINE PERSONALITY DISORDER:
This disorder can be widely misunderstood. This is partly because of the actual nature of the disorder as well as the effects the disorder has on individuals affected by the person who has the disorder such as family, friends and work colleagues. Individuals with this disorder can be regarded as ‘difficult’, ‘temperamental’, ‘angry’ individuals, thus labelling them as troublesome.
Often the individuals behaviour can be seen as manipulative and destructive, which technically speaking it is, however the fact that it is actually an illness is often overlooked especially by those deeply affected by actions taken by the individual with Borderline personality disorder. This disorder also can manifest itself in many different ways often occurring with other disorders such as bipolar disorder, major depression, anxiety disorders and substance abuse. Unfortunately this can sometimes lead to a diagnosis of Borderline Personality Disorder completely being missed.
7. ETIOLOGY OF BORDERLINE PERSONALITY DISORDER:
It appears that as with many other disorders, the etiology of Borderline Personality disorder is quite complex yet seems to involve both the environment within which the individual has grown in, and the genes the individual has inherited.
Research strongly suggests that there is a correlation between childhood sexual abuse and an individual developing this disorder. There is also evidence suggesting that Post-Traumatic-stress disorder and Borderline Personality disorder are closely related. Several other studies provide evidence that person’s suffering from Borderline Personality Disorder have an innate inability to tolerate stress or regulate emotional affects predisposing them to deterioration in unpleasant environmental conditions.
Adolescents or teenagers are often described as being temperamental, moody, impulsive, moody and angry. They are also often described as having a poor self-image and be deemed emotional due to the very real experience of their hormones changing. This coupled with various other issues that can be related to adolescence makes diagnosing an adolescent with a disorder such as Borderline Personality Disorder very challenging. Borderline Personality Disorder has exceptionally similar characteristics to that of a developing and growing teenager.
This disorder can be debilitating to an individuals life, wrecking havoc in relationships and work environments and resulting in the individual living in extreme amounts of emotional pain for large periods of their lives. It is therefore a huge responsibility of the clinician to make the appropriate and correct diagnosis of Borderline Personality Disorder because if a diagnosis is made early enough in the patient’s life, it is highly possible they may make a full recovery and live a full, healthy and emotionally stable life.