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Description this book Undergraduate students of psychology. Miller pdf, Download Leslie A. If you want to download this book, click link in the last page 5. Consequently, all disorders, including personality disorders, are listed in Section II of the manual. A person must meet 5 of 9 criteria to receive a diagnosis of borderline personality disorder. These alternative criteria are based on trait research and include specifying at least four of seven maladaptive traits. Its two subtypes are described below. At least three of the symptoms mentioned in F The ICD also describes some general criteria that define what is considered a personality disorder.
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Theodore Millon has proposed four subtypes of BPD. He suggests that an individual diagnosed with BPD may exhibit none, one, or more of the following: .
The Single Woman-Married Man Syndrome by Richard Tuch | Waterstones
People with BPD may be misdiagnosed for a variety of reasons. One reason for misdiagnosis is BPD has symptoms that coexist comorbidity with other disorders such as depression, posttraumatic stress disorder PTSD , and bipolar disorder. People with BPD are prone to feeling angry at members of their family and alienated from them. On their part, family members often feel angry and helpless at how their BPD family members relate to them.
However, these links may apply to personality disorders in general. Onset of symptoms typically occurs during adolescence or young adulthood, although symptoms suggestive of this disorder can sometimes be observed in children. They are also more likely to develop other forms of long-term social disabilities. However, BPD can sometimes be diagnosed before age 18, in which case the features must have been present and consistent for at least one year. A BPD diagnosis in adolescence might predict that the disorder will continue into adulthood.
Lifetime comorbid co-occurring conditions are common in BPD. Compared to those diagnosed with other personality disorders, people with BPD showed a higher rate of also meeting criteria for . A study found that at some point in their lives, 75 percent of people with BPD meet criteria for mood disorders, especially major depression and bipolar I, and nearly 75 percent meet criteria for an anxiety disorder. There are marked gender differences in the types of comorbid conditions a person with BPD is likely to have—  a higher percentage of males with BPD meet criteria for substance-use disorders, while a higher percentage of females with BPD meet criteria for PTSD and eating disorders.
Regardless that it is an infradiagnosed disorder, a few studies have shown that the "lower expressions" of it might lead to wrong diagnoses. The many and shifting Axis I disorders in people with BPD can sometimes cause clinicians to miss the presence of the underlying personality disorder. However, since a complex pattern of Axis I diagnoses has been found to strongly predict the presence of BPD, clinicians can use the feature of a complex pattern of comorbidity as a clue that BPD might be present.
Many people with borderline personality disorder also have mood disorders , such as major depressive disorder or a bipolar disorder. At face value, the affective lability of BPD and the rapid mood cycling of bipolar disorders can seem very similar. First, the mood swings of BPD and bipolar disorder tend to have different durations. In some people with bipolar disorder, episodes of depression or mania last for at least two weeks at a time, which is much longer than moods last in people with BPD.
Second, the moods of bipolar disorder do not respond to changes in the environment, while the moods of BPD do respond to changes in the environment. Similarly, an undesirable event would not dampen the euphoria caused by bipolar disorder, but an undesirable event would dampen the euphoria of someone with borderline personality disorder. Third, when people with BPD experience euphoria, it is usually without the racing thoughts and decreased need for sleep that are typical of hypomania ,  though a later study of data collected in found that borderline personality disorder diagnosis and symptoms were associated with chronic sleep disturbances, including difficulty initiating sleep, difficulty maintaining sleep, and waking earlier than desired, as well as with the consequences of poor sleep, and noted that "[f]ew studies have examined the experience of chronic sleep disturbances in those with borderline personality disorder".
Because the two conditions have a number of similar symptoms, BPD was once considered to be a mild form of bipolar disorder   or to exist on the bipolar spectrum. However, this would require that the underlying mechanism causing these symptoms be the same for both conditions. Differences in phenomenology, family history, longitudinal course, and responses to treatment indicate that this is not the case.
Premenstrual dysphoric disorder PMDD occurs in 3—8 percent of women. They are distinguishable by the timing and duration of symptoms, which are markedly different: the symptoms of PMDD occur only during the luteal phase of the menstrual cycle ,  whereas BPD symptoms occur persistently at all stages of the menstrual cycle. In addition, the symptoms of PMDD do not include impulsivity. About three-fourths of people diagnosed with BPD also meet the criteria for another Axis II personality disorder at some point in their lives. In a major study — see adjacent table — the rate was The Cluster as a whole affects about half, with schizotypal alone affecting one third.
BPD is itself a Cluster B disorder. The other Cluster B disorders, antisocial , histrionic , and narcissistic , similarly affect about half of BPD patients lifetime incidence , with again narcissistic affecting one third or more. Psychotherapy is the primary treatment for borderline personality disorder. Medications are useful for treating comorbid disorders, such as depression and anxiety.
Long-term psychotherapy is currently the treatment of choice for BPD. More rigorous treatments are not substantially better than less rigorous treatments. Transference focused therapy aims to break away from absolute thinking. In this, it gets the people to articulate their social interpretations and their emotions in order to turn their views into less rigid categories.
Who do you think you are?
The therapist addresses the individual's feelings and goes over situations, real or realistic, that could happen as well as how to approach them. Dialectical behavior therapy has similar components to CBT, adding in practices such as meditation. In doing this, it helps the individual with BPD gain skills to manage symptoms. These skills include emotion regulation, mindfulness, and stress hardiness. This type of therapy relies on changing people's behaviors and beliefs by identifying problems from the disorder.
CBT is known to reduce some anxiety and mood symptoms as well as reduce suicidal thoughts and self-harming behaviors. Mentalization-based therapy and transference-focused psychotherapy are based on psychodynamic principles, and dialectical behavior therapy is based on cognitive-behavioral principles and mindfulness. Some research indicates that mindfulness meditation may bring about favorable structural changes in the brain, including changes in brain structures that are associated with BPD.
A review by the Cochrane collaboration found that no medications show promise for "the core BPD symptoms of chronic feelings of emptiness, identity disturbance, and abandonment. Of the typical antipsychotics studied in relation to BPD, haloperidol may reduce anger and flupenthixol may reduce the likelihood of suicidal behavior.
Among the atypical antipsychotics , one trial found that aripiprazole may reduce interpersonal problems and impulsivity. The effect of ziprasidone was not significant. Of the mood stabilizers studied, valproate semisodium may ameliorate depression, impulsivity, interpersonal problems, and anger. Lamotrigine may reduce impulsivity and anger; topiramate may ameliorate interpersonal problems, impulsivity, anxiety, anger, and general psychiatric pathology. The effect of carbamazepine was not significant. Of the antidepressants , amitriptyline may reduce depression, but mianserin , fluoxetine , fluvoxamine , and phenelzine sulfate showed no effect.
Omega-3 fatty acid may ameliorate suicidality and improve depression.
As of [update] , trials with these medications had not been replicated and the effect of long-term use had not been assessed. Because of weak evidence and the potential for serious side effects from some of these medications, the UK National Institute for Health and Clinical Excellence NICE clinical guideline for the treatment and management of BPD recommends, "Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behavior associated with the disorder.
They suggest a "review of the treatment of people with borderline personality disorder who do not have a diagnosed comorbid mental or physical illness and who are currently being prescribed drugs, with the aim of reducing and stopping unnecessary drug treatment". There is a significant difference between the number of those who would benefit from treatment and the number of those who are treated. The so-called "treatment gap" is a function of the disinclination of the afflicted to submit for treatment, an underdiagnosing of the disorder by healthcare providers, and the limited availability and access to state-of-the-art treatments.
Experience of services varies. People with BPD typically have a chronically elevated risk of suicide much above that of the general population and a history of multiple attempts when in crisis. Borderline personality disorder remains the most commonly associated personality disorder with suicide. At the time, there were 60 specialized inpatient beds in England, all of them located in London or the northeast region. With treatment, the majority of people with BPD can find relief from distressing symptoms and achieve remission, defined as a consistent relief from symptoms for at least two years.
Within four years, By the end of the study, Patient personality can play an important role during the therapeutic process, leading to better clinical outcomes. Recent research has shown that BPD patients undergoing dialectical behavior therapy DBT exhibit better clinical outcomes correlated with higher levels of the trait of agreeableness in the patient, compared to patients either low in agreeableness or not being treated with DBT.