Intro: BPD is usually diagnosed in Australia using the American Psychiatric Association Diagnostic and statistical manual of mental disorders 5th edition (DSM-5). Prior to the release of the DSM-5 there was much discussion re changing the diagnostic criteria however a decision could not be reached and the criteria remained unchanged from the DSM-IV-TR. (# see note below)
World Health Organization International statistical classification of diseases and related health problems 11th Revision (ICD-11) includes diagnostic criteria for personality disorder and a borderline pattern. The ICD11 also includes a new diagnosis of complex post traumatic stress disorder
A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) or the following:
^ DSM-5 p663
# The appendix (p 766-7) of the DSM-5 lists Proposed Diagnostic Criteria for BPD which mentions "the typical features of BPD as instability of self-image, personal goals, interpersonal relationships, and affect, accompanied by impulsivity, risk taking, and/or hostility. Characteristic difficulties are apparent in identity, self-direction, empathy, and/or intimacy, along with specific maladaptive traits in the domain of Negative Affectivity, and also Antagonism and/or Disinhibition"
……characterised by problems in:
The ICD-11 describes one of the predominant traits as ‘borderline pattern’
The Borderline pattern descriptor may be applied to individuals whose pattern of personality disturbance is characterized by:
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by many of the following:
Complex post traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g. torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). All diagnostic requirements for PTSD are met.
In addition, Complex PTSD is characterised by severe and persistent
1) problems in affect regulation;
2) beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and
3) difficulties in sustaining relationships and in feeling close to others.
These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Ref: Ref: European Journal of Psychotraumatology 2013, 4:20706 and DSM 5
NB. This is a representation of the current understanding. For full criteria please refer to the DSM5 and ICD11
A first meeting/consultation interview between Jake -- diagnosed with BPD (Borderline Personality Disorder) and likely co-occurring PTSD -- and Dr. Choi-Kain, who is an expert clinician and director of the Gunderson Personality Disorders Institute at McLean Hospital.
Debrief with Jake -- diagnosed with BPD (Borderline Personality Disorder) and likely co-occurring PTSD -- after his first meeting with Dr. Choi-Kain (expert clinician/researcher).
Debrief with Dr. Choi-Kain (expert clinician/researcher) after her first meeting with Jake -- diagnosed with BPD (borderline personality disorder) and likely co-occurring PTSD (post-traumatic stress disorder). The main topic is the differences and similarities between BPD and PTSD, and which treatment options may be appropriate at what time -- with a backdrop of Dr. Choi-Kain's first meeting with Jake