How do we distinguish between bipolar mood disorder, cyclothymic temperament, and borderline personality disorder?
Borderline personality disorder is marked by primitive defenses and interpersonal hypersensitivity.The ability to accurately distinguish between these conditions frequently leads to treatment success; misdiagnosis can result in major failures.
For instance,. Lithium therapy can lead to remission of symptoms and prevention of future episodes in appropriately selected patients . In contrast, medication does not treat the core symptoms of borderlinedisorder. Misdiagnosis of borderline personality disorder as a mood disorder often results in multiple failed medication trials and prolonged suffering and impairment.Much diagnostic confusion results from significant symptomatic overlap, particularly in the area of mood symptomatology. Below are two fundamental features of borderline personality disorder that are not present in bipolar spectrum disorders. I teach psychiatry residents to use these pointers to help differentiate the two forms of psychopathology. They are:. These defenses pervade the lives of borderline patients. For instance, splitting refers to the tendency to see self and others as being either"all good" or"all bad," with an inability to see things in"shades of gray." This symptom is captured by2. Borderline personality disorder is marked by the patient's fundamental interpersonal hypersensitivity . Symptoms of borderline personality disorder are mediated by the patient's subjective experience of the major object . This was Gunderson's seminal contribution to understanding borderline psychopathology. He wrote, for instance, that the"characteristic disturbances in interpersonal relations uniformly provide the most distinguishing aspect of the borderline syndrome vis-à-vis a variety of other diagnoses" . Contrary to Linehan's claim that emotional dysregulation represents the"core" of borderline personality disorder, mood problems in borderline patients are actually secondary to interpersonal hypersensitivity, which is the"engine" that drives all borderline symptoms.which Masterson saw as the primary affective state in the borderline personality. For instance, a person with borderline personality disorder may experience feelings of depression, emptiness, anddespair in response to a minor or imagined distancing by their romantic partner. These symptoms can easily be misdiagnosed as a major mood disorder. Mood symptoms are actually a very poor discriminating feature, and this is the source of much confusion, misdiagnosis, and mistreatment . Both borderline personality disorder and bipolar spectrum disorders can present with intense affective shifts, but in borderline patients, these shifts are reactive to interpersonal events rather than driven by endogenous mood cycling. In addition, individuals with cyclothymic temperament exhibit chronic, low-grade mood instability that fluctuates independently of relational dynamics and lacks the. Arlington, VA: American Psychiatric Publishing., is an Assistant Professor of Psychiatry at the University of Central Florida College of Medicine and Adjunct Assistant Professor of Psychiatry at Tufts University School of Medicine.Being overly polite might seem kind, but it often leads to problems anyway, in relationships, with friends, and at work.Self Tests are all about you. Are you outgoing or introverted? Are you a narcissist? Does perfectionism hold you back? Find out the answers to these questions and more with Psychology Today.
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