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Borderline personality disorder dsm 5 code


Diagnosing borderline personality disorder - PMC

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Borderline | Personality disorder

What is borderline personality disorder (BPD)?

There is confusion around the diagnosis of BPD, known in the WHO classification (ICD-10) as Emotionally unstable personality disorder, borderline type. In order to understand the nature of the disorder, a word about personality disorders (PDs) in general is necessary, as BPD is in some ways unique among PDs.

Personality disorders are a group of mental health difficulties that are present throughout a persons life, and are part of their normal way of relating with other people, and thinking of themselves – and the actions that stem from this. They are disorders in that they cause suffering, either to the person themselves or (less commonly) those around them. Not everyone with a PD seeks help, in fact most probably do not; like most disorders, a PD can be more or less severe, and cause more problems at particular times of life, such as during transitions (leaving home, changing job, loss events). About 5% of the population of the UK would be diagnosed with a PD of some sort (there are 9 or 10 types depending on the classification system used) if they presented to a psychiatrist, which gives an indication of how few actually do. As a comparison, this is five times as many as suffer with schizophrenia, very few of whom do not receive a diagnosis and treatment at some point in their lives if they live in the developed world. There is debate about whether PDs should be classified with other mental illnesses, as they differ in important ways: they tend to be lifelong and consistent, or stable, throughout most of that time; in other words they seem more like a part of the way the person is constituted than an illness visited upon them. In this they may appear to resemble autistic spectrum disorder or differences in a continuous variable such as IQ more than for example schizophrenia or depression.

The ICD-10 lists the personality disorders as follows:

F60  Specific personality disorders

F60.0  Paranoid personality disorder
F60.1  Schizoid personality disorder
F60.2  Dissocial personality disorder
F60.3  Emotionally unstable personality disorder
.30 Impulsive type
.31 Borderline type
F60. 4  Histrionic personality disorder
F60.5  Anankastic personality disorder
F60.6  Anxious [avoidant] personality disorder
F60.7  Dependent personality disorder
F60.8  Other specific personality disorders
F60.9  Personality disorder, unspecified

Borderline personality disorder differs from the other PDs in important ways. It is probably less stable and lifelong than other PDs, although this may be an artefact of the larger body of research devoted to BPD. It appears to be less pervasive, meaning people with BPD tend not to present in the same way in different situations. This is curious, as pervasiveness is a central element of the personality disorders. People with BPD are also more likely to seek treatment than people with other PD diagnoses; the majority of people receiving treatment in specialist centres suffer from BPD, often with one or more other PDs.

The most prominent features of BPD are self harm/suicidality, emotional instability (unpredictable variations in mood, both sad/happy and angry/irritable), impulsivity (doing things on impulse without due consideration of the consequences) and disordered attachment (stormy relationships, very strong feelings of abandonment when a close relationship ends). It is the first two of these that most commonly lead to people seeking help.

The International Classification of Diseases 10 of the World Health Organisation (ICD-10) includes the following description of emotional unstable personality disorder:

F60.3  Emotionally unstable personality disorder

A personality disorder in which there is a marked tendency to act impulsively without consideration of the consequences, together with affective instability. The ability to plan ahead may be minimal, and outbursts of intense anger may often lead to violence or “behavioural explosions”; these are easily precipitated when impulsive acts are criticised or thwarted by others. Two variants of this personality disorder are specified, and both share this general theme of impulsiveness and lack of self-control.

F60.30 Impulsive type
The predominant characteristics are emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others.

F60.31 Borderline type
Several of the characteristics of emotional instability are present; in addition, the patient’s own self-image, aims, and internal preferences (including sexual) are often unclear or disturbed. There are usually chronic feelings of emptiness. A liability to become involved in intense and unstable relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a series of suicidal threats or acts of self-harm (although these may occur without obvious precipitants).

The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM 5) specifies 5 out of the following 9 symptoms must be present for the diagnosis to be made:

  1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization 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 behavior covered in Criterion 5.
  5. Recurrent suicidal behavior, gestures, or threats, or self- mutilating behavior.
  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 (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

There is some debate about whether BPD should continue to be regarded as a single entity, as it can appear to be a collection of symptoms which happen to occur together in a group of people but perhaps as commonly occur separately, and that labelling them as a syndrome when occurring together does not add much to our understanding. A similar argument occurs about PDs as a whole, as comorbidity is so common (i.e. if you have one you are very likely to have more than one), and statistical experiments sometimes fail to identify the PDs (or indeed BPD) in the population (through for example cluster analyses). To widen matters further, following the publication of DSM 5, the usefulness of the term schizophrenia was called into question by the British Psychological Society. These debates are not uncommon in psychiatry.

Borderline Personality Disorder

The clinical category "Borderline Personality Disorder" is attracting the growing attention of researchers and public health officials around the world.

ICD-10. ICD-10 classifies borderline personality disorder as a subset of emotionally unstable personality disorder.

The characteristics of BPD are more clearly defined in the American DSM-5 classification of mental disorders, and therefore the bulk of the world literature on this disorder is based on the DSM-V definition of BPD:

DSM - V . According to the DSM-V, features of borderline personality disorder include marked instability in interpersonal relationships, self-image, emotional instability, and marked impulsivity. All signs of the disorder occur at a young age and manifest themselves in various situations. Diagnosis requires the presence, in addition to the general criteria for a personality disorder, five (or more) of the following:

nine0020
  • Tendency to make excessive efforts to avoid real or imagined abandonment. Note: Do not include suicidal behavior and acts of self-harm described in Criterion 5.
  • Tendency to engage in intense, tense and unstable relationships characterized by alternating extremes of idealization and devaluation.
  • Identity disorder: marked and persistent instability of the image or feeling of the self.
    • nine0021 Impulsivity in at least two areas that involve self-harm (eg, spending money, sexual behavior, substance abuse, traffic violations, habitual overeating). Note: Do not include suicidal behavior and acts of self-harm described in Criterion 5.
  • Recurrent suicidal behavior, hints or threats of suicide, acts of self-harm.
  • Affective instability, very changeable mood (for example, periods of intense dysphoria, irritability or anxiety, usually lasting for several hours and only occasionally for several days or more). nine0022
  • Constantly experienced feeling of emptiness.
  • Inappropriate manifestations of intense anger or difficulty in controlling anger (eg, frequent irritability, persistent anger, repeated fights).
  • Transient stress-induced paranoid ideas or severe dissociative symptoms

    • The lives of people with borderline personality disorder are often filled with agonizing emotional swings, relationship problems, self-harmful behavior, and chronic suicidality. nine0042

    Women suffer from BPD significantly more often than men.

    Issue: BPD burden

    • BPD is considered in the world literature as one of the most costly categories of mental disorders;
    • According to current epidemiological studies, up to 6% of the adult population in developed countries suffers from BPD;
    • 20% of psychiatric patients meet a diagnosis of BPD according to DSM-5 criteria; nine0022
    • 10% of outpatient mental patients meet the diagnosis of BPD;
    • BPD patients account for up to 50% of all patients, the most active use of mental health services resources;
    • 10% of BPD patients complete suicide (50 times more than the general population)
    • Highest risk of suicide among all mental disorders (for women), and second highest risk of suicide among all mental disorders in men;
      • nine0021 According to post-mortem psychological examination, up to 1/3 of suicides are committed by people with BPD.

    Borderline personality disorder signs and symptoms • Psychologist Yaroslav Isaikin

    According to the Diagnostic and Statistical Manual of Mental Disorders

    According to DSM-V, signs of borderline personality disorder include severe instability in interpersonal relationships, self-image, emotional instability, and pronounced impulsiveness. nine0003

    All signs of the disorder begin at a young age and appear in a variety of situations.

    Diagnosis requires five (or more) of the following in addition to the general criteria for a personality disorder:

    1. A tendency to exert excessive effort to avoid a real or imagined fate being abandoned . Note: Do not include suicidal behavior and acts of self-harm described in Criterion 5.
    2. Tendency to engage in intense, tense and unstable relationships characterized by alternation of extremes - idealization and devaluation.
    3. Identity disorder: noticeable and persistent instability of the image or feeling of the self.
    4. Impulsivity in at least two areas that involve self-harm (eg, spending money, sexual behavior, substance abuse, traffic violations, habitual overeating). Note: Do not include suicidal behavior and acts of self-harm described in Criterion 5.
    5. Recurrent suicidal behavior, hints or threats of suicide, acts of self-harm .
    6. Affective instability, very changeable mood (for example, periods of intense dysphoria, irritability or anxiety, usually lasting for several hours and only occasionally for several days or more).
    7. Constantly experienced feeling of emptiness .
    8. Inappropriate manifestations of intense anger or difficulty controlling anger (eg, frequent irritability, persistent anger, repeated fights).
    9. Transient stress-induced paranoid ideas or severe dissociative symptoms

    Behavioral patterns in Borderline Personality Disorder (Marsha M. Linehan)

    1. Emotional vulnerability - significant difficulty in regulating negative emotions, including high sensitivity to negative emotional stimuli and slow return to normal emotional state and a sense of their own emotional vulnerability. May include a tendency to blame the social environment for unrealistic expectations and demands. nine0022
    2. Self-invalidation - tendency to ignore or deny, not to recognize one's own emotional reactions, thoughts, ideas and behavior. Unrealistically high standards and expectations are being set. May include intense shame, self-hatred, and self-directed anger.
    3. Ongoing crisis – model of frequent stressful, negative environmental events, breakdowns and obstacles, some of which arise as a result of an individual's dysfunctional lifestyle, inadequate social environment or random circumstances. nine0022
    4. Repressed feelings - The tendency to suppress and over-control negative emotional reactions - especially those associated with grief and loss, including sadness, anger, guilt, shame, anxiety and panic.
    5. Active passivity - a tendency to a passive style of solving interpersonal problems, including the inability to actively overcome the difficulties of life, often in combination with vigorous attempts to involve members of one's environment in solving one's own problems; learned helplessness is the lack of motivation for an individual to respond by action in situations where there is a real opportunity to improve the situation. nine0022
    6. Perceived competence - the tendency of an individual to appear more competent than he actually is; usually explained by the inability to generalize the characteristics of mood, situation and time; also the inability to demonstrate adequate non-verbal signals of emotional distress.

    Take the BPD probability test

    Clinical Rating Scale for Borderline Personality Disorder (Dmitry Romanov)

    Allows the diagnosis of BPD based on consideration of signs that are easily identified through an appropriate question asked to the patient by a doctor (features 2-13), as well as based on the assessment of the patient's behavior during the interview (sign 15). Confident diagnosis of BPD is carried out when registering a total score of 12 points or more. nine0003

    1. Female

    Most studies indicate that BPD is more common in females. Recent studies of BPD demonstrate the predominance of females compared to males by almost 2 times (Wang L., Ross C. A., Zhang T., Dai Y., Xiao, Z., 2012). In addition, women with BPD seek specialized help more often than men, which, in particular, is due to gender differences in social rules of behavior.

    2. Presence of a situation of violence in childhood and adolescence 9(Goldberg D., 2010) one and parents, etc.)

    A frequently observed anamnestic symptom of BPD is associated with the subsequent formation of gender identity disorders in patients (Kernberg O., 1975)

    4. Hostility towards one of the parents

    5. Early separation (for example, early marriage, leaving the parental home after reaching the age of majority)

    due to the existing defect of formation, they are incapable of complete separation and often experience hostile feelings towards the parent, with whom separation problems are associated, as well as towards the marriage partner. Patients are characterized by an overvalued desire to free themselves from the control of significant persons (McWilliams N., 1994)

    7. History of self-harm/suicide

    Almost all researchers call this diagnostic feature as an obligate criterion for BPD (Lainen M., 2008). Clinical diagnostic criterion DSM-V

    8. History of at least one episode of brutal aggressive behavior (attack, destruction of things)

    Behavioral equivalent of the DSM diagnostic criterion 5

    consequences

    An extremely high association of BPD and substance use disorders has been shown, reaching 73% (B. Grant et al., 2008)

    Frequently noted by investigators BPD

    11. More than one marriage (including common-law marriage)

    Associated with the inability of patients with BPD to establish long-term relationships based on trust (see relevant DSM diagnostic criterion 5)

    12.

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