Problems Relating To The Diagnosis Of Borderline Personality Disorder (BPD):
In order to be diagnosed with borderline personality disorder (BPD) an individual must suffer from AT LEAST FIVE SYMPTOMS out of a total of NINE listed in the DSM V (The Diagnostic And Statistical Manual Of Mental Disorders, Fifth edition). These nine symptoms are listed in the table presented below :
It logically follows, therefore, that two individuals could BOTH BE DIAGNOSED WITH FIVE OF THE ABOVE SYMPTOMS, YET HAVE ONLY ONE OF THESE SYMPTOMS IN COMMON WITH ONE ANOTHER.
However, despite the fact that BPD can manifest itself in very different ways in different individuals, when it comes to therapy we often find that a ‘one-size fits all‘ approach is taken.
Furthermore, the different therapies available for the treatment of BPD tend to focus upon a presumed, single, fundamental, underlying ‘core feature’ of the disorder, yet these features differ depending upon the selected form of therapy. In other words, different types of therapy for BPD are predicated upon differing theories the disorder. In his excellent book, Integrated Modular Treatment For Borderline Personality Disorder, Livesly, a leading expert in the treatment of borderline personality disorder, provides the following examples :
DIALECTICAL BEHAVIOR THERAPY – this therapy focuses primarily upon the symptom emotional dysregulation or, in other words, the inability to control intense, volatile and quickly fluctuating emotions. (To read my article about dialectical behavior therapy, please click here).
MENTALIZATION BASED THERAPY – this therapy assumes the main difficulty that BPD patients suffer from is a marked impairment of their ability to ‘mentalize’ –(To read my post explaining what ‘mentalization’ is, and what may cause impairment to a person’s ability to mentalize,please click here).
TRANSFERENCE-FOCUSED THERAPY – this therapy is predicated upon the notion that the BPD sufferer’s primary problem is a disturbance in his/her fundamental personality structure
SCHEMA-FOCUSED THERAPY – this therapy assumes that the BPD sufferer’s main underlying problem is his/her maladaptive schemas which s/he developed as a result of a dysfunctional childhood. (Click here to read my previously published article entitled : Childhood Trauma Leading To The Development Of Negative Schema.)
And, of course, Livesly points out, the ‘core features’ / symptoms that these different therapies focus, and the different theories that underpin them, dictate the ‘modus operandi in relation to the forms of treatment they provide.
Because BPD is a multifaceted disorder and those who suffer from it will present with different constellations of serious symptoms, treating them with therapies that focus primarily on just one core feature (as in the case of the four therapies described above) may be inadequate – instead, more holistic forms of treatment may be appropriate that integrate methods from an array of therapies relevant to the unique pattern of symptoms manifested by each individual ; this is the main thesis Livesly’s book which can be purchased by clicking the image below :
David Hosier BSc Hons; MSc; PGDE(FAHE).