View Full Version : How easily is it misdiagnosed?


Gourmet
10-20-05, 06:04 AM
Hi. I'm concerned about a loved one recently diagnosed with borderline personality disorder.

Many of the criteria fit. But I have serious doubts on some of the other traits.

Have any of you been misdiagnosed with this? She has been diagnosed Attention Deficit by one physician and from my observations this looks very right. And now a psychiatrist says borderline.

I see more bipolar, but I am most certainly not qualified past my reading and observations of her behavior.

How easy is this misdiagnosed and when it is, is it usually misdiagnosed as bipolar?

thanks.
~gourmet~

UnleashTheHound
10-20-05, 11:29 AM
I was just doing some research on the various personality disorders, and many seem to overlap each other, and overlap with things like ADHD, bipolar, etc.

So I think it's probably easy to be misdiagnosed.

mctavish23
10-20-05, 11:56 AM
I am very glad that I don't work with adults,as I think it's more difficult than working with kids.

I do see adults oncall and have spent many years seeing both.

The thing about Borderline Personality that I look for (in addition to the DSM-IV criteria) is how they handle relationship issues , as well as their resistance to treatment (therapy).

As a general (anecdotal ) rule of thumb, Boderline PD's are notorious for saying "Yes, but" in terms of responding to suggestions for change.

Again, this is anecdotal and I'm not suggesting that I'd diagnose this way, but they can come up with every excuse in the book as to why they didn't follow thru on suggestions /homework from therapy.

They also have a quality where by they "drain you dry (of energy)" and then move on to the next person (to do the exact same things as though they've never heard those ideas before).

I do have friends who're well trained in DBT, which I believe is an excellent, if not THE best therapy for this problem.

take care
mctavish23 (Robert)

QueensU_girl
02-06-06, 05:35 PM
Basically, as my shrinkie honey says "any sexually abused woman who has self-injured is almost automatically labelled as BPD".
(However, the DSM Criteria are much more specific than this.)

Even the 'impulsivity' [of ADD, ferinstance] is usually seen as a BPD trait. hah!

I see the BPD label as a way of saying "you were abused, now you are a pain in the ***, so we will label you with this 'kiss of death' diagnosis, so we can reject you and blame you for your screwed up outcome."

I have not been called this, myself (as I am probably the least 'manipulative' person going) -- but i know a few women who have, when i really think they had other issues, at least as serious as a PD, going on.

Mctavish -- I am of the opinion that DBT [dialectic behavior therapy] is useful for more disorders than just BPD. :) It holds universal appeal to clinicians, i think. I see that it could have good applications for other problems like depression, etc.

PS. re: "Again... every excuse..." -- i think you are referring to "help rejecting complaining". :) This manifestation appears as someone needing to be in the "sick role".

Alternately, the new DSM criteria, i understand, states the Irritability is an alternate variant of Sadness, in the diagnosis of Depression. I think a lot of *****y, whiney, irritable complainers actually have undiagnose and untreated depression.


PPS the "drain you dry" expression. There is a good book out by Albert Bernstein called "Emotional Vampires". It basically covers all the varieties of PD people out there.

The one analogy i have heard and appreciate is this. Most mental disorders drive the sufferer crazy. The personality disorders drive the rest of us crazy. [That is certainly how it feels. There is never any resolution or improvement in a person's status. It's boring and frustrating.]


But i think it is also important to realize that this disorder comes from not having had basic developmental early life needs met (neglect and rejection) coupled with extreme abuse and anger from the main caregiver/s. It's not the person's fault that they have not been able to grow right. The person is still at where they're at.


I think one line from Marsha Linehan's DBT Literature that I perused goes something like this: "we are all doing the best that we can", and that is soooooooo true.

And this remains -- until the sufferer learns new "skill sets", for things such as "handling ambiguity"/learning to not "split" people; avoiding generalizations and jumping to conclusions; managing strong emotions; getting beyond ego-centric thinking [me, me, I, I] coping with ongoing frustration in daily life, etc.


Emma

mctavish23
02-08-06, 07:11 PM
Emma,

Very well said.Thanks.:)

robert

Scattered
02-09-06, 01:40 PM
Hi. I'm concerned about a loved one recently diagnosed with borderline personality disorder.


Many of the criteria fit. But I have serious doubts on some of the other traits.

Have any of you been misdiagnosed with this? She has been diagnosed Attention Deficit by one physician and from my observations this looks very right. And now a psychiatrist says borderline.

I see more bipolar, but I am most certainly not qualified past my reading and observations of her behavior.

How easy is this misdiagnosed and when it is, is it usually misdiagnosed as bipolar?

thanks.
~gourmet~This is a rather large peeve of mine -- there is almost a knee jerk reaction label anyone who has self injured as Borderline. I've worked with borderline clients and I agree with Robert and Emma that it's more the feel of being drained and frequently manipulated that kind of clues me in to Borderline. My observation is that there is a certain group that self harm that really are confused by there own behavior and tend to be very secreative, there is another group that uses their self injury to get a response from others. The first group are people that may have relationship issues, PTSD, self harm or other issues that meet some of the criteria but do not have this black and white manipulative pattern going on. Since Borderline is the only diagnosis that mentions self mutilation, some doctors like Emma said, automatically give the diagnosis.

I think self injury is also well represented in the ADD population. There's a post from a year or so ago where one teen said that all his friends who self injured were also ADD. A reason many self injurer's give for their behavior is to help their focus. When they're not diagnosed with Borderline they are frequently diagnosed with non specific impulse disorder (note ADHD - Hyperactive/Impulsive ) or Bipolar (a large percent of Bipolar individuals also have ADHD). I would really like to see more research done in this area, because treating an ADDer for Borderline alone probably won't help much -- wrong meds, wrong treatment approach. I've known of ADDers to stop the self harm completely once they started stimulent medication for their ADD and not relapse, except when they left off their meds. I've also seen how frequently others being treated for other conditions persist in the behavior despite medications and treatment. If ADD is in play -- it's really important to treat it if one wants a successful outcome.

Okay -- end of pet peeve rant :soapbox: (for now anyway!:p ).

Scattered

QueensU_girl
02-23-06, 01:04 AM
On the surface, the BPDer and the ADDer share some common features -- including mentions of 'Impulsivity' and Lack of Focus/'Emptiness?'/Inability to acheive goals.

The main thing about BPD is that the person has limited abilities to establish states of limbic [emotional], attributional or behavioural modulation.

By "modulation", i mean the 'Volume Control'. They are either on 1 or 11, [never 3, or 5, or 7].

There is no grey, there is no middle ground, emotionally.

They have a hot and irritable limbic system, or temporal lobe...

As one person wrote, they have a sort of "dyslimbia", or hyperemotionality. I found that to be highly accurate, and insightful.


The Roles that are set up and played out are often very extreme, too.

The inability to modulate their attributions about others, or the tendency toward 'splitting', is the inability to separate people from actions -- creating people who are grossly elevated in the highest esteem, or absolutely and utterly degraded.


For example: in Relationships, they are emotionally either being 'victimized', or being a 'victimizer'. There is no middle ground of being assertive and drawing boundary lines. They are often getting abused in relationships (hostile parents; abusive, anti-social male partners) or they 'snap' and abuse innocent people [eg anger 'displacement', scapegoating others, etc].

Stress is never dealt with [or even MENTIONED] until it is a Crisis situation. And then it is an explosion situation where nasty things are said and nasty things/revenge acts occur. A lot of passive-agggerssive/sneaky behaviours. The Victim is usually innocent, and is almost always caught off-guard.

They cannot separate the Deed from the Person. [eg. I can -=dislike=- that you blow smoke in my faace, but overall i can =-like-= YOU.

If you won't give them a cigarette, you are an "Effing B****". If you do, then you are the Best Thing Since Sliced Bread.

(But this is only -=to your face=-. You don't want to know what they say about you behind your back. ;>)

They will seem to have "different personalities" with different people.
eg nice to your Boss -- and your Boss likes them; then they morph into an evil twisted creature before your eyes.

We have a fellow Tenant in our Apt Building who has caused us endless grief. She sucks up to the Super and Management. So when we complain about her flip out verbal rage attacks on us, the Mgmt can't believe that "this nice lady" behaves in such a freakish manner.

Basically (a) their Middle Name is MANIPULATION, and (b) you feel like YOU ARE the one going crazy.

You are BEST to go thru the DSM-IV criteria YOURSELF, and see what you think. [Assuming this person is not showing you only one side of themself.]

Do -=you=- FEEL manipulated? do you feel DRAINED?

If you say "i don't know", you are not dealing with a person with BPD.

Emma

QueensU_girl
02-23-06, 01:11 AM
re: self injury


I think self injury would be seen in ADD, as Scattered says, in and of itself.

ADD creates a lot of feelings of failure (and rightly so).

This sort of loss of potential and shame and sense of disappointment and failure creates a RAGE at the SELF.

I guess i speak from personal experience. I was supposed to be a doctor by this point. I was supposed to be earning 100 000+/yr. And here i sit in poverty -- failed out of school, due to 1/2 a credit that i cannot Pass -- partly b/c of ADD's brain effects.

I am financially destroyed by student loan debt.

Severe stress causes the desire to self-destruct. This has been proven again and again in lab animals. (eg rats and mice who chew themselves, 'overgroom' to the point of tissue damage, kill their young, etc)

Research seems to show that self injury is not a suicide attempt. It is actually a coping and survival behaviour for those who have endured Unusually High levels of Stress.

There are many theories, but I tend to beleive that self injury is just a way of trying to trigger some endorphin release, so we can selfsoothe -- much like drug users use drugs.

Ironically, I did some of my Psychology/Neuroscience training in self injurious behaviour. (There are a few types of Populations that do it.)

mctavish23
02-23-06, 01:13 AM
One symptom does not a diagnosis make.:)