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Trait Stages of Diagnosis for Borderline Personality Disorder

Trait Stages of Diagnosis for Borderline Personality Disorder


  • The authors describe an alternative model for borderline personality disorder (BPD) diagnosis that is dimensional in nature and requires fulfillment of 4 of 7 personality traits.
  • The criticism of the DSM categorical model is particularly pertinent in the case of personality disorders. To resolve this, Section III of DSM-5 proposes an alternative model for personality disorders that consists of 3 components:

    1. Level of personality functioning

    2. Specific personality disorder diagnoses are reduced to 6

    3. A system of pathological personality traits

  • DSM-5's system of pathological personality traits are organized into 5 domains: negative affectivity, detachment, antagonism, disinhibition, and psychoticism. Within these domains, there are 25 trait facets. From this perspective, people with BPD are identified by impairment in personality functioning, characterized by difficulties in 2 or more of the following 4 areas:

    Identity: impoverished, poorly developed self-image, often excessive self-criticism; chronic feelings of emptiness; dissociative states under stress

    Self-direction: instability in goals, aspirations, values, career plans

    Empathy: impoverished ability to recognize the feelings and needs of others, especially as a result of hypersensitivity (feeling rejected or insulted; perceptions of others are negatively biased)

    Intimacy: intense, unstable, and conflicted close relationships characterized by mistrust and neediness; close relationships often viewed in extremes of idealization and devaluation, reflected in a pattern of over-involvement or withdrawal

  • An alternative model is dimensional in nature, which is in keeping with research evidence that indicates that “personality disorders are continuous with normal personality,”[see reference 6 here] and the personality functioning scale accommodates a severity factor, which is a good predictor of outcome. The trait stage of diagnosis for BPD requires fulfillment of 4 or more of the following 7 traits. Of the 4 or more traits fulfilled, at least 1 of these must be impulsivity, risk-taking, or hostility. The first is emotional lability. Also see Sudden Onset of Tics, Tantrums, Hyperactivity, and Emotional Lability: Update on PANS and PANDAS.


  • Diagnosis for BPD requires fulfillment of 4 or more of the following 7 traits: emotional lability, anxiousness, separation anxiety, depressivity, impulsivity, risk-taking, and hostility (one of the last 3 must be included)


  • Diagnosis for BPD requires fulfillment of 4 or more of the following 7 traits: emotional lability, anxiousness, separation anxiety, depressivity, impulsivity, risk-taking, and hostility (one of the last 3 must be included)


  • Diagnosis for BPD requires fulfillment of 4 or more of the following 7 traits: emotional lability, anxiousness, separation anxiety, depressivity, impulsivity, risk-taking, and hostility (one of the last 3 must be included)


  • Diagnosis for BPD requires fulfillment of 4 or more of the following 7 traits: emotional lability, anxiousness, separation anxiety, depressivity, impulsivity, risk-taking, and hostility (one of the last 3 must be included). 4 or more of the 7 traits must include 1 of the traits in red: impulsivity, risk-taking, or hostility.


  • Diagnosis for BPD requires fulfillment of 4 or more of the following 7 traits: emotional lability, anxiousness, separation anxiety, depressivity, impulsivity, risk-taking, and hostility (one of the last 3 must be included). 4 or more of the 7 traits must include 1 of the traits in red: impulsivity, risk-taking, or hostility.


  • Diagnosis for BPD requires fulfillment of 4 or more of the following 7 traits: emotional lability, anxiousness, separation anxiety, depressivity, impulsivity, risk-taking, and hostility (one of the last 3 must be included). 4 or more of the 7 traits must include 1 of the traits in red: impulsivity, risk-taking, or hostility.

  • The personality functioning scale accommodates a severity factor, which is a good predictor of outcome. The main criticism has been that the new model, with its use of dimensional and trait approaches, is an “unwieldy conglomeration of disparate models that cannot happily coexist and raises the likelihood that many clinicians will not have the patience and persistence to make use of it in their practices” [see reference 7 here]. Clinicians should not be expected to regard their patients in terms of so many subcomponents. However, this may be a way forward for thinking about the conceptualization of personality disorder. For more on this topic and a full discussion, see Update on Diagnostic Issues for Borderline Personality Disorder, on which this slideshow is based.

Comments

In simple terms, my diagnosis of BPD is correct. It does not include psychosis, schizophrenia or
delusions. It is a concise way to show the basics, without including other non-pertinent information.

JORDAN @

I can have only empathy for those beginning their lives in the toxic shadow of abusive parent figures. Both epigenetic and genetic forces are powerfully combined with life’s narratives to create the outcomes in interpersonal behavior that are subject to measurement by scientists and clinicians. If the present dissection allows more precision in the review of these traits, then perhaps the format will prove useful.
Impulsivity, hostility, and rejection sensitivity seem to create serious relational strain and might provide common grounds for study while each maintaining unique biopsychological sub systems. Time for all so affected is of the essence! Good luck with further research.

Samuel Gary @

Very helpful for all affected. Thank you, Samuel Gary.

Kathryn @

I do not understand what this adds to or supersedes with the DSM-- it also seems far short of anything that would be useful in developing a comprehensive treatment plan or assessing severity.

coffee and seneca @

The emotional blunting, akathisia, toxic delusions, akathisia induced aggressiveness, emotional lability, akathisia induced violence against self and others: - can all lead to the erroneous label of borderline personality disorder in addition to misdiagnosed "psychotic depression" and "bipolar disorder".

The intensity and duration of the persistent destruction of intimacy and sexuality caused by SSRIs ----> PSSD - (persisting for months and years - even after slow taper withdrawal) - add to the very real risk of misdiagnosis.

The suffering of SSRI/ SNRI withdrawal syndromes also produces adverse changes in personality and social functioning.

roger @

You exagerate.

Markham @

Total rubbish. How about a history of being emotionally, verbally and/or physically abused? How about alcoholic, drug abusing parents? How about poverty? People in family incarcerated? How about acting out family issues and then getting punished? This works in both lower and higher-functioning families, and in both lower and higher income families.. My parents were doctors, and I am married to a clinical psychologist. How about getting a life, folks! The psychoanalytic model is out of date, and was never on target. Forget Sigmund.

Kathryn @

The Adverse Child Experiences lobby has pretty much nailed it when we talk about the psychoanalytical insight to our causes of personality disorders. Although Freud was a bit of a drug addict and experimented on his own children, his direction was pretty valid. ACE research shows that childhood experiences have a strong influence on our life expectancies.

I have an ACE count of 4. The research works for me.

Martin @

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