PYC 4802 – ASSIGNMENT 02
UNISA
malissahulme@gmail.com
4271-896-1
[Type the fax number]
5/14/2012
MALISSA HULME
I will discuss the problems related to assessing and classifying / diagnosing 16 to 20 year olds with patterns of impulsivity, instability in interpersonal relationships, self-image and affect.
Contents
Introduction 2
DSM-IV Criteria for Borderline Personality Disorder 2
Diagnosis of Borderline Personality Disorders 4
Instruments Available for the Assessment/Diagnosis of Borderline Personality Disorder 5
Problems Related to Assessing and Classifying/Diagnosing 16-20 Year Olds 5
Conclusion 8
Bibliography 9
Introduction
I will discuss the problems related to assessing and classifying / diagnosing 16 to 20 year olds with patterns of impulsivity, instability in interpersonal relationships, self-image and affect. These criteria are directed toward a diagnosis of borderline personality disorder.
According to the Diagnostic and Statistical Manual of Mental Disorders (here forth referred to as the DSM-IV-TR) personalities are defined as enduring patterns of perceiving, relating to, and thinking about the environment and oneself. Personality traits are prominent aspects of personality that are exhibited in a wide range of important social and personal contexts. Only when personality traits are inflexible and maladaptive and cause either significant functional impairment or subjective distress do they constitute a Personality Disorder.(Association, 2000) The manifestations of personality disorders are often recognized in adolescence and continue throughout most of adult life.
DSM-IV Criteria for Borderline Personality Disorder
According to the DSM-IV-TR the fundamental feature of borderline personality disorder is a persistent pattern of “instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts” (Association, 2000). There are nine criteria for borderline personality disorder of which an individual has to meet at least five of any of these criteria where they are then diagnosed with this Axis II Personality disorder. These nine criteria are as follows:
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 (for example, 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 (for example, 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 (for example, frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
Diagnosis of Borderline Personality Disorders
Kernberg documented that no one symptom is indicative of a personality disorder, but rather a cluster of symptoms need to be distinguished in order to exceed any developmentally appropriate symptom in intensity and duration (P.F. Kernberg, Personality Disorders in Children and Adolescents, 2000).
A diagnosis for borderline personality disorder is determined by the presence of any five of the nine diagnostic criteria. Therefore there are numerous combinations of criteria that can comprise a diagnosis of borderline personality disorder. Although it is indicated that five or more criteria are needed to make a diagnosis, it is documented that some patients who have clinically significant symptoms of borderline personality disorder, may have fewer than five diagnostic criteria required for an official diagnosis.
As stated by the DSM-IV-TR, individuals with borderline personality disorder exhibits “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts” (Association, 2000).
Instruments Available for the Assessment/Diagnosis of Borderline Personality Disorder
There are six methods available to assess borderline personality disorder. By means of Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV), Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), Structured Interview for DSM-IV Personality (SIDP-IV), International Personality Disorder Examination (IPDE), Personality Assessment Schedule (PAS) and lastly by means of Standardized Assessment of Personality (SAP).
Problems Related to Assessing and Classifying/Diagnosing 16-20 Year Olds
Most individuals who present symptoms of borderline personality disorder affirm an onset of symptoms around puberty and late adolescence. According to Durrett and Westen who used structured interviews, adolescents between the ages of 12 to 17 meet the criteria for personality disorders at the same rates as young adults between the ages of 18 to 37 years (Durrett & Westen, 2005).
Kernberg stated that clinicians may be reluctant to diagnose individuals with borderline personality disorder as they believe children and adolescents personality has not yet crystallized. Continuous developmental changes take place during young adulthood and adolescence seeing as they are in a time of transition.(Snelgar, 2011) Adolescents and young adults with identity problems (especially when accompanied by substance use) may transiently display behaviors that misleadingly give the impression of Borderline Personality Disorder. Such situations are characterized by emotional instability, "existential" dilemmas, uncertainty, anxiety-provoking choices, conflicts about sexual orientation, and competing social pressures to decide on careers. (Association, 2000) This makes it difficult to differentiate between normal development and stress and chronic criteria relating to a personality disorder. “Personality disorders are chronic, by definition, clinicians understandably prefer to wait and see before coming to conclusions. Studies indicate that there appears to be a subgroup of adolescents who move in and out of borderline personality diagnosis.” (Miller, Muehlenkamp, & Jacobson, 2008) Consequently, there is no reason why the same pathology should be called one thing before a defined age and another afterward. (Paris J. , 2005)
For reasons both personal and theoretical, clinicians have been disinclined to make a diagnosis of a personality disorder in children and adolescents. A reason for this reluctance is that all professionals who work with young individuals have reservations about placing such a severe a label on them(P.F. Kernberg, Personality Disorders in Children and Adolescents, 2000). This life-long diagnosis adversely affect the child’s self-esteem, family life and and/or prejudice her future by appearing in his/her personal record(Snelgar, 2011).
A diagnosis of borderline personality disorder might cause clinicians to neglect to examine whether the symptoms are still present and whether the diagnosis is still accurate. It is an unfortunate reality that a diagnosis of borderline personality disorder can indeed lead to rejection by mental health system. The stigma surrounding borderline personality disorder causes practitioners to be weary in becoming their clinicians, seeing as working with patients who are chronically suicidal and who do not form strong treatment alliances will continue being difficult.(Scanlan & Purcell, 2009)
Borderline personality disorder is a complex syndrome with symptoms that overlap multiple Axis I disorders which makes it exceedingly difficult to diagnose.The DSM-IV-TR provides some examples of confusions and misdiagnoses that might occur because of similarities in criteria;Histrionic Personality Disorder, Schizotypal Personality Disorder, Paranoid Personality Disorder, Narcissistic Personality Disorder, Antisocial Personality Disorder, Dependent Personality Disorder, Personality Change due to a General Medical Condition and symptoms that may develop in association with chronic substance use. Making an accurate Axis II diagnosis requires experience. Personality disorders frequently seem to lack exact indicative criteria, since many of their features describe problems in interpersonal functioning that require clinical judgment for accurate assessment. Consequently it is important to distinguish among these disorders based on differences in their characteristic features as well as the broad range of clinical phenomena (affective, impulsive, interpersonal, and cognitive).
The impression that personality disorders are untreatable or at least not treatable using the pharmacological tools, might be another indicator as to why clinicians are resistant to diagnosing patients with a personality disorder. Not all clinical settings are equipped for efficiently treating patients with borderline personality disorder by means of psychotherapy.
Conclusion
As indicated in the essay, there are numerous factors that need to be addressed when assessing, classifying and diagnosing adolescents and young adults with personality disorders, specifically patients with borderline personality disorders. Based upon the literature of Miller, Muehlenkamp, & Jacobson (2008), mental health practitioners should strongly consider formally assessing for personality disorders, either categorically or continuously, when working with adolescents. Irrespective of the presence of a full-fledged disorder, adolescents may accurately display symptoms of distress and dysfunction, like suicidal tendencies, self-mutilation, identity disturbance, academic failure, social dysfunction, and substance abuse in which case an intervention is necessary. (Miller, Muehlenkamp, & Jacobson, 2008)
Even though there is a negative stigma connected with the diagnosis which poses serious concern, it should not prevent clinicians from assessing and carefully considering the diagnosis when warranted. This will allow many more adolescents to receive the appropriate treatment and prevent a refractory pattern of dysfunctional behavior. This will also grant researchers the opportunity to further investigate this area. (Miller, Muehlenkamp, & Jacobson, 2008) A failure to diagnose might jeopardize the future of the individual by hindering him/her to obtain the necessary and appropriate treatment. (P.F. Kernberg, Personality Disorders in Children and Adolescents, 2000)
Bibliography
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Barlow, D. &. (2009). Abnormal psychology: An integrative approach. Belmont: Wadsworth/Cengage Learning.
Durrett, C., & Westen, D. (2005). The structure of Axis II Disorders in Adolescents: A Cluster and Factor Analytic Investigation of DSM-IV Catagories and Criteria. Journal of Personality Disorders, 440-462.
Goodman, M. H. (2009). Quieting the affective storm of Borderline Personality Disorder. American Journal of Psychiatry, 522-528.
Gunderson, J. (2009). Borderline Personality Disorder: Ontogeny of a diagnosis. American Journal of Psychiatry, 530-539.
Guthrie, D. M. (2006, Fall). PRAXIS. Adolescent Borderline Personality Disorder and Dialectical Behavior Therapy, VI, pp. 35-43.
Helen Bondurant, B. G. (2004). Construct Validity of the Adolescent Borderline Personality Disorder: A Review. The Canadian Child and Adolescent Psychiatry Review, 53–57.
Hoffman, P. (2007, Winter). National Education Alliance for Borderline Personality Disorder. Borderline Personality Disorder: A most misunderstood illness.
Kernberg, O. &. (2009). American Journal of Psychiatry. Borderline Personality Disorder, pp. 505-508.
Meyerson, D. (2009). Is Borderline Personality Disorder under diagnosed? Medpage Today.
Miller, A. L., Muehlenkamp, J. J., & Jacobson, C. M. (2008). Fact or fiction: Diagnosing borderline personality disorder in adolescents. ScienceDirect.
Oldham, J. (2009). Borderline Personality Disorder comes of age. American Journal of Psychiatry, 509-511.
P.F. Kernberg, A. W. (2000). Personality Disorders in Children and Adolescents. New York: Basic Books.
P.F. Kernberg, A. W. (2000). Personality Disorders in Children and Adolescents. New York: Basic Books.
Paris, J. (2005). Diagnosing Borderline Personality Disorder in Adolescence. Adolescent Psychiatry, 230-250.
Paris, J. (2007). Why Psychiatrists are Reluctant to Diagnose Borderline Personality Disorder. Psychiatry, 35–39.
ROBERT O. FRIEDEL, M. (2012). Borderline Disorder. Retrieved 04 23, 2012, from BPD OVERVIEW: http://www.bpddemystified.com/index.asp?id=2
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Scanlan, F., & Purcell, D. R. (2009). Diagnosing Borderline Personality: What are the Issues and what is the Evidence? headspace. Orygen Youth Health Research Centre.
Snelgar, B. (2011). Psychologists' and Psychiatrists' opinions on Cluster B personality Symptomology in Children and Adolescents. University of Witwatersrand.
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