Borderline Personality Disorder

Under the DSM IV the diagnostic criteria for BPD is at least five out of the following five features:

.1. Frantic efforts to avoid real or imagined abandonment

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)

5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour

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
Anyone with five or more of the above traits and symptoms may be diagnosed with Borderline Personality Disorder. However, the traits must be long-standing (pervasive) and there must be no better explanation for them (for example a physical illness, another mental illness or substance misuse

Information about BPD treatment

Treatment across the UK is a lottery postcode. However the evidence based practice approach for treating BPD is with both group and/or individual psychotherapy, creative therapies like art therapy, dance and movement therapy, drama therapy and other psychological approaches.Using evidence based practice the outcomes have been shown to be significantly better than "treatment as usual".

Approaches should ideally include mentalization based treatment, individual and group therapies, cognitive behaviour therapy and/or dialectical behavioural therapy for those who self harm or have destructive behaviour difficulties.

However treatment will vary from locality to locality. Some localities will have a specialist service and others will offer support and treatment through a generic Community Mental Health Team.There should be a personality disorder clinical lead in each locality. If not-ask why not as this is now considered good practice.

Eating Disorders and BPD

As the media covers the forensic end of personality disorders more and more I thought I would say a bit about borderline personality disorder. It is as common as schizophrenia and bipolar disorder however unlike these other two illnesses the main focus of treatment is psychological therapies with medication to help reduce symptoms of agitation and depression for example.

As many as 38% of those with BPD have an eating disorder, and a further proportion abuse drugs and or alcohol as well. I haven’t much space to go into it all here but some key things to think about……..

. There was a clear message from the department of health in 2003 that all MH trusts should be providing specialist PD services. I am seeing in my generic mental health work many service users with both acute and chronic self harm difficulties who experience eating disorders which has been undiagnosed and or those with EDs and a personality disorder. The good practice "gold standard" recommendation now is that those who self harm should be offerred dialectical behaviour therapy and those with eating disorders as well have found this very helpful in conjunction with other treatments.

DBT is generally available from the clinical psychology department or local PD service if there is one. Where there isn't a service there should be a lead psychiatrist or consultant clinical psychologist with a specialist interest. It's important for these services to be identified as it makes a real difference on the impact of care someone receives.

NICE are currently working on guidelines for the treatment and management of borderline personality disorder which are due out in 2008 -lets not wait until then to raise awareness that there is treatment available for a very treatable yet distressing condition.