[Weee4ADHD123]

I just took the sanity quiz and I got reall high score for BPD. I didn't know what it was so I went and checked it out. Come to find out I have LOTS of the symptoms for BPD, the most dominating of which is an unrealistic fear of rejection. I always feel so guilty for making my dad leave me and I have the worst time making friends because when I do I try my best not to make them mad. Whne they do get mad at me I get equally frustrated because they are not accepting me and are mad at me.

So basically I'm mad at them for being mad at me

[RACEKA]

Don't take those tests too seriously. My T says that BPD is overdiagnoised.

I've taken those personality tests and I have all of the disorders. I think everyone falls into at least 1 of those.

[Direction]

I agree with Raceka and would add to what degree does it effect your life - yes most people at one time in their life may experience similiar symptoms.

If you believe these symptoms effects your life moderate to severally it is worth talking to a professional. There may be ways you can make them less severe. Again remember it is just an on-line test...

[mlpHolmes]

It does get confusing all the different symptoms. I think the categorization is for a semblemce of order. Remember the medical field tries to make some order out of our multitude, vast # of symptoms, which could be rather chaotic if not organized in some manner. So to help their clients they find it useful to categorize & label symptoms. Docs are certainly aware most of us don't fit exactly into only 1 specific category, (is anything easy - LOL!)
But . . .b/c were human, we may have a little of this symptom, & some of that, & sometimes even . . . etc. This is IMHO, but I hope You find it helpful. xoxooxoxoxoxoxo

er... to help their clients obtain reimbursement from insurance companies and help psychiatry look like a 'real science just like medicine' they like to clasify and categorise mental disorders...

i tend to think the little self quizzes are more harmful than helpful but anyhoo...

When I talked with my current therapist in one of our first sessions, I mentioned that a previous psychologist who I had been seeing right before, had mentioned a personality disorder (dependent). It wasn't a diagnosis really but it felt like it. I wanted to know what this T thought about 1) diagnoses/labels and 2) personality disorders. So I asked.

She said that a diagnosis can be helpful but isn't always and is mostly helpful for insurance purposes (she worked for an insurance company for 20 years). And she said it can change in the course of treatment, so how relevant is it anyway.

And more importantly, she said in response to the personality disorder symptoms, after a little chuckle "What ISN'T a personality disorder? The ways we have of dealing with things are part of our personality."

I liked that.

[psisci]

What makes them disorders is that people continue to act/react in specific ways despite ongoing negative consequences.

hmm. wanna try and find me someone who doesn't do that in some respects?

(especially when under stress)

[psisci]

People without a disordered personality. Flexibility is intact.

> People without a disordered personality

that begs the question:

how many individuals are there in the world who don't exhibit inflexibility of the personality in some respects (especially when under stress)?

maybe... everyone has a disordered personality???

in which case... we would seem to have a reductio of that definition...

(because clearly we want some people to be disordered while others are not)

[psisci]

The concept of disorder, by the very definition puts those behaviors described into the the bottom 1-2 percentile at best. SO the DSM, who's writers have based everything they conceptualize on statistics, world-wide, do not call disorder the things that are common. What is the recognized prevalence rate for BPD? This was a very broad-stroke explanation. In reality most disroders need to exhibit significant deviation from a standard population at the rate of p<.01, or also known as less than 99.9% of the average population.

right. so it seems that one important feature of a definition of mental disorder is that the prevalence rates work out right. (you don't want to define it such that nobody meets it or such that everybody meets it)

the trouble is...

can they have their cake (the prevalence about right)

and eat it too (have the definition of a personality disorder that they attempt to offer)

i guess i'm fond of a dimensional approach (to do with severity) but it is unclear you can have a conception of a personality disorder as a inner dysfunction kind of thing as surely inner dysfunctions would be categorical?

(so much the worse for the notion of dysfunction IMHO).

i'm really very interested in something you said in general about disorder being different from illness. i'd be interested to know what you mean by that 'cause i'm looking at those notions at the moment...

[psisci]

PM me about this, as we may be able to have a meaningful discussion about this.

thanks but i'm more in favour of having meaningful discussions on the boards

[psisci]

That's what I figured............

[gardenergirl]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
alexandra_k said:
> People without a disordered personality

that begs the question:

how many individuals are there in the world who don't exhibit inflexibility of the personality in some respects (especially when under stress)?



</div></font></blockquote><font class="post">

Part of the diagnostic criteria for personality disorders of any type is that they are chronic and pervasive. That would rule out being inflexible or rigid in defense mechanisms and coping patterns in some respects and/or when under stress as fitting the criteria for a personality disorder.

gg

the reason why i prefer to have meaningful discussions on the boards is so that other people can weigh in on the discussion. if the discussion is conducted by PM then other people don't get the opportunity to benefit from it.

you are of course welcome to PM me if you would like to do so. maybe there is something you would like to say that you don't feel comfortable on the boards.

it isn't very often that i will get involved in an in depth discussion via personal message, however.

hey gg. chronic and pervasive... that kind of means if you are dx'd with a personality disorder then you are regarded as chronic by definition, huh. i suppose that pervasive means something like 'across a lot of contexts' and maybe that is what you are getting at with the 'chronic' thing too.

sure. it does make sense to me. guess i'm a big fan of the continuum view, however.

thinking about how to reconcile the 'inner malfunction' criterion with the acknowledgement that disorders can be a matter of degree. can inner malfunctions be a matter of degree??? hard to see how...

[drunksunflower]

i agree on the dimensional issue (vs categorical).

[psisci]

I am not sure what a dimensional issue is, but categorical Dx is for paperwork purposes only. It gave substance to chaos, but in no way help us help others. The so called spectrum Dx ideas do not as well really, we treat symptoms not DSM's.

[drunksunflower]

What alex was talking about.

I remember writing about it in an exam once where we had to critique the DSM.

Many moons ago :>

gosh that wasn't very helpful was it.

[psisci]

Ya that is the difference between school and real life.

[drunksunflower]

Indeed!

:>

There is currently much debate over whether nosology (classification / taxonomy) should be dimensional or categorical in psychiatry. the dimensional vs categorical debate seems to have a couple of different applications.

- Firstly, whether there is a categorical or dimensional difference between the people who are mentally disordered and the people who aren't. if there was a fact as to whether every individual either is or isn't mentally disordered then a categorical approach would be justified. if there was a matter of degree (with funny borderline cases where there is no further fact of the matter) then a dimensional system would be appropriate.

- Secondly, whether there is a categorical or dimensional difference between the people who have a certain kind of mental disorder and the people who don't. if there is a fact as to whether every individual has a particular kind of mental disorder or not then a categorical approach would be justified. if there was a matter of degree (with funny borderline cases where there is no further fact of the matter) then a dimensional system would be appropriate.

part of this debate involves mapping behavioural symptoms in state space. the notion is that we list the symptoms that people do exhibit and then over time we try and see whether there are correlations to be found between different symptoms. if we found that certain symptoms were found to be clustered together in a fair few people then we may have grounds for regarding these clustered symptoms to indicate a natural kind of disorder. this is fairly much the approach that Kraepelin took when he distinguished (roughly) schizophrenia from mood disorders. Bentall has some interesting things to say about the number of people with schizoaffective (who seem to suggest that there is a continuum of symptom clusters from the schizophrenic spectrum through the mood spectrum).

- Thirdly, whether there is a categorical or dimensional difference between the people who have a certain symptom (e.g., delusion) and the people who don't. if there is a fact as to whether every individual is deluisonal or not then a categorical approach would be justified. if there was a matter of degree (with funny borderline cases where there is no further fact of the matter such as belief in ghosts, god, aliens etc) then a dimensional system would be appropriate.

The DSM maintains (there is a little blurb in it somewhere) that while it offers a categorical system mental illness is more approprately regarded as dimensional (it doesn't say in precisely what respects it is regarded as dimensional). The DSM states that the main reason it persists with a categorical approach (on all three of the above issues) is because there is no workable dimensional system of classification at present. The DSM doesn't say this, but basically, while theorists have been pushing for a dimensional approach there is very little consensus from these theorists as to what a dimensional system should look like. There is also the very reasonable concern that the system must be workable in practice (ie teachable to new clinicians and it mustn't take too long to diagnose patients).

The psychodynamic diagnostic manual (PDM) has attempted to dimensionally define personality disorders. Not a bad attempt, I reckon, though the psychodynamic terminology is likely to result in the manual isolating itself from more biologically or cognitive behaviour therapy oriented clinicians (to say nothing of insurance companies). It attempts to get around the insurance company issue (I think) by using the same coding system as the DSM (though I could be wrong on this).

I think that the main reason why the DSM wants to stay categorical is that it makes it look more like medical nosologies / systems of classification. At first glance anyway there is a fact as to whether someone is invaded by a certain pathogen or not. There is a fact as to whether someone has a fractured leg or not. In the attempt to be a 'real science just like medicine' psychiatry presents itself as being more determinate than it really is.

This move is of course supported by the drug companies (anti-depressants rectify a certain kind of illness just like medication for diabetes!!). This move is also supported by consumers feel like being labelled validates their distress and (in some cases) gives them hope for improvement. This move is also supported by those who advocate that mental disorders should be reimbursed by health insurers comperably to the reimbursement received for physical conditions.

The reasons for remaining categorical are extra-scientific in the sense of being politically and socially driven.

And so... The science suffers :-(

As do the people who are told they are chronic and the like :-(

different strokes for different folks, i guess.

for some people the way forward is to turn their mind toward living and to just get out there and live their life.

for other people the way forward is to come to some sort of understanding of oneself and ones struggles.

the thing that helped me most was my studies. my studies and (something that i've been trying my hardest to obtain for a very long time) a sympathetic therapist who is willing to work with me.

a therapist who is willing and able to emotionally connect with me, sure.

also... a therapist who is willing and able to intellectually engage with my understanding / conception of what is going on.

different strokes for different folks...

[drunksunflower]

Here's a fairly generic article on it

http://www.pubmedcentral.nih.gov/art...?artid=1414654

2004, not sure where the thinking has gone from here.

Does anyone use the ICD-10 (showing my ignorance here) but I remember there was some argument for DSM over that ..

hmmm i used to know / be interested in this stuff :/

i like reading your posts alexandra