We have seen that if a person has suffered significant and protracted childhood trauma, s/he is at greatly increased risk of being diagnosed, as an adult, with borderline personality disorder (BPD). According to the Diagnostic and Statistical Manual of Mental Disorders (usually abbreviated to DSM), a person diagnosed with BPD must meet at least FIVE of the following nine criteria:
1) Extreme swings in emotions
2) Explosive anger
3) Intense fear of rejection/abandonment sometimes leading to frantic efforts to maintain a relationship
6) Unstable self-concept (not really knowing ‘who one is’)
7) Chronic feelings of ’emptiness’ (often leading to excessive drinking/eating etc ‘to fill the vacuum’)
8) Dissociation ( a feeling of being ‘disconnected from reality’)
9) Intense and highly volatile relationships
NB These symptoms must have been stable characteristics present for at least six months
However, some theorists and researchers have pointed out certain problems with defining BPD in this manner and question the validity of the diagnosis; I outline the most serious of these problems below :
1) In order to be diagnosed with BPD, a person need display just five of the above nine symptoms. It logically follows from this that two people could each be diagnosed with five of the above symptoms, yet have only one of those five symptoms in common with one another. In other words, two people could each be manifesting very different symptoms, yet receive identical diagnoses.
2) Stipulating that an individual must have five or more of the above symptoms is essentially arbitrary (why not four or six?). Also, linked to this criticism, there seems to be a third problem with the diagnosis :
3) The third problem is this : a person with four of the above symptoms, even if they were very severe, would have to be (according to the diagnostic criteria) diagnosed as NOT having BPD whereas a person who just manages to be judged to be displaying five symptoms (even if none are as severe as the first person’s four symptoms) WOULD be diagnosed as having BPD. This brings us onto the fourth problem with the diagnosis :
4) In accordance with the diagnostic criteria, an individual is either deemed to HAVE BPD or NOT HAVE BPD. In other words, it is an ‘all or nothing’ diagnosis which doesn’t allow for grey areas. This is ironic as one of the symptoms BPD sufferers are said to show is ‘black and white’ or ‘all or nothing thinking’ (such as seeing others as ‘all good’ or ‘all bad’ but never as anything inbetween).
Because of this problem, some critics have suggested that it would be better to view BPD as a ‘spectrum’ disorder, with each individual occupying a specific place on this spectrum (in the way that autism is treated as a spectrum disorder).
5) A diagnosis of BPD does not seem to describe a unique, separate, distinct disorder clearly delineated from other personality disorders ; indeed, many who have been diagnosed with BPD are found to suffer from comorbid conditions such as antisocial personality disorder and narcissistic disorder
In conclusion it should be mentioned that many critics of the BPD diagnosis feel many individuals have been wrongly diagnosed with it (and unnecessarily stigmatized) and should be diagnosed with complex post traumatic stress disorder instead.
In relation to the above, you may wish to read these other posts:
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David Hosier BSc Hons; MSc; PGDE(FAHE).
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