Wednesday, March 23, 2011

A Matter of Severity: Controversy in BPD - Part 2

I thought to add this to the previous post, but I'm adding things as I find them so .... Another controversy revolves around the question:

Is it possible to distinguish between a normal personality and a personality disorder, how do you do it, and where do you draw the line?

Without a clinical measurement of severity in personality discrepency it's difficult to recognize where you draw the line between a healthy, relatively normal personality and something severe enough to be considered a disorder. Not only that, but who's to say what is normal for one person is not normal for another? Unfortunately {in terms of diagnosis} people are all different so it's nearly impossible to devise a steady measurment from patient to patient. So how do you decide on a distinguishing factor...

"It has become increasingly clear that some form of severity assessment is necessary to decide on the priorities to use for the management of personality disorder. The notion of severe personality disorder is central to much of the work in the area of forensic psychiatry. What is clear from empirical research studies is that those with more severe personality disorder do not have stronger manifestations of one single disorder as often postulated, but instead their personality disturbance extends across all domains of personality. Although severity is not normally taken into account when classifying mental illness, it is important in personality disorders, as normal personality and personality disorder are both on the same continuum. Unfortunately, there is no measure of severity for personality disorder in the DSM or ICD classification, and the absence of these measures is of significant concern. Indeed, treatment is justified when it is likely to ameliorate distressing or disabling syndromes, even when the patients fail to meet the full diagnostic criteria of psychiatric disorders and, consequently, the measure of severity is highly relevant to the planning and provision of treatment. A reliable way of assessing personality disorder is to use 3 levels of severity (SeeTable Below). By using this measure of severity, it is possible to use the cluster system to get a measure of severity and this measure is also relevant in assessing those with the most severe personality disorders in forensic psychiatry."

I think this ties into the idea that recognition and diagnosis of BPD is not stable. With so many different aspects and potential combinations of symptoms it's difficult to pin point what are the distinguishing characteristics for BPD if some symptoms present, but only to a mild degree, wheras others present with much greater prominence. If something is less inhibiting should it be consider part of the dysfunction? Should only the most severe problems be included in diagnosis? Or should all manifestations be addressed and lumped together? I personally thing the 3rd is the best idea. However noting which problems are the most harmful to a persons functionality can provide a guideline for psych/therapists to map out a course of treatment addressing the most prominent features sooner.


  1. I couldn't agree more. I think there are certain characteristics that people with PD all exhibit in some shape or form. Having a guideline would definitely allow those in need of help to get it. That is the hope anyways.

  2. Part of the problem with certain PDs, especially BPD, is that it takes so long to identify them, and identify them correctly. It's so important to get an accurate diagnosis as soon as possible.

  3. Everyone has some personality traits that might make them a little narcissistic or avoidant etc.. but I guess there is a level where those traits become disordered. I'm not sure BPD is one condition, as I've heard it said that BPD is more of an umbrella term that describes people with a number of disordered traits together. It is so complex and as you say getting an accurate diagnosis is essential (and often hard to get). BPDs are just so different from each other and choosing say 5 out of 9 criteria can mean only one trait in common leading to a very different condition...

    1. This is why individual therapy is so important.


Leave me a comment! It makes me feel good and less paranoid about talking to myself =)

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