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Emotionally unstable (borderline) personality disorder. - March 23rd 2011, 05:27 PM

What can you tell me about this? My psychiatric nurse thinks that I have it, but to be honest, I know very little about it. My mood fluctuates a lot, from being almost manic, to very, very depressed. I also have an eating disorder, and self harm. I've never reacted to medication, and therapy hasn't ever helped me much.

Does anybody else have BPD? What kind of treatments are there for it? Can anyone tell me anything at all?
   
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Re: Emotionally unstable (borderline) personality disorder. - March 23rd 2011, 05:46 PM

I've been diagnosed with Borderline Personality Disorder, and basically the mood fluctuations are a part of it. If its not full-on Mania, that is probably why they think you have BPD. Also, the frequency of the mood swings is another diagnostic criteria, as well as how you act, feel, etc. Self-harm and body image issues are usually a huge part of BPD.

Your nurse shouldn't diagnose you with this until you've gone through an evaluation, and although I personally haven't started treatment yet, it was explained to me.

Basically, for BPD, the treatment is a special type of therapy, either CBT or DBT depending on the professional, but it's essentially the same concept. I still don't completely understand it, but I think the therapy is meant to kind of change how you think of these things, and how you perceive things such as emotional responses, self-image, etc. I'm not 100% sure, but that's kind of how the psychiatrist explained it to me, but not exactly.

If you'd like to learn more, this is an online copy of the guide my psychiatrist gave to my boyfriend and I: Borderline Personality Disorder: An Information Guide for Families


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Re: Emotionally unstable (borderline) personality disorder. - March 23rd 2011, 06:47 PM

I've done both cbt and dbt. Cbt is more clinically based, therapy where you go through your thought process and point out the unhealthy thoughts, then work to change them. Dbt is more based on eliminating the thoughts and realizing that they are wrong, unhealthy and unrealistic. Group therapy is a huge part of dbt.
at least that's how I understand it.


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Re: Emotionally unstable (borderline) personality disorder. - March 23rd 2011, 07:46 PM

My nurse is trained in psychiatry, so she has a pretty reasonable idea. Although I'll be seeing a psychiatrist in the near future. That really clears things up, though! I've done CBT before, but never DBT. I've never actually heard of it.

Thank you!
   
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Re: Emotionally unstable (borderline) personality disorder. - March 23rd 2011, 08:09 PM

Well the problem is, Borderline Personality Disorder has similar symptoms to other things, so I'd hope you would get tested/questioned/evaluated/whatever to find out whether you really do or not.

The psychiatrist I've been seeing went over this questionnaire thing with me that took almost an hour to do, to differentiate my different symptoms to come up with my diagnosis in the end. I don't know how it works where you live, or with who you see, but it's most likely that you'll be asked a series of questions to differentiate symptoms before treatment.

The fact that you've been resistant to medicine in your treatment means there is definitely a higher chance of it being BPD over anything else though, since BPD is primarily treated with CBT/DBT.


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Re: Emotionally unstable (borderline) personality disorder. - March 23rd 2011, 08:12 PM

I will for sure, probably within the next week. I've never really been given an exact diagnosis, which is driving me crazy, if I'm not already.
   
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Re: Emotionally unstable (borderline) personality disorder. - March 23rd 2011, 09:42 PM

The questionaire thing is called a diagnostic interview and it covers a lot of psychiatric disorders. But yeah, like thirteen said you should see an actual psychiatrist sooner than later.
I was diagnosed with borderline before because the symptoms are really similar to a lot of disorders. Turns out that psychiatrist was wrong, its that hard. Thats why a nurse shouldn't be the one to diagnose you, even if she has psychistric training.


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Re: Emotionally unstable (borderline) personality disorder. - March 23rd 2011, 11:55 PM

It's possible that the factors she used to diagnose you are a symptom of your eating disorder or SH. She would obviously know better, but when I was experiencing my eating disorder I turned into a different person and experienced manic episodes, extreme anxiety, and mood swings. I'd personally treat that before anything else because while medication or counseling can help soothe those things, you might find that they leave on their own with your eating disorder once you begin to manage that.
   
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Re: Emotionally unstable (borderline) personality disorder. - March 24th 2011, 06:41 PM

I know the weight is a huge factor in this, which is why, really, until I decide to gain weight there's not much anybody can do to help me. Then again if it was down to me, I'd keep losing until I'm dead.
   
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Re: Emotionally unstable (borderline) personality disorder. - March 26th 2011, 10:23 AM

Since some of the symptoms of eating disorders and SH are similar to BPD, the diagnostic criteria for BPD includes 2 important things. First, any maladaptive, self-damaging behaviours, including eating disorders, are not to be considered. Second, if there are abandonment issues as a possible behaviour that involve suicide, they are not to be considered in this, they are considered separately.

Although the fluctuation of moods is a symptom, you do not need to display that in order to receive the diagnosis of BPD. Many do display it but not needed.

Your psychiatric nurse can have undergone whatever training but cannot give a diagnosis. If she does, she can be sued for impersonation because only doctors can diagnose and she is not a doctor. She can say it's possible you may have a disorder but no more. She could tell you about it but it's not desired because it runs a high risk of convincing yourself you have a certain disorder so when the doctor discovers that, the nurse is a confounding variable.

There are some controversies over whether BPD exists but the dominant view is that it does exist. There are treatments and they depend on the symptoms and diagnostic criteria you meet. DBT was designed specifically for BPD and it has a pretty good reported outcome. However, because you may have eating disorders also, the treatments for that must be considered.

I don't have BPD, SH nor eating disorders so I cannot relate directly and give experience. I study neuroscience and pharmacology, so I can give you information on the pharmacological aspects of treatment. For eating disorders, there are pharmacological treatments that are very effective. I'm tired so won't explain all of it but one view of eating disorders involves 2 hormones: leptin and ghrelin, and a neurotransmitter dopamine. Everyone has these and they are mostly implicated in feeding and eating. Dopamine is implicated in many things but for eating disorders, it's implicated in part for the motivational factor to keep engaging in the harmful acts despite knowing the consequences. Treatment for that is very difficult as it runs throughout the brain and medications meant to affect it, such as anti-psychotics, have many side-effects and currently no such medication is free from those side-effects. Again, I'm not going to discuss why, it's just as if not longer than the leptin-ghrelin explanation and probably more complicated.

For leptin-ghrelin, ghrelin stimulates hunger, leptin inhibits hunger feelings. Some treatments involve either giving ghrelin, ghrelin agonists or ghrelin-like substances, as they have been shown to be effective. In 2009, Maria Hotta et al., found ghrelin infusion increases food/caloric/energy intake by 12-36%. http://www.jstage.jst.go.jp/article/..._1119/_article

I don't know if it's currently used clinically or if it's still in research, you'll have to ask your psychiatrist. There are other medications that can be used to better one's mood and along with psychotherapy, be willing to eat. Assuming you have anorexia, one big problem with treatment is depending how long this has occured for, the body will be resistant to eating large amounts of food because it has "adapted" to the state of starvation.

For BPD, pharmacological treatments are very diverse because around 144 people all with different symptoms yet all can have BPD.

You may be given a questionnaire but the results of it are not necessarily a diagnosis. Instead, it's data that can be evidence for the diagnosis or refute a diagnosis.

What is possible is because you mention self-harm and suicide (i.e. don't care if you die from starvation), that sends red flags out as any clinician with a functioning brain knows he/she must attend to it. You could receive a diagnostic code 799.9, which isn't of any disorder. http://docs.google.com/viewer?a=v&q=...akmX3un_1SbWOw
Ignore the stuff about the column of codes, that's the group's own internal coding system. Instead, pay attention to the column named service description, as they show reasons for code 799.9 in a clear way that's easy to understand and includes the possibilities of it. A doctor wouldn't tell you "I'm putting you on code 799.9", they'd just say "diagnosis not found yet but we're concerned because of the sucicide/self-harm mentioned".


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