Advocacy for Borderline Personality Disorder


Help us Bring Borderline Personality Disorder into the light!


Please sign this petition to support changing the name and designation of Borderline Personality Disorder (BPD) in the next publication of the Diagnostic Statistical Manual of Mental Disorder - 5th edition (DSM-V).
 
The DSM task force is currently open for comments on their proposed change to the BPD diagnosis:
 
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=17
 
Background  

The DSM is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers. The DSM-V is due to be published in 2013. The DSM organizes each psychiatric diagnosis into five levels (axes) relating to different aspects of disorder or disability (only two are important to us):



  • Axis I: clinical disorders, including major mental disorders, as well as developmental and learning disorders
  • Axis II: underlying pervasive or personality conditions, as well as mental retardation

BPD is currently categorized under AXIS II because it is deemed a personality disorder.

Changing BPD to AXIS 1

The BPD Awareness Campaign is dedicated to changing BPD to AXIS I for the following reasons:

The most recent research on BPD indicates that this disorder is a highly treatable condition. It is not permanent and unchanging as is currently indicated under the AXIS II designation.


BPD is excluded from many managed care and healthcare plans, and most parity bills in the United States


In Canada, treatment is often restricted to those with an Axis I diagnosis such as Schizophrenia, Bipolar Disorder and Clinical Depression


Due to stigma, support groups are virtually nonexistent and family members are often blamed for the illness


Clinicians, aware that a person meets criteria for BPD, often substitute an Axis I diagnosis such as major depression, bipolar disorder, and/or posttraumatic stress disorder, which are reimbursable. This results in under-diagnosis of BPD and over diagnosis of other disorders.



Putting BPD onto AXIS 1 would make it a mainstream serious mental illness that is worthy of care and treatment.


Changing the Name


The BPD Awareness Campaign is dedicated to changing the term BPD for the following reasons:



It is inaccurate and confusing - Mental illness is no longer categorized as either neurotic or psychotic. Therefore BPD cannot fit on the "Borderline".



It imparts no relevant or descriptive information-  It says nothing of the key elements of BPD- Emotional dysreguation, Impulsivity, Cognitive dysregulation



It reinforces stigma-  the very mention of the term "personality disorder" suggests that the person's  personality is flawed. This is very upsetting to individuals in recovery, especially when they are already questioning their self-worth and identity



One possible alternative proposed by Marsha Linehan, Ph.D (an expert in BPD) is Emotional Regulation Disorder. This term integrates a key component of BPD - Emotion dysreguation. Another term proposed is Emotional Processing Disorder.This last term better integrates emotional dysreguation and the cognitive dysreguation which is now thought to be a key factor in BPD. Another interesting possibility could be Emotional Deficit Impulsivity Disorder.

Current Proposal from DSM Task Force

The work group is recommending that this disorder be reformulated as the "Borderline Type."


"Individuals who match this personality disorder type have an extremely fragile self-concept that is easily disrupted and fragmented under stress and results in the experience of a lack of identity or chronic feelings of emptiness.  As a result, they have an impoverished and/or unstable self structure and difficulty maintaining enduring intimate relationships.  Self-appraisal is often associated with self-loathing, rage, and despondency.  Individuals with this disorder experience rapidly changing, intense, unpredictable, and reactive emotions and can become extremely anxious or depressed.  They may also become angry or hostile, and feel misunderstood, mistreated, or victimized.  They may engage in verbal or physical acts of aggression when angry.  Emotional reactions are typically in response to negative interpersonal events involving loss or disappointment.


Relationships are based on the fantasy of the need for others for survival, excessive dependency, and a fear of rejection and/or abandonment.  Dependency involves both insecure attachment, expressed as difficulty tolerating aloneness; intense fear of loss, abandonment, or rejection by significant others; and urgent need for contact with significant others when stressed or distressed, accompanied sometimes by highly submissive, subservient behavior.  At the same time, intense, intimate involvement with another person often leads to a fear of loss of an identity as an individual.  Thus, interpersonal relationships are highly unstable and alternate between excessive dependency and flight from involvement.  Empathy for others is severely impaired.

Core emotional traits and interpersonal behaviors may be associated with cognitive dysregulation, i.e., cognitive functions may become impaired at times of interpersonal stress leading to information processing in a concrete, black-and white, all-or-nothing manner.  Quasi-psychotic reactions, including paranoia and dissociation, may progress to transient psychosis.  Individuals with this type are characteristically impulsive, acting on the spur of the moment, and frequently engage in activities with potentially negative consequences.  Deliberate acts of self-harm (e.g., cutting, burning), suicidal ideation, and suicide attempts typically occur in the context of intense distress and dysphoria, particularly in the context of feelings of abandonment when an important relationship is disrupted.  Intense distress may also lead to other risky behaviors, including substance misuse, reckless driving, binge eating, or promiscuous sex.


Instructions


A.  Type rating.  Rate the patient%u2019s personality using the 5-point rating scale shown below.  Circle the number that best describes the patient%u2019s personality. 


5 = Very Good Match: patient exemplifies this type

4 = Good Match: patient significantly resembles this type

3 = Moderate Match: patient has prominent features of this type

2 = Slight Match: patient has minor features of this type

1 = No Match: description does not apply 


B.  Trait ratings.  Rate extent to which the following traits associated with the Borderline Type are descriptive of the patient using this four-point scale:   


0 = Very little or not at all descriptive

1 = Mildly descriptive

2 = Moderately descriptive

3 = Extremely descriptive

1. Negative Emotionality: Emotional Lability

Having unstable emotional experiences and mood changes; having emotions that are easily aroused, intense, and/or out of proportion to events and circumstances


2. Negative Emotionality: Self-harm

Engaging in thoughts and behaviors related to self-harm (e.g., intentional cutting or burning) and suicide, including suicidal ideation, threats, gestures, and attempts


3. Negative Emotionality: Separation insecurity

Fears of rejection by, and/or separation from, significant others; distress when significant others are not present or readily available


4. Negative Emotionality: Anxiousness

Feelings of nervousness, tenseness, and/or being on edge; worry about past unpleasant experiences and future negative possibilities; feeling fearful and threatened by uncertainty


5. Negative Emotionality: Low self-esteem

Having a poor opinion of one%u2019s self and abilities; believing that one is worthless or useless; disliking or being dissatisfied with one%u2019s self; believing that one cannot do things or do them well


6. Negative Emotionality: Depressivity

Having frequent feelings of being down/ miserable/ depressed/ hopeless; difficulty %u201Cbounding back%u201D from such moods; belief that one is simply a sad/ depressed person


7. Antagonism: Hostility

Irritability, hot temperedness; being unfriendly, rude, surly, or nasty; responding angrily to minor slights and insults


8. Antagonism: Aggression

Being mean, cruel, or cold-hearted; verbally, relationally, or physically abusive; humiliating and demeaning of others; willingly and willfully engaging in acts of violence against persons and objects; active and open belligerence or vengefulness; using dominance and intimidation to control others


9. Disinhibition: Impulsivity

Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans; failure to learn from experience


10. Schizotypy: Dissociation Proneness

Tendency to experience disruptions in the flow of conscious experience; %u201Closing time,%u201D (e.g., being unaware of how one got to one%u2019s location); experiencing one%u2019s surroundings as strange or unreal"

Dr. David Kupfer, J. MD
DSMV Chair


Western Psychiatric Institute & Clinic
3811 Ohara St. #210
Pittsburgh, PA 15213-259

Dear Dr. Kupfer:

We the undersigned support the APA Assembly resolution of May 2001 to explore moving Borderline Personality Disorder (BPD) to Axis I and changing the name of BPD. Dr. Steve Hyman, former director of NIMH, is in full support of this change. We believe the severity, chronicity and degree of disability of BPD justifies placement of BPD on Axis I.



The most recent research on BPD indicates that this disorder is a highly treatable condition. Nevertheless, people all over the world with BPD are often left out from receiving treatment because clinicians are under the false impression that people with BPD cannot recover. This myth is perpetuated by the definition of Axis II disorders, namely that Axis II disorders are permanent and unchanging. In the United States, BPD is excluded from many managed care and healthcare plans, and most parity bills due to its Axis II placement.



The name BPD is confusing- it is not in any way descriptive of the disorder or the psychological pain that accompanies it, and merely serves to reinforce existing stigma. A number of alternatives have been proposed such as Emotional Regulation Disorder and Emotional Processing Disorder which more accurately reflect the nature of the condition. As the name and designation stand right now, it allows for the continued trivialization of a very severe and painful mental illness. A change in name would be beneficial to patients and families, as it would begin to change the pervasive professional stigma against these patients.



We ask that you share this petition with your colleagues on the DSM-V taskforce and the Personality Disorders Workgroup. We hope the taskforce will do all they can to bring about these much needed changes so that people with BPD can have hope, access to appropriate treatment and equal opportunity for recovery as do people suffering with other mental illnesses. Thank you for your time and consideration.

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