How Is Borderline Personality Disorder Diagnosed?

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Usually, with personality disorder, a person is faced with social maladjustment, it is with these complaints that he most often comes to a psychologist (traumatic experience of parting, failure in his personal life, conflicts with the environment, chemical addictions, difficulties with keeping a job, etc.). Rarely does anyone come to a psychologist with a childhood trauma. Already in the course of psychotherapy, it becomes clear that problems come from childhood (emotional deprivation, physical abuse, which influenced a person's attitude to the world, the perception of others, emotional stability).

Since childhood, a person has formed a certain "baggage" of psychological defenses, which largely determined the type of his response, as well as the hereditary factor (people of the thinking type often use logic instead of emotions, isolation from the stressor, people of the artistic type - impulsivity, emotionality, seeking attention). The lack of adaptability of psychological defenses, as a rule, leads to difficulties in interaction.

To diagnose yourself with a personality disorder, you must undergo a diagnostic interview with a specialist

To begin with, compare your condition with the classification of Gannushkin-Kerbikov. Personality disorders are characterized by:

1. totality pathological character traits (a person discovers maladjustment at school, in personal relationships, at work, he is uncritical to his behavior and believes that others are hostile towards him, and not he towards them, for example);
2. stability, low reversibility pathological traits of character (unlike neurosis, which occurs situationally in response to a certain stimulus, personality disorder can be both congenital and formed in childhood as a result of prolonged influence of traumatic factors; personality disorder cannot be cured, but with the help of psychotherapy and a favorable environment you can enter the stage of compensation);
3. severity pathological features to the degree of stable social maladjustment (a person may show exaggerated emotional reactions, increased vulnerability, suspicion, avoidance of social activity, etc.).

totality pathological character traits (a person discovers maladjustment at school, in personal relationships, at work, he is uncritical to his behavior and believes that others are hostile towards him, and not he towards them, for example); stability, low reversibility pathological traits of character (unlike neurosis, which occurs situationally in response to a certain stimulus, personality disorder can be both congenital and formed in childhood as a result of prolonged influence of traumatic factors; personality disorder cannot be cured, but with the help of psychotherapy and a favorable environment you can enter the stage of compensation); severity pathological features to the degree of stable social maladjustment (a person may show exaggerated emotional reactions, increased vulnerability, suspicion, avoidance of social activity, etc.).

To diagnose personality disorder, psychoanalyst Nancy McWilliams recommends paying attention to the following criteria:

1. Are we dealing with an obvious new formation of a problem, or has it existed to one degree or another for as long as a person remembers himself? 2. Was there a sharp increase in his anxiety related to neurotic symptoms, or was there a gradual deterioration in his general condition? 3. Has the person himself expressed a desire to seek treatment, or have others (relatives, friends, legal authority, etc.) referred him? 4. Are his symptoms alien to the Ego, Ego-dystonic (the person sees them as problematic and irrational), or are they Ego-synthones (he sees them as the only possible reactions to the current conditions of life)? 5. Is the person's ability to see the perspective of his problems (“the observing Ego” in analytical jargon) adequate to develop an alliance with the therapist in the fight against problematic symptoms, or does the person view the therapist, psychologist as a potentially hostile or magical savior? 6. Are mature defense mechanisms prevailing in human behavior or primitive ones? 7. How integral is the identity, the image of a person's “I”? People with personality disorder often have difficulty describing their personality (their characteristics, strengths, weaknesses, beliefs, needs, life goals, or have a contradictory relationship to the same phenomenon). 8. Is there an adequate sense of reality? To make a differential diagnosis between borderline and psychotic levels of personality structure, Otto Kernberg advises the following: one can choose some unusual traits by commenting on this and asking the client if he realizes that other people may also find this trait strange. So, for example, a person with pronounced narcissistic traits may not notice when he communicates arrogantly, he may even be very surprised if the therapist draws his attention to this feature, but admits that it is, in contrast to the psychotic.

Tasks of the therapist - make the ego-syntonic ego-dystonic, form a person's criticism of his behavior, new ways of coping.

Client's task - maintain a working alliance with a psychotherapist, cooperating with him against his symptom, even despite occasional mistrust and hostility.

Thus, a client with a personality disorder develops an "observing Ego", the ability to analyze his thoughts, check them for reality, look at his behavior in a relationship with the therapist "from above", correct maladaptive schemes, keep in contact, train adaptive skills of self-regulation, coping with anxiety.

Why is it difficult for borderline clients to stay in therapy?

When "border guards" feel close to another person, they panic out of fear of absorption and total control, and when they move away, they feel traumatic abandonment. This central conflict of their emotional experience leads to a relationship that is walking back and forth, including the therapeutic relationship, where neither closeness nor distance is satisfying. Living with such a basic conflict is exhausting for border guards, their families, friends, and therapists.

When the fact of personality disorder is established, it is necessary to determine the type of personality disorder (schizoid, borderline, obsessive-compulsive or otherwise). You can be guided by the criteria of DSM or ICD-10.

DSM-IV PLR Criteria:

1) Furious impulses to avoid real or imagined abandonment. 2) A pattern of unstable and intense interpersonal relationships, characterized by an alternation between extreme idealization and devaluation. 3) Identity Disorder: A distinctly and constantly unstable Self-image or sense of self. 4) Impulsivity in at least two self-damaging areas (eg, waste, sex, substance abuse, uninhibited driving, gluttony). 5) Repetitive suicidal behavior, gestures or threats, or self-injurious behavior. 6) Affective instability and distinct reactivity to environmental situations (for example, intense episodic depression, irritability or anxiety, usually lasting several hours and rarely several days). 7) Chronic feeling of emptiness. 8) Inappropriate, intense anger or difficulty in controlling it.9) Transient (transient) stress-related paranoia or severe dissociative symptoms (feelings of unreality).

To diagnose PLR, it is enough to match five of the above signs

Between the neurotic and the borderline personality structure, there is also a layer in the form of the borderline personality organization

This means that a person does not get the criteria for making a diagnosis of PMD (for example, he does not have patterns of self-harming, suicidal behavior, there is a formed identity, there is no feeling of emptiness, but at the same time there is affective instability, increased emotionality, a tendency to long-term "stuck" on some problem, fear of abandonment, a tendency to a codependent type of attachment, a weakened volitional component, etc.).

Diagnostic tests (standardized, projective) can also determine the type of personality disorder

The SMIL test, the 16-factor Kettell questionnaire, the Ammon test, the diagnosis of early maladaptive schemes, the T. Yu. Lasovskaya and Ts. P. Korolenko to determine the PLR, projective test - "Drawing of a nonexistent animal M. Dukarevich." Starting my work with clients, first of all, I conduct a comprehensive personality diagnostics free of charge in order to understand what personality structure I work with and what the strategy of psychotherapy should be. If necessary, I take supervision from colleagues. A more detailed, structured material on personality disorders can be found in a colleague of mine. Understanding the characteristics of his personality gives a therapeutic effect when a person reaches some certainty about his condition and the diagnosis does not look like hanging a label, but rather like self-knowledge, self-examination

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