Of the many diseases and disorders highlighted during May — stroke, asthma, hepatitis and lupus just name a few — one jumps out not because of the national attention it garners, but because it is one of the most overlooked and misdiagnosed disorders in medicine today.
Borderline Personality Disorder (BPD) affects a reported 1.6 percent of adults each year in the U.S., according to the National Institute of Mental Health (NIMH). BPD is a tricky mental illness that can effectively disguise itself as depression or Bipolar Disorder, usually because those illnesses can crop up as a result of BPD.
A proper diagnosis of BPD requires time and multiple tests, and many doctors go with the first thing they find. Dr. Larry Kubiak, the director of psychological services at Tallahassee Memorial HealthCare’s Behavioral Health Center, said the first round of tests for BPD usually lead doctors to think something easier to diagnose is wrong.
“One of the things that you find is you have a lot of diagnoses that have some symptoms (of BPD) and are similar,” he said. “Unless you’ve done a very thorough job of assessment you look at the results and say, ‘Oh well they have an anxiety disorder.’ ”
A misdiagnosis can lead to months or years of treatment and medication for a symptom — like mood swings or depression — for BPD instead of looking at the underlying cause. Kubiak said BPD is a personality disorder which can’t just be treated with medication.
“Symptoms represent vacillations in three main areas: How you see yourself, how you relate to other people and your mood,” Kubiak said.
The NIMH reports people with BPD usually suffer from problems with regulating emotions and thoughts, impulsive and reckless behavior and unstable relationships with other people. The Diagnostic and Statistical Manual IV, which Kubiak calls the Bible for identifying disease, says a patient must meet at least five out of nine criteria used to diagnose BPD.
• Frantic efforts to avoid real or imagined abandonment.
• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
• Identity disturbance: markedly and persistently unstable self-image or sense of self.
• Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
• Recurrent suicidal behavior, gestures, or threats, or self-harming behavior.
• Affective mood instability.
• Chronic feelings of emptiness.
• Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
• Transient, stress-related paranoia.
The DSM IV states these traits must lead to a “pervasive pattern of instability of interpersonal relationships, self image and affects and marked impulsivity beginning by early adulthood.”
“Borderline personality disorder is a serious mental illness that can cause a lot of suffering, carries a significant risk of suicide and requires an accurate diagnosis along with targeted treatment,” said National Alliance on Mental Illness Executive Director Michael Fitzpatrick in a news release.
Fitzpatrick released the statement during NAMI-sponsored congressional briefing on BPD.
“We know that treatment works, but too often stigma discourages people with mental illness from getting the help that they need. Untreated mental illness has significant personal, social and economic implications. We urge Congress to increase funding of research, treatment and services for those living with BPD and their families.”
Potentially the most damaging part of BPD is the hopelessness many patients feel while trying to live with it, Kubiak said. There is no one cure-all treatment for BPD, however there are effective forms of therapy and medicine is typically prescribed to help with symptoms like depression.
“Once you have an accurate diagnosis there are some very good treatments out there,” Kubiak said. “Don’t be afraid to reach out for those treatments.”
** If you or someone you know is struggling with Borderline Personality Disorder, contact our office to schedule an Initial Assessment.