What Is Paranoid Ideation
Paranoid ideation is a symptom that can occur in borderline personality disorder, post-traumatic stress disorder , and psychotic disorders such as schizophrenia. It involves transient, stress-related paranoia. Paranoia is characterized by the experience of feeling threatened, persecuted, or conspired against. It can also loosely refer to beliefs of general suspicion regarding the motives or intentions of others.
If you have borderline personality disorder , it’s likely that you have experienced transient paranoid ideation under stress. It is one of the possible criteria for diagnosis, according to the current Diagnostic and Statistical Manual of Mental Disorders .
Types Of Personality Disorders
Diagnosis of a personality disorder requires a mental health professional looking at long-term patterns of functioning and symptoms. Diagnosis is typically made in individuals 18 or older. People under 18 are typically not diagnosed with personality disorders because their personalities are still developing. Some people with personality disorders may not recognize a problem. Also, people may have more than one personality disorder. An estimated 9 percent of U.S. adults have at least one personality disorder.2
What Are The Consequences Of Borderline Personality Disorder
Like all the other personality disorders, BPD can cause significant challenges in virtually every aspect of life.
Forming and maintaining social relationships due to emotional instability can be one of the biggest problems for many individuals and this can lead to additional issues such as low self-esteem, an extreme fear of being abandoned, or even suicidal ideation.
If you or someone you know is experiencing suicidal thoughts, help is available. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255 and is available 24/7, or you can text the word HOME to 741741 to reach the Crisis Text Line.
People with a borderline personality disorder may also become very impulsive. Many of these behaviors, such as gambling, unsafe sex, and binge eating, can have a profoundly negative effect on their financial well-being and overall health.
People with BPD may resort to substance abuse and self-harm to cope with the extreme ups and downs that come with the condition.
Enhancing Healthcare Team Outcomes
Borderline personality disorder is one of the most difficult mental health disorders to manage it is best managed with an interprofessional team, including psychiatrists, psychologists, pharmacists, mental health nurses, and social workers. Pharmacists review prescribed medications, check for drug-drug interactions, and provide patients education. Mental health nurses and social workers provide care, monitor patients, participate in the education of patients and their families, and provide follow-up to the team. Unfortunately, there are no medications that seem to help psychotherapy may help some patients, but compliance with treatment is low. The outcomes for most patients are poor, with many running into legal, social, and personal problems.
What Are The Challenges In Making The Diagnosis
The current diagnostic criteria for borderline personality disorder allow for 256 different combinations of symptoms that could lead to a diagnosis. Clinicians thus may find it challenging to make a diagnosis of borderline personality disorder. Because of their limited time to spend with patients, clinicians can look for several key factors to help them decide whether further assessment for the disorder is necessary.
The most important factor is whether the difficulties have been long standing or, for adolescents, present for at least 1 year.11 If there is a sudden change in functioning or new symptoms, a diagnosis of borderline personality disorder is less likely according to the DSM-IV-TR definition.11
Having difficulties in multiple areas is another important factor.11,21 For example, suicidality or self-harm without problems with mood or relationships is less likely to be borderline personality disorder, whereas a history of suicide attempts along with impulsive substance use and problems with chronic feelings of emptiness and anger is more suggestive of a diagnosis.
If the diagnosis of borderline personality disorder is not made, an affected person may end up with several diagnoses of comorbid disorders, none of which responds to common treatments. For example, patients who have major depressive disorder and comorbid borderline personality disorder generally do not respond as well to antidepressant medications as patients do who have major depressive disorder alone.55
Development And Course Of Bpd
Borderline Personality Disorder often begins in early adulthood. Its symptoms are greatest in the young adult years, and they decrease as with advancing age.
Symptoms like self-harm and suicidal behavior reduce as age increases. While other symptoms like intense emotions, impulsively, and intense relationships are often for life.
People with BPD who go for treatment often show significant improvement within the first year of treatment. Studies suggest that after about ten years of treatment, about half of those diagnosed with BPD may no longer meet the criteria for Borderline Personality Disorder.
Borderline Personality Disorder BPD more common among first-degree relatives of those with the disorder than in the general population. The same is seen in relatives of people with Substance Use Disorder, Antisocial Personality Disorder, and Depressive or Bipolar Disorder.
What Should I Do If I Think I Have Bpd
If you think you may have BPD, the first step is to find a mental health professional. While they can be hard to find, there are clinicians who are specially trained to treat BPD and answer your questions. Start by asking your primary care doctor for a referral, or check with family and friends to see if they have any recommendations of a local professional with expertise in your condition.
Borderline Personality Disorder Discussion Guide
Get our printable guide to help you ask the right questions at your next doctor’s appointment.
If you have health insurance, you may want to talk to the insurance company about whether the clinician takes your insurance and how many sessions would be covered and how much the co-pay would be.
If you do not have insurance, you may qualify for public assistance programs or services through your state or region’s department of mental health or social services. You can also ask your primary care physician for a referral, or look into whether medical centers or universities in your area offer psychiatric or psychological services.
In addition to working with a clinician, it may help to educate yourself about the variety of effective treatments available, including medication, psychotherapy, and self-help treatments. Finally, it is important to know that you are not alone and that with help, people with BPD lead normal and fulfilling lives.
The Criteria For A Diagnosis
BPD is a pervasive pattern of instability in interpersonal relationships, self-image, and emotion, as well as marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five of the following:
- Chronic feelings of emptiness
- Emotional instability in reaction to day-to-day events
- Frantic efforts to avoid real or imagined abandonment
- Identity disturbance with markedly or persistently unstable self-image or sense of self
- Impulsive behavior in at least two areas that are potentially self-damaging
- Inappropriate, intense anger or difficulty controlling anger
- Pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Ms Bs Alternative Model For Personality Disorders Profile Over Time
Ms. Bs Time 1 AMPD profile was defined by severe impairment in all LPFS domains of personality functioning which speaks to great impediments in relating to self and relating to others. Ms. B suffered from an impoverished and unstable identity which depended on overt validation and caretaking from others for cohesion. However, Ms. B easily perceived persecution, criticism, and judgment from others and often felt alone, excluded, and abandoned. Taken together, Ms. B generally experienced herself as denied and rejected by a withholding, critical other. Ms. B had difficultly observing and understanding her inner world as she experienced contradictory internal standards for behavior which clouded her ability to observe the impact of her own oscillating aggressive and overly dependent behavior on others. Ms. B was caught in a vicious cycle of heavily depending on others for regulation, experiencing others as withholding and rejecting, and not recognizing that her own aggressive and dependent responses drove away and burned out others. Ms. B had experienced numerous relationships ruptures with important others leaving her with few relationships on which she could truly depend on. This lack of interpersonal support further confirmed Ms. Bs sense of herself as denied and rejected.
Diagnostic Changes In Dsm
Transition-age youth
According to DSM-5, features of a personality disorder usually begin to manifest during adolescence and early adulthood. In earlier versions of DSM, a personality disorder could not be diagnosed in someone under age 18 however, DSM-5 now allows this diagnosis if the features have been present for at least one year. This change has important implications for treatment. For example, recent research indicates that BPD can be a reliable diagnosis in youth, providing an opportunity to intervene early to improve prognosis . The one diagnosis that cannot be made for people under age 18 is antisocial personality disorder.
Axis I and Axis II disorders
With the release of DSM-5 came a major change in how personality disorders are considered in a diagnostic assessment. The previous manual, DSM-IV, featured a system that separated diagnoses into five axes. Most of the major psychiatric disorders were classified as Axis I disorders. They included:
- major depressive disorder
- obsessive compulsive disorder
- substance use disorders.
Although Axis I and II no longer exist in DSM-5, this chapter still uses these terms because they are conceptually helpful when discussing diagnosis and treatment of personality disorders.
Dsm : Bpd Signs And Symptoms
According to the American Psychiatric Association, Borderline Personality Disorder is typified by an unstable or poorly developed self-image, rapidly changing personal goals, intense but unstable relationships colored with neediness due to real or imagined fear of abandonment and an impaired ability to recognize the needs and feeling of others.
Borderline Personality Disorder is associated with an increased likelihood of feeling slighted or insulted, impulsive behavior, increased risk-taking, and hostility.
The prevalence of BPD in the population is estimated to be between 1.6% and 5.9%. This disorder is seen more in females than in males as most of the people diagnosed are women .
The 5th edition of the diagnostic and statistical manual of mental disorder has two sets of diagnostic criteria for Borderline Personality Disorder, the main diagnostic criteria, and the alternate diagnostic criteria.
How Should Patients Be Informed Of Their Diagnosis
Once a diagnosis of borderline personality disorder has been established, it is important to inform the patient of the diagnosis and discuss the implications for treatment options and outcomes. There is no evidence to indicate that informing patients of the diagnosis causes problems, so it is unfortunate that this important step is often omitted.56
When informing a patient about a suspected diagnosis of borderline personality disorder, clinical experience suggests that it is helpful to show the patient the list of diagnostic criteria and explain why the diagnosis is being considered. Educating patients about the increasing number of specific treatments and the good prognosis with gradually resolving symptoms can also help reduce their anxiety about a diagnosis that is highly stigmatized in the medical system and the general population. Even a single psychoeducation session could help to reduce symptoms, as was found in a randomized trial in which 30 of 50 late adolescent women found to have borderline personality disorder were randomly assigned to attend such a session within a week after being told about their diagnosis.57 Patients can also be directed to specific resources that can provide more information .
Borderline Personality Disorder Dsm
Reviewed by Whitney White, MS CMHC, NCC., LPC
Borderline personality disorder is a severe mental health issue that involves difficulties regulating mood and emotions. BPD’s signs and symptoms can be difficult to manage but it is possible, and effective treatments are available. This article will explain what borderline personality disorder is, how its described in the DSM-5, and what treatments may be helpful to those with the disorder.
Implications For Profile Change Across Therapist Ratings
As demonstrated by high within-patient profile correlations relative to within-therapist profile correlations, the AMPD appears to be sensitive to clinical change, particularly for personality functioning severity as reflected in Criterion A. Although Mr. D and Ms. B struggled with empathy, particularly at Time 1, Mr. D and Ms. B each pulled for unique countertransferential reactions that were similarly experienced by both therapists. Mr. Ds difficulty observing and tolerating the impact of his behavior on others, tended to leave both therapists feeling parentified in moments of his irresponsibility and rebelliousness. However, with Ms. B., her inability to see beyond the immediacy of her own affect and needs left both therapists feeling dismissed and ineffective when clinician responses to her repeated bids for help were promptly rejected. Although both patients struggled to understand the perspective of others, these difficulties manifested in different ways that are captured by Criterion B of the AMPD: Mr. D presenting as impulsive and Ms. B as affectively dysregulated. These differences between patients that were jointly experienced by each of the treating clinicians was mirrored in the LPFS and PID-5 ratings suggesting that the ratings reflect clinical phenomenon rather than rater bias.
Petulant Borderline Personality Disorder
Individuals with Petulant borderline personality Disorder have a unique characterization. Their moods are unpredictable and they can switch from aggressive anger or rage to being petulant and sulky. They possess an unhealthy obsession for control due to the feeling unworthy or unloved by their near and dear ones. This type of BPD is associated with manipulation and extreme relationship dissatisfaction. Substance abuse and other damaging behaviors typically follow.
Following are some Example behaviors observed in people with petulant borderline personality disorderIrritability and impatience
- Obstinacy and insolent
- Unpredictable mood swings
Rater Agreement And The Grand Mean Ampd Profile For The Bpd Criteria
The inter-rater agreement for the raters evaluation of each of the nine BPD criteria with the elements of Criteria A and B was quantified by ICCs . Because the interests of the current study were generally in the mean values of raters evaluations of BPD criteria, and because group-level and correlational analyses including profile analyses were employed, we used the consistency ICC to benchmark rater agreement . Table shows ICCs for Criterion A and Criterion B for each BPD criterion. Regarding the LPFS, eight of the nine DSM-5 BPD criteria demonstrated strong levels of agreement, except for BPD criterion 8 , which was not as strong. For the 25 traits of Criterion B of the AMPD, all ICCs were strong. The global mean ICC across the four domains of the LPFS and all nine BPD criteria was strong, as it was for the 25 traits. This robust level of rater agreement supported combining clinician ratings and computing mean AMPD metrics for each of the nine BPD criteria across the 20 raters. In turn, a grand mean across all nine BPD criteria was also found .
Table 1 Initial rater ICCs
What Is The Treatment For Borderline Personality Disorder
Treatment for borderline personality disorder can be difficult and usually includes a combination of medications and psychotherapy.
Psychotherapy is the first-line treatment for people with borderline personality disorder. Types of psychotherapies used to treat borderline personality disorder include:
- Dialectical behavior therapy , which uses concepts of mindfulness and attention to ones own experience, interpersonal effectiveness, regulating emotions, and stressing tolerance without impulsivity
- Cognitive behavioral therapy , which helps people identify and change core beliefs and behaviors and may help reduce mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors
Medications used to treat borderline personality disorder are often aimed at treating specific symptoms such as depression, mood swings, and other co-occurring mental disorders.
Medications may include:
Start The Assessment Process
When you arrive for your first therapy session, it’s normal to feel nervous and uncomfortable, particularly if you are new to therapy. It’s not easy to meet a new person and start sharing private details about your life. Keep in mind, however, that the more direct and honest you are during your BPD assessment, the more you will get out of it.
Your BPD assessment may take one session or several sessions. Your therapist will tell you how long the assessment will take and what types of tests or interviews they’ll employ, if any.
Different providers use different tools to conduct an assessment. Generally, you can expect the therapist to ask questions about your current and past symptoms, family and work history, and current life situation. Some therapists will also give you a short questionnaire to fill out and/or administer a psychological test, which is typically longer and asks more questions. You can also ask any questions you may have.
Borderline Personality Disorder Discussion Guide
Get our printable guide to help you ask the right questions at your next doctor’s appointment.
Fear Of Being Alone Or Abandoned
This is one most prominent signs since it can cause a full spectrum of emotions.
They are basically terrified of being left alone or abandoned even in most trivial scenarios.
This can trigger feelings of betrayal, for example, if your partner goes to the store and is taking more time than usual, this will immediately cause an intense panic attack.
This could make the person with BPD adopt certain behaviors like extreme jealousy, being controlling and manipulative, followed by a constant clinginess and conflict, just to keep the other person with them.
You Think About Them When You Make Decisions
A favorite person is often on the receiving end of the strong emotions held by a person with BPD. This means observing their joy when the favorite person makes time to be with them, or shouldering mean words or a cold shoulder upon refusing the wishes of a person with BPD.
To avoid tantrums, and to ensure peace reigns with a person with BPD, a favorite person will find that they put the person with BPD into consideration when making decisions that might affect them.