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发帖数: 16092 | 1 I was pretty sure it was paranoia, because according to DSV V4.0:
A pervasive pattern of instability of interpersonal relationships, self-
image, and affects, and marked impulsivity beginning by early adulthood and
present in a variety of contexts, as indicated by five (or more) of the
following:
1. frantic efforts to avoid real or imagined abandonment. Note: Do not
include suicidal or self-mutilating behavior covered in Criterion 5.
2. a pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization and
devaluation.
3. identity disturbance: markedly and persistently unstable self-image or
sense of self.
4. impulsivity in at least two areas that are potentially self-damaging (e
.g., spending, sex, substance abuse, reckless driving, binge eating). Note:
Do not include suicidal or self-mutilating behavior covered in Criterion 5.
5. recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior
6. affective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usually lasting a few hours
and only rarely more than a few days).
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger (e.g.,
frequent displays of temper, constant anger, recurrent physical fights)
9. transient, stress-related paranoid ideation or severe dissociative
symptoms
The DSM IV goes on to say:
The essential feature of Borderline Personality Disorder is a pervasive
pattern of instability of interpersonal relationships, self-image, and
affects, and marked impulsivity that begins by early adulthood and is
present in a variety of contexts.
Individuals with Borderline Personality Disorder make frantic efforts to
avoid real or imagined abandonment (Criterion 1). The perception of
impending separation or rejection, or the loss of external structure, can
lead to profound changes in self-image, affect, cognition, and behavior.
These individuals are very sensitive to environmental circumstances. They
experience intense abandonment fears and inappropriate anger even when faced
with a realistic time-limited separation or when there are unavoidable
changes in plans (e.g. sudden despair in reaction to a clinician’s
announcing the end of the hour; panic of fury when someone important to them
is just a few minutes late or must cancel an appointment). They may believe
that this "abandonment" implies they are "bad." These abandonment fears are
related to an intolerance of being alone and a need to have other people
with them. Their frantic efforts to avoid abandonment may include impulsive
actions such as self-mutilating or suicidal behaviors, which are described
separately in Criterion 5.
Individuals with Borderline Personality Disorder have a pattern of unstable
and intense relationships (Criterion 2). They may idealize potential
caregivers or lovers at the first or second meeting, demand to spend a lot
of time together, and share the most intimate details early in a
relationship. However, they may switch quickly from idealizing other people
to devaluing them, feeling that the other person does not care enough, does
not give enough, is not "there" enough. These individuals can empathize with
and nurture other people, but only with the expectation that the other
person will "be there" in return to meet their own needs on demand. These
individuals are prone to sudden and dramatic shifts in their view of others,
who may alternately be seen as beneficent supports or as cruelly punitive.
Such shifts often reflect disillusionment with a caregiver who nurturing
qualities had been idealized or whose rejection or abandonment is expected.
There may be an identity disturbance characterized by markedly and
persistently unstable self-image or sense of self (Criterion 3). There are
sudden and dramatic shifts in self-image, characterized by shifting goals,
values, and vocational aspirations. There may be sudden changes in opinions
and plans about career, sexual identity, values, and types of friends. These
individuals may suddenly change from the role of a needy supplicant for
help to a righteous avenger of past mistreatment. Although they usually have
a self-image that is based on being bad or evil, individuals with this
disorder may at times have feelings that they do not exist at all. Such
experiences usually occur in situations in which the individual feels a lack
of meaningful relationship, nurturing and support. These individuals may
show worse performance in unstructured work or school situations.
Individuals with this disorder display impulsivity in at least two areas
that are potentially self-damaging (Criterion 4). They may gamble, spend
money irresponsibly, binge eat, abuse substances, engage in unsafe sex, or
drive recklessly. Individuals with Borderline Personality Disorder display
recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior (Criterion 5). Completed suicide occurs in 8%-10% of such
individuals, and self-mutilative acts (e.g., cutting or burning) and suicide
threats and attempts are very common. Recurrent suicidality is often the
reason that these individuals present for help. These self-destructive acts
are usually precipitated by threats of separation or rejection or by
expectations that they assume increased responsibility. Self-mutilation may
occur during dissociative experiences and often brings relief by reaffirming
the ability to feel or by expiating the individual’s sense of being evil.
Individuals with Borderline Personality Disorder may display affective
instability that is due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usually lasting a few hours and
only rarely more than a few days) (Criterion 6). The basic dysphoric mood
of those with Borderline Personality Disorder is often disrupted by periods
of anger, panic, or despair and is rarely relieved by periods of well-being
or satisfaction. These episodes may reflect the individual’s extreme
reactivity troubled by chronic feelings of emptiness (Criterion 7). Easily
bored, they may constantly seek something to do. Individuals with Borderline
Personality Disorder frequently express inappropriate, intense anger or
have difficulty controlling their anger (Criterion 8). They may display
extreme sarcasm, enduring bitterness, or verbal outbursts. The anger is
often elicited when a caregiver or lover is seen as neglectful, withholding,
uncaring, or abandoning. Such expressions of anger are often followed by
shame and guilt and contribute to the feeling they have of being evil.
During periods of extreme stress, transient paranoid ideation or
dissociative symptoms (e.g., depersonalization) may occur (Criterion 9), but
these are generally of insufficient severity or duration to warrant an
additional diagnosis. These episodes occur most frequently in response to a
real or imagined abandonment. Symptoms tend to be transient, lasting minutes
or hours. The real or perceived return of the caregiver’s nurturance may
result in a remission of symptoms.
Associated Features and Disorders
Individuals with Borderline Personality Disorder may have a pattern of
undermining themselves at the moment a goal is about to be realized (e.g.,
dropping out of school just before graduation; regressing severely after a
discussion of how well therapy is going; destroying a good relationship just
when it is clear that the relationship could last). Some individuals
develop psychotic-like symptoms (e.g., hallucinations, body-image
distortions, ideas of reference, and hypnotic phenomena) during times of
stress. Individuals with this disorder may feel more secure with
transitional objects (i.e., a pet or inanimate possession) than in
interpersonal relationships. Premature death from suicide may occur in
individuals with this disorder, especially in those with co-occurring Mood
Disorders or Substance-Related Disorders. Physical handicaps may result from
self-inflicted abuse behaviors or failed suicide attempts. Recurrent job
losses, interrupted education, and broken marriages are common. Physical and
sexual abuse, neglect, hostile conflict, and early parental loss or
separation are more common in the childhood histories of those with
Borderline Personality Disorder. Common co-occurring Axis I disorders
include Mood Disorders, Substance-Related Disorders, Eating Disorders (
notably Bulimia), Posttraumatic Stress Disorder, and Attention-Deficit/
Hyperactivity Disorder. Borderline Personality Disorder also frequently co-
occurs with the other Personality Disorders.
Specific Culture, Age, and Gender Features
The pattern of behavior seen in Borderline Personality Disorder has been
identified in many settings around the world. Adolescents and young adults
with identity problems (especially when accompanied by substance abuse) may
transiently display behaviors that misleadingly give the impression of
Borderline Personality Disorder. Such situations are characterized by
emotional instability, "existential" dilemmas, uncertainty, anxiety-
provoking choices, conflicts about sexual orientation, and competing social
pressures to decide on careers. Borderline Personality Disorder is diagnosed
predominantly (about 75%) in females.
Prevalence
The prevalence of Borderline Personality Disorder is estimated to be about 2
% of the general population, about 10% among individuals seen in outpatient
mental health clinics, and about 20% among psychiatric inpatients. In ranges
from 30% to 60% among clinical populations with Personality Disorders.
Course
There is considerable variability in the course of Borderline Personality
Disorder. The most common pattern is one of chronic instability in early
adulthood, with episodes of serious affective and impulsive dyscontrol and
high levels of use of health and mental health resources. The impairment
from the disorder and the risk of suicide are greatest in the young-adult
years and gradually wane with advancing age. During their 30s and 40s, the
majority of individuals with this disorder attain greater stability in their
relationships and vocational functioning.
Familial Pattern
Borderline Personality Disorder is about five times more common among first-
degree biological relatives of those with the disorder than in the general
population. There is also an increased familial risk for Substance-Related
Disorders, Antisocial Personality Disorder, and Mood Disorders.
Differential Diagnosis
Borderline Personality Disorder often co-occurs with Mood Disorders, and
when criteria for both are met, both may be diagnosed. Because the cross-
sectional presentation of Borderline Personality Disorder can be mimicked by
an episode of Mood Disorder, the clinician should avoid giving an
additional diagnosis of Borderline Personality Disorder based only on cross-
sectional presentation without having documented that the pattern of
behavior has an early onset and a long-standing course.
Other Personality Disorders may be confused with Borderline Personality
Disorder because they have certain features in common. It is, therefore,
important to distinguish among these disorders based on differences in their
characteristic features. However, if an individual has personality features
that meet criteria for one or more Personality Disorders in addition to
Borderline Personality Disorder, all can be diagnosed. Although Histrionic
Personality Disorder can also be characterized by attention seeking,
manipulative behavior, and rapidly shifting emotions, Borderline Personality
Disorder is distinguished by self-destructiveness, angry disruptions in
close relationships, and chronic feelings of deep emptiness and loneliness.
Paranoid ideas or illusions may be present in both Borderline Personality
Disorder and Schizotypal Personality Disorder, but these symptoms are more
transient, interpersonally reactive, and responsive to external structuring
in Borderline Personality Disorder. Although Paranoid Personality Disorder
and Narcissistic Personality Disorder may also be characterized by an angry
reaction to minor stimuli, the relative stability of self-image as well as
the relative lack of self-destructiveness, impulsivity, and abandonment
concerns distinguish these disorders from Borderline Personality Disorder.
Although Antisocial Personality Disorder and Borderline Personality Disorder
are both characterized by manipulative behavior, individuals with
Antisocial Personality Disorder are manipulative to gain profit, power, or
some other material gratification, whereas the goal in Borderline
Personality Disorder is directed more toward gaining the concern of
caretakers. Both Dependent Personality Disorder and Borderline Personality
Disorder are characterized by fear of abandonment, however, the individual
with Borderline Personality Disorder reacts to abandonment with feelings of
emotional emptiness, rage, and demands, whereas the individual with
Dependent Personality Disorder reacts with increasing appeasement and
submissiveness and urgently seeks a replacement relationship to provide
caregiving and support. Borderline Personality Disorder can further be
distinguished from Dependent Personality Disorder by the typical pattern of
unstable and intense relationships.
Borderline Personality Disorder must be distinguished from Personality
Change Due to a General Medical Condition, in which the traits emerge due to
the direct effects of a general medical condition on the central nervous
system. It must also be distinguished from symptoms that may develop in
association with chronic substance use (e.g., Cocaine-Related Disorder Not
Otherwise Specified).
Borderline Personality Disorder should be distinguished from Identity
Problem...which is reserved for identity concerns related to a developmental
phase (e.g., adolescence) and does not qualify as a mental disorder."
But now I doubt if my diagnosis is correct, because he has these symptoms
too
Positive symptoms: Extra feelings or behaviors that are usually not present,
such as:
•Believing that what other people are saying is not true (delusions)
•Hearing, seeing, tasting, feeling, or smelling things that others do
not experience (hallucinations)
•Disorganized speech and behavior
Negative symptoms: A lack of behaviors or feelings that usually are present,
such as:
•Losing interest in everyday activities, like bathing, grooming, or
getting dressed
•Feeling out of touch with other people, family, or friends
•Lack of feeling or emotion (apathy)
•Having little emotion or inappropriate feelings in certain situations
•Having less ability to experience pleasure
Schizophrenia affects different people differently and symptoms can vary
from person to person. Some people may have many symptoms, while others may
only have a few.
Men diagnosed with schizophrenia usually start to show symptoms between
their late teens and early 20s. Women usually develop symptoms during their
mid-20s to early 30s.
Please discuss his symptoms with me, so we can better help Nile, you may
consult the established guidelines, which are available in the Diagnostic
and Statistical Manual of Mental Disorders.
Thanks! |
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