dsm iii

In this interview with Adam Curtis, Spitzer admitted that his Taskforce [for writing DSM-III] was interested only in the experiences that characterised the disorder. It was not interested in understanding the individual patient’s life or why they suffered from these experiences. Because these contextual factors were overlooked, experiences of sadness, anxiety or unhappiness were often listed as symptoms of underlying disorders, rather than seen as natural and normal human reactions to certain life conditions that needed to be changed.
—  Davies J (2014) Cracked: Why Psychiatry is Doing More Harm Than Good. London: Icon Books. 44-45

yknow, i get why it’s appealing to think that ableism only has to do with people with specific medicalized conditions? but that’s… just not how things work?

for one thing, this specific medical model of “this is what Defines a mental illness, this is specifically what this particular mental illness Is, regardless of our individual philosophical backgrounds” is new. very new. like DSM-I and ICD-6 new (1952 and 1949, for reference). hell, i’ve seen it argued that current ideas about “mental illnesses are bounded, specific things that share the same causes among its patients” is better traced to the DSM-III (1980), tho that’s not a view i particularly agree with.

but in any case, I’m pretty sure anti-mental illness ableism existed more than 150 years ago. to say less about all sorts of illnesses that were only identified and focused on very recently, and whose boundaries are still fuzzy as hell and being renegotiated constantly

hell, from my view, defining disability only in terms of the medical is a big ole step backwards that disability rights activists have been actively fighting against for a while now (*waves arms* social model of disability!! society’s ideas about multiplicity disable us even if we don’t fall into the classical category of DID uugh) 

especially with something like multiplicity, which is practically the exemplar of “bad insane crazy”. to someone who thinks that we’re all axe-murderers waiting to happen or fakey roleplaying liars, saying “no, this isn’t a disorder for us” isn’t gonna change anything. endogenic systems still get diagnosed with DID or OSDD-1 or, I think more often actually, schizophrenia or borderline or anything to try to get at this idea that “you shouldn’t be multiple, you shouldn’t be like this, so we’re gonna figure out something to apply to you”.

- Ace

“Over his many years at the Children’s Clinic in Vienna, Hans Asperger studied more than 200 children he would ultimately treat for what he called autistische Psychopathen (autistic psychopathy). Some were prodigies who couldn’t make it through school; others were more disabled and were shunted into asylums. But what they all had in common was a family of symptoms—in Silberman’s words, ‘social awkwardness, precocious abilities, and fascination with rules, laws, and schedules’—that Asperger recognized, right away, made up a continuum, one occupied by children and adults alike, and he viewed those differences as cause for celebration, not distress. When he finally shared his findings with the world, the only reason he focused on his higher-­functioning patients, Silberman contends, was a chilling function of the era: The ­Nazis, on a mad campaign to purge the land of the ‘feebleminded,’ were euthanizing institutionalized children with abandon. In so doing, Asper­ger accidentally gave the impression that autism was a rarefied condition among young gen­iuses, not the common syndrome he knew it to be. His paper on the subject, published in 1944, remained unavailable in English for decades, and his records were ‘buried with the ashes of his clinic,’ which was bombed the same year.

“Meanwhile, in the United States, a brilliant, energetic child psychiatrist named Leo Kanner was developing a radically different picture of autism, one that stipulated the condition was uncommon and unique, affecting only young children (anyone older was schizophrenic, psychotic—anything else) and, though biological in origin, somehow activated by cold and withholding parents. ‘By blaming parents for inadvertently causing their children’s autism,’ Silberman writes, ‘Kanner made his syndrome a source of shame and stigma for families worldwide.’

“Thus the history of autism was written, paving the way for a decades-long attempt to cure, rather than adapt…Even more important, because Kanner’s needle-­narrow definition of autism prevailed for so long, the public labored under the misapprehension that there was a sudden ‘epidemic’ of autism when the DSM-III-R, published in 1987 (and just as critically, the DSM-IV in 1994), finally expanded the definition to include those who had slipped through the sieve for ­decades.

“The autism pandemic, in other words, is an optical illusion, one brought about by an original sin of diagnostic parsimony. The implications here are staggering: Had the definition included Asperger’s original, expansive vision, it’s quite possible we wouldn’t have been hunting for environmental causes or pointing our fingers at anxious parents.”

–From the New York Times review of Neurotribes: The Legacy of Autism and the Future of Neurodiversity, Steve Silberman

makamu-a-tumbling  asked:

So, here is my follow-up question on your help with the PSTD: the world the character lives in is an alternate version of the late 19th and early to mid 20th centuries. I know that psychology was in its infancy as a discipline then, so I am wondering if he could get therapy for it then. For plot reasons, my MC is himself interested in forensic psychology (and psychoanalysis- yes, I know...), so I am also wondering whether he'd be able to recognise that there is something wrong with him himself?T

The Shrink was able to clarify that this story takes place in 1920′s Munich and Vienna, which is definitely an interesting time period in the history of psychology! Freudian psychoanalysis was in full swing at that point, and those cities were definitely hotspots for the newly developing field of psychotherapy. So it’s very possible to have your character seeing one of those early therapists.


PTSD as a diagnosis was not recognized until 1978, when it was included in the DSM-III, so you won’t be able to use that term. However, there were certain things back in that era that could be seen as proto-PTSD diagnoses.

These include:

Soldier’s heart / Irritable heart / Da Costa’s syndrome (1862) - It’s unclear, but it’s possible that this was used as an attempt to explain why soldiers returning from the American civil war weren’t the same. However, it was thought to be a physiological heart condition, not a mental disorder.

Railway spine (1867) - specifically referring to the symptoms that passengers in railway accidents developed. However, this diagnosis was controversial, with many thinking it was a result of neurological damage, others saying it was just another form of hysteria.

Shell shock (1915) - this term only arose in WWI, and was thought to be a result of brain damage suffered as reaction to artillery shells going off nearby. It took some time for people to realize that there was a psychological, not physical, component. 

All of these were thought to be medical conditions, not mental illnesses - so keep that in mind when writing how your character ends up in treatment. Your character was likely referred to a psychoanalyst after medical doctors could find nothing ‘wrong’ with them.


Whether or not your character could get into “forensic psychology” depends on how you define the term - it’s a pretty broad subject. There were some scattered studies related to legal settings (eye witness testimony, development of the polygraph) in the time frame you’re talking about, but generally psychologists were not taken seriously by the American court system until the 1960s (I’m not sure about other countries).


As for recognizing there’s something wrong with themselves…that’s up to your character. Honestly, it’s pretty likely that they’d realize something is wrong with themselves, but your character may or may not realize that it’s related to their trauma.


http://www.pbs.org/wgbh/pages/frontline/shows/heart/themes/shellshock.html

https://www.ptsd.va.gov/public/ptsd-overview/basics/history-of-ptsd-vets.asp

http://criminal-justice.iresearchnet.com/forensic-psychology/history-of-forensic-psychology/

http://criminal-justice.iresearchnet.com/forensic-psychology/history-of-forensic-psychology/us-developments/


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anonymous asked:

Hai Uhm is there a difference between ADD and ADHD cause I stim alot but I was diagnosed with ADD and I've read things online that said their the same but idk Nd you guys seem like you know what your talking about aas

What is the difference between ADD and ADHD?

  • North America: In the DSM-III, the disorder was called ADD; in 1994, in the DSM-IV, that was changed to ADHD, and it was split into three different types. So basically, the term “ADD” is old terminology that we don’t use anymore. However, most people who use this term mean Inattentive ADHD, or “ADHD without the H” (H meaning “hyperactivity”). The current edition of the DSM, the DSM-5, retains the three types.
  • The ICD-10 is the diagnostic manual used in the rest of the world, and it still has a diagnosis of ADD included while also using ADHD for Hyperactive ADHD. We don’t know when the next edition will be published or if this will be changed at all.
  • Note that as the founder of this blog is located in Canada, we follow the DSM-5 for discussions of type and diagnosis. However, it should likewise be noted that the ICD-10 is used in most of the rest of the world, especially in Europe.

What are the types of ADHD?

  • ADHD - Primarily Inattentive Type is what most people mean when they say “ADD.” It is characterized by “daydreaming” and difficulty focusing on things that are important to focus on.
  • ADHD - Primarily Hyperactive/Impulsive Type is what most people think of when they hear “ADHD.” It is characterized by physically hyperactive behaviours and impulsive behaviours, like moving around a lot and talking without thinking first.
  • ADHD - Combined Type is just what it says: it’s a combination of symptoms from both of the other two types.
  • Having a diagnosis of Inattentive type does not mean you won’t show symptoms of Hyperactive/Impulsive type, and vice versa. The diagnostic criteria states that you must have at least six symptoms (or five if you’re 17 or older) listed for a particular type, and Combined type is considered to be an even split of symptoms from the other two types (meaning at least five or six symptoms - depending on age - per type, so 10 or 12 total).

(Source)

i struggle

Borderline Personality Disorder

What is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, theDiagnostic and Statistical Manual for Mental Disorders, Third Edition(DSM-III) listed BPD as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.

Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name “borderline personality disorder” is misleading, a more accurate term does not exist yet.

Most people who have BPD suffer from:

  • Problems with regulating emotions and thoughts
  • Impulsive and reckless behavior
  • Unstable relationships with other people.

People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

Causes

Research on the possible causes and risk factors for BPD is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.

Studies on twins with BPD suggest that the illness is strongly inherited. Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.

Social or cultural factors may increase the risk for BPD. For example, being part of a community or culture in which unstable family relationships are common may increase a person’s risk for the disorder. Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.

Signs & Symptoms

According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:

  • Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
  • A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
  • Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
  • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
  • Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days
  • Chronic feelings of emptiness and/or boredom
  • Inappropriate, intense anger or problems controlling anger
  • Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

Suicide and Self-harm

Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with BPD have suicidal behaviors, and about 4 to 9 percent commit suicide.

Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with BPD. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.

Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with BPD may self-harm to help regulate their emotions, to punish themselves, or to express their pain. They do not always see these behaviors as harmful.

Who Is At Risk?

According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year.  BPD usually begins during adolescence or early adulthood. Some studies suggest that early symptoms of the illness may occur during childhood.

Diagnosis

Unfortunately, BPD is often underdiagnosed or misdiagnosed.

A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.

The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional’s attention.

Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, BPD is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder. According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also meet the diagnostic criteria for another mental illness. Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia. These conditions are associated with obesity, which is a common side effect of the medications prescribed to treat BPD and other mental disorders.

No single test can diagnose BPD. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with BPD showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe BPD showed a more intense emotional response than people who had less severe BPD.

anonymous asked:

I don't understand your anti-psychiatry standpoint tbh. I looked through the entire tag and I just don't understand it. I have OCD, and all I feel coming from you is that my mental illness is simply just a product of society or something???? i hate my OCD, i want it gone, it's ruined my life, it's ruined my grades and honestly without my psychologist and without antidepressants i'd be in a much worse state. i dont understand, all i feel is that youre saying mental illnesses are fake or somethin

Honestly I don’t have much to tell you that isn’t somewhere in that tag. If your idea of whether they’re real relies on a doctor’s stamp of biological causation then they’re “fake” but I don’t buy the terms of the establishment to begin with and want to have a conversation using those terms. That is, I don’t think the question of whether mental illnesses are “real” or “fake” is useful- human pain is real whether it is recognized by the medical establishment or not. But the people who’ve built this establishment will tell you that they lack completely the things doctors need in other kinds of medicine in order to justify their existence: useful categories of diagnosis that are likely to be diagnosed the same by different physicians, chemical or measurable ways to distinguish between disorders, diagnoses which say something about causation (you have diabetes because of this relationship to insulin), etc etc. My problem is not even that psychiatry is ideological (all medicine, hell all science is ideological) but that it claims ardently not to be, even though we know historically that psychiatry has always hit the most marginalized the hardest and labelled them sick for reacting like healthy human beings put under disgusting, inhumane conditions created by capital and social situations: women, the poor, black people and other people of color, reacting to the stress of their lives, personal trauma, misogyny, people who are reacting to being put in inhumane conditions have always been the first to be labelled sick because it allows the society at large to ignore the problems which definitely exacerbate any issues a person may already have. How many people have mental illnesses that make their lives nearly unbearable which might be more bearable if they didn’t have to strain themselves at work every day to feed themselves? How many black people are looking for ways to deal with intergenerational trauma and a world in which their friends and family can be killed for nothing while walking down the street and the cop can get away with it?


My point is not that mental illnesses are not real- obviously people feel pain that can be helped by things like medication, and I usually leave psychologists off the table and focus on psychiatry as an institution because they can be separated, though not completely. My point is that the increasing medicalization of human pain and emotional pain is the result of a social and political set of trends which have made that a priority, not sort of untouchable scientific fact. If more people are diagnosed with mental disorders per year, that can tell us one of three things: either more people are sick, or we are including more people as sick, or both. It is not the result of science. When asked, in the face of evidence strongly suggesting that DSM III categories needed at the very least some cleaning up to make them more stable, reliable, etc to more accurately diagnose patients, why they didn’t cut diagnoses they didn’t find useful, DSM IV creators shrugged and said, “Well they were in the 3rd and it was easier to leave them.” When DSM III collaborators were asked the same thing, they gave the same answer and said their decisions around updating their manual were mostly based around a few debates between a very few members of the establishment. These categories have existed for years without much public debate/actual patient input as to their relevance, social implications (how many kleptomaniacs of color do you know of?), or origins. Frankly, most psychiatrists who are not very high up in their field have no say in its terminology. So at the very least it is an establishment controlled by a small group of very powerful doctors, often paid off by pharmaceutical companies which only have to show 2 positive trials to the FDA (regardless of the number of negative studies, the structure of those studies, etc) in order to get drugs onto the market and onto the scrip pads of overworked, stretched out psychiatrists who see their patients for 30 minutes perhaps every two weeks.


The question is not “is mental illness real” at all, because obviously people have symptoms which can be grouped into diagnositc labels. That’s not something I think should be up for debate at all. The question is, how useful is the medicalization of those symptoms, and how useful is the psychiatric establishment’s presumption that those symptoms arise specifically from the disorder itself (which conveniently cannot be measured or tested for in most cases) rather than that these symptoms often occur naturally in groupings? I’ve read the process of medicalization described as how constellations are formed- they do not exist in and of themselves (they are just stars) but get grouped by our perceptions, politics, histories, and mythologies into patterns which we can then see on the sky, even though we wrote them their ourselves. For example, depression has a fairly well-defined set of diagnostic criteria. But causation is left completely unaccounted for by the diagnostic model, something that would be unthinkable in any other medical field. If one of my best friends dies tomorrow, it makes sense that I would be extremely depressed for weeks, perhaps months. This is clinical depression, as much as clinical depression that seems to pop up from nowhere is clinical depression. But they do not describe the same phenomenon. Likewise, I know a ton of people with OCD actually. Many have it running in the family- most disorders seem to have at least biological components. But many have no other family members with OCD (that they know of) and instead developed OCD as a coping mechanism for childhood trauma, wherein they were able to control how many times the light switch got flicked before bed even if they could not control their beatings at the hands of abusive parents. The end result is the same, but these are fundamentally different situations and psychiatry has no way to account for this yet because en masse it is disinterested in listening to actual patient narratives and talking about pain, trauma, social factors like how terrible it feels to be poor, etc etc. If I went to a doctor with low sodium levels, they would ask me things to make sure that this was not the result of something like a low sodium diet, or exercising to exhaustion too often, and make a diagnosis based on other biological markers. Psychiatrists don’t have this, and are more interested in treating disorders in the form of walking bodies than in helping people deal with their pain.


I think when an establishment has the power to medicate, imprison, discredit the experiences of, and abuse its own patients it legitimacy must be critiqued and its power must be called into question. I actually had rather neutral/only mildly negative experiences with the psychiatric establishment, and I still consider them traumatizing- I don’t discuss my life and feelings in terms of them anymore, but I have diagnoses listed on the books somewhere that take pain that resulted from a lot of things (including, yeah, family history and a likely genetic predisposition but also years and years of intense emotional and sometimes physical abuse and trauma resulting from that) and list them as a diagnostic code. I am not even particularly anti-medication itself: I took meds for a few years to help me function on a daily basis when my pain was at its worst, and there’s no shame in taking medication for any period of time if it helps you live your life. The question is not “do people have mental illnesses” at all but “How can psychiatry actually respond to patient needs and desires and histories and experiences organically rather than stuffing them into boxes and THEN dealing with them as patients?” I have friends with BPD who’ve had to lie about receiving manipulative treatment from doctors to get out of psych wards for fear that they’d be seen as manipulating their doctors, I have friends who’ve almost died from eating disorders that weren’t recognized because they weren’t thin enough for doctors to care yet (more likely to happen to women and that is DEFINITELY ideological- make yourself even smaller or we don’t care), and on and on and on. My premise is not that psychiatry is never useful (of course it is, and any time that it is and people decide to interact with it to make their lives easier I’m 500000000000% in favor of that), and frankly my views have moderated a bit since I updated that tag regularly, but I do think that we need to be having conversations about why people are asked to hand over total control of their life stories to doctors who don’t trust them to know themselves.

hah i mean i get the desire to “use the DSM against syscoursers”, but i can’t help but feel like it reifies the idea that the DSM should matter at all here

i mean, it is sorta amusing that the criteria, when including DDNOS/OSDD-1, essentially boils down to “is multiple to some extent”, and that these kids reaaally need to learn why the “distress/dysfunction/disability”-type criteria are important historically. but at the end of the day, i don’t really care whether or not we could “technically” fit as OSDD-1 or DSM-III MPD or whatever; the point is that we exist, and should be allowed to exist outside of psychiatry, regardless.

- Ace

2

Hysteria is undoubtedly the first mental disorder attributable to women, accurately described in the second millennium BC, and until Freud considered an exclusively female disease. Over 4000 years of history, this disease was considered from two perspectives: scientific and demonological. It was cured with herbs, sex or sexual abstinence, punished and purified with fire for its association with sorcery and finally, clinically studied as a disease and treated with innovative therapies. However, even at the end of 19th century, scientific innovation had still not reached some places. During the 20th century several studies postulated the decline of hysteria amongst occidental patients (both women and men) and the escalating of this disorder in non-Western countries. The concept of hysterical neurosis is deleted with the 1980 DSM-III. The evolution of these diseases seems to be a factor linked with social “westernization”, and examining under what conditions the symptoms first became common in different societies became a priority for recent studies over risk factor.

What is the difference between ADD and ADHD?
  • North America: In the DSM-III, the disorder was called ADD; in 1994, in the DSM-IV, that was changed to ADHD, and it was split into three different types. So basically, the term “ADD” is old terminology that we don’t use anymore. However, most people who use this term mean Inattentive ADHD, or “ADHD without the H” (H meaning “hyperactivity”).
  • The ICD-10 is the diagnostic manual used in the rest of the world, and it still has a diagnosis of ADD included while also using ADHD for Hyperactive ADHD. We don’t know when the next edition will be published or if this will be changed at all.

(Source)

Personality Disorders

Brief Description of the Fourteen Personality Disorders of DSM-III, DSM-III-R, and DSM-IV

Schizoid: Apathetic, indifferent, remote, solitary. Neither desires nor need human attachments. Minimal awareness of feelings of self or others. Few drives or ambitions, if any.

Avoidant: Hesitant, self-conscious, embarrassed, anxious. Tense in social situations due to fear of rejection. Plagued by constant performance anxiety. Sees self as inept, inferior, or unappealing. Feels alone and empty.

Depressive: Somber, discouraged, pessimistic, brooding, fatalistic. Presents self as vulnerable and abandoned. Feels valueless, guilty, and impotent. Judges self as worthy only of criticism and contempt.

Dependent: Helpless, incompetent, submissive, immature. Withdraws from adult responsibilities. Sees self as weak or fragile. Seeks constant reassurance from stronger figures.

Histrionic: Dramatic, seductive, shallow, stimulus-seeking, vain. Overreacts to minor events. Exhibitionistic as a means of securing attention and favors. Sees self as attractive and charming.

Narcissistic: Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. Sees self as admirable and superior, and therefore entitled to special treatment.

Antisocial: Impulsive, irresponsible, deviant, unruly. Acts without due consideration. Meets social obligations only when self-serving. Disrespects societal customs, rules, and standards. Sees self as free and independent.

Sadistic: Explosively hostile, abrasive, cruel, dogmatic. Liable to sudden outbursts of rage. Feels selfsatisfied through dominating, intimidating and humiling others. Is opinionated and closeminded.

Compulsive Restrained, conscientious, respectful, rigid. Maintains a rule-bound lifestyle. Adheres closely to social conventions. Sees the world in terms of regulations and hierarchies. Sees self as devoted,
reliable, efficient, and productive.

Negativistic: Resentful, contrary, skeptical, discontented. Resist fulfilling others’ expectations. Deliberately inefficient. Vents anger indirectly by undermining others’ goals. Alternately moody and irritable, then sullen and withdrawn.

Masochistic: Deferential, pleasure-phobic, servile, blameful, self-effacing. Encourages others to take advantage. Deliberately defeats own achievements. Seeks condemning or mistreatful partners.

Paranoid: Guarded, defensive, distrustful and suspiciousness. Hypervigilant to the motives of others to undermine or do harm. Always seeking confirmatory evidence of hidden schemes. Feels righteous, but persecuted.

Schizotypal: Eccentric, self-estranged, bizarre, absent. Exhibits peculiar mannerisms and behaviors. Thinks can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blurs line between reality and fantasy.

Borderline: Unpredictable, manipulative, unstable. Frantically fears abandonment and isolation. Experiences rapidly fluctuating moods. Shifts rapidly between loving and hating. Sees self and others alternatively as all-good and all-bad.

Let’s get rid of the term ‘borderline personality disorder’

The psychological diagnosis of Borderline Personality Disorder (or BDP) continues to be one of the more heavily debated of the psychological disorders.  The straight-up truth, however, is that it’s a full on pejorative label with stigma that all too often causes clinicians to view borderline clients in a negative and resentful fashion.  The significant majority of people identified as borderline are women and the diagnostic criteria reflects a largely male-oriented ideas of healthy psychological functioning.

It can be true that psychotherapy with borderline clients can often be extremely difficult and arduous and it is not uncommon for therapists to feel exhausted and manipulated by their borderline clients.  Although I feel that the specific ways in which BPD is conceptualized and understood often contributes to this negative outlook.

Psychological theorists, such as Judith Herman, Basil Van der Kolk  and many others, argue that BDP is often better understood as a ‘complex’ form of posttraumatic stress disorder (PTSD). Complex PTSD is a more pervasive and ingrained form of chronic difficulties with stress and anxiety that stem from significant experiences of trauma.  Many of the symptoms entailed in complex PTSD can look very similar to the clinical presentation of BDP.

The idea of seeing BPD as a complex form of PTSD is supported by multiple research findings that have found that a significantly high percentage of people diagnosed with BPD have histories of being victims of substantial traumas (Courtois, 2009; Van der Kolk et al., 2006; Driessen et al., 2000; Zanarini et al., 1997; Ogata et al., 1990).

A study reported by Zanarini et al. (1997), for example, looked a large sample of individuals diagnosed with BPD and found that a significant majority of these people had experiences with sexual abuse at some point during their childhoods. Based on these results, and the results of additional studies, Zanirini and her colleagues concluded that severe experiences of trauma appear to be a substantial etiological factor in most cases of BPD.

Judith Herman (1997) notes that identifying someone as being the victim of a trauma tends to elicit a more sympathetic reaction from psychotherapists and other mental healthcare providers. That is to say, a therapist who sees her client as having trauma-related difficulties is less likely to feel annoyed and resentful toward the client as opposed one who is identified as borderline. Complex PTSD is simply a more compassionate diagnosis… one that fosters a greater degree of understanding and empathy (factors that are often essential if a treatment is going to be effective).

Research reported by Courtois et al. (2009) and Van der Kolk et al. (2006) found that treatments that are based on a primary diagnosis of Complex PTSD are substantially more effective and successful compared to those based upon a primary diagnosis of BPD.  Considering that these two diagnostic labels essentially refer to the same condition, it would appear that the therapist’s perspective, compassion, and understanding concerning the root cause of psychological difficulties might often be a key factor in determining a treatment’s ability to succeed and bring about positive results.

Of course there are plenty of people in the professional community who argue against this whole idea, who reject the notion of re-conceptualizing BDP as a complex form of PTSD.  And many would site the neurological evidence gathered that suggests BPD is a largely organic condition caused by subtle neurological abnormalities that lead to greater sensitivity and vulnerability to negative affect.  This idea is largely supported by functional MRI scans that demonstrate significant alterations in the brain scans of subjects identified with BPD versus neurotypical controls.

These opponents argue that the high rates of histories of trauma among those identified with BPD is merely a co-morbid correlation.  Some have even gone so far as to suggest that the increased prevalence of histories of childhood sexual abuse in BPD may itself be a result of these neurological factors. The argument here is that the reduced abilities for impulse control and social inhibition acts as a factor that increase the likelihood that a specific child will be a victim of sexual abuse (Siever, 1997; Siever et al., 1998).  

Yes, you read that right…  These guys actually came up with a neurological version of blaming the victim.  It’s deplorable and the kind of arcane thinking that makes us headshrinkers look like assholes.   

What I feel these arguments fail to take into account, however, is the fact that the brain is a much more plastic and dynamic organ than many give it credit for.  Neurological structures are just as likely to be shaped and affected by our experiences as the other way around.  More current research has shown similar structural abnormalities among combat veterans diagnosed with PTSD.  This shows that traumatic experiences can impact on the functioning and even the structural anatomy of the brain. 

And the heightened sensitivity in limbic regions of those identified with PTSD are not all that different compared to similar findings among patients identified with BPD.

Now of course the real problem with re-conceptualizing BPD as complex PTSD is that there are many people diagnosed with BPD who do not have histories of significant abuse and trauma (Zlotnick et al., 2003). When considering this factor, however, it is important to keep in mind that what constitutes a psychological trauma can be an extremely relative and subjective matter.  Physical and sexual abuse is clearly traumatic and it can be easy to understand how such experiences might impact on psychological functioning. Other instances of trauma, however, can be much more subtle and covert, yet nonetheless be just as psychologically damaging.

In my own research (Goldblatt et al., 2003), my colleagues and I found that children who were neglected and who were separated from primary attachment figures were indistinguishable from children who had experienced severe physical and/or sexual abuse on a number of empirical rating scales. 

These results, coupled with the results of similar studies (Bradley, 2000; Salzman et al., 1997; Van der Kolk, 1994) indicate that neglect and attachment difficulties can be just as traumatic and psychologically damaging as childhood experiences of sexual and/or physical abuse.

What this indicates is that people diagnosed with BPD who do not have histories of severe childhood trauma may still be understood as possibly experiencing a complex form of PTSD.

With the publication of the new Diagnostic and Statistical Manual of Mental Disorders (the DSM-5), Complex PTSD has been recognized as an official diagnostic label.  Unfortunately, the research has found that the inclusion of this disorder has not correlated with a reduction of cases where patients are identified as BPD.  There are a number of factors that may be contributing to this finding… not the least of which being that, as a new diagnosis, clinicians might shy away from utilizing Complex PTDS for worries that insurance providers will reject reimbursement claims.  

Hopefully things will change soon and we will see less and less cases of BPD.  We’ll see…




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anonymous asked:

Hey can you tell me what bpd means/symptoms of it thank you sorry to bother

hi anon, 

you are not bothering us at all!

Here is some general information about BPD, including causes symptoms treatments and everything.

What is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, theDiagnostic and Statistical Manual for Mental Disorders, Third Edition(DSM-III) listed BPD as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.

Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name “borderline personality disorder” is misleading, a more accurate term does not exist yet.

Most people who have BPD suffer from:

  • Problems with regulating emotions and thoughts
  • Impulsive and reckless behavior
  • Unstable relationships with other people.

People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

Causes

Research on the possible causes and risk factors for BPD is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.

Studies on twins with BPD suggest that the illness is strongly inherited. Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.

Social or cultural factors may increase the risk for BPD. For example, being part of a community or culture in which unstable family relationships are common may increase a person’s risk for the disorder. Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.

Signs & Symptoms

According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:

  • Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
  • A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
  • Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
  • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
  • Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days
  • Chronic feelings of emptiness and/or boredom
  • Inappropriate, intense anger or problems controlling anger
  • Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

Suicide and Self-harm

Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with BPD have suicidal behaviors, and about 4 to 9 percent commit suicide.

Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with BPD. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.

Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with BPD may self-harm to help regulate their emotions, to punish themselves, or to express their pain. They do not always see these behaviors as harmful.

Who Is At Risk?

According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year.  BPD usually begins during adolescence or early adulthood. Some studies suggest that early symptoms of the illness may occur during childhood.

Diagnosis

Unfortunately, BPD is often underdiagnosed or misdiagnosed.

A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.

The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional’s attention.

Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, BPD is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder. According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also meet the diagnostic criteria for another mental illness. Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia. These conditions are associated with obesity, which is a common side effect of the medications prescribed to treat BPD and other mental disorders.

No single test can diagnose BPD. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with BPD showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe BPD showed a more intense emotional response than people who had less severe BPD.

Treatments

BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many people with this illness improve over time.

BPD can be treated with psychotherapy, or “talk” therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional’s care, it is essential for the professionals to coordinate with one another on the treatment plan.

The treatments described below are just some of the options that may be available to a person with BPD. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.

Psychotherapy

Psychotherapy is usually the first treatment for people with BPD. Current research suggests psychotherapy can relieve some symptoms, but further studies are needed to better understand how well psychotherapy works.

It is important that people in therapy get along with and trust their therapist. The very nature of BPD can make it difficult for people with this disorder to maintain this type of bond with their therapist.

Types of psychotherapy used to treat BPD include the following:Cognitive behavioral therapy (CBT). CBT can help people with BPD identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.

  1. Dialectical behavior therapy (DBT). This type of therapy focuses on the concept of mindfulness, or being aware of and attentive to the current situation. DBT teaches skills to control intense emotions, reduces self-destructive behaviors, and improves relationships. This therapy differs from CBT in that it seeks a balance between changing and accepting beliefs and behaviors.
  2. Schema-focused therapy. This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas, or the ways people view themselves. This approach is based on the idea that BPD stems from a dysfunctional self-image—possibly brought on by negative childhood experiences—that affects how people react to their environment, interact with others, and cope with problems or stress.

Therapy can be provided one-on-one between the therapist and the patient or in a group setting. Therapist-led group sessions may help teach people with BPD how to interact with others and how to express themselves effectively.

One type of group therapy, Systems Training for Emotional Predictability and Problem Solving (STEPPS), is designed as a relatively brief treatment consisting of 20 two-hour sessions led by an experienced social worker. Scientists funded by NIMH reported that STEPPS, when used with other types of treatment (medications or individual psychotherapy), can help reduce symptoms and problem behaviors of BPD, relieve symptoms of depression, and improve quality of life. The effectiveness of this type of therapy has not been extensively studied.

Families of people with BPD may also benefit from therapy. The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative’s symptoms.

Some therapies, such as DBT-family skills training (DBT-FST), include family members in treatment sessions. These types of programs help families develop skills to better understand and support a relative with BPD. Other therapies, such as Family Connections, focus on the needs of family members. More research is needed to determine the effectiveness of family therapy in BPD. Studies with other mental disorders suggest that including family members can help in a person’s treatment.

Other types of therapy not listed in this booklet may be helpful for some people with BPD. Therapists often adapt psychotherapy to better meet a person’s needs. Therapists may switch from one type of therapy to another, mix techniques from different therapies, or use a combination therapy. For more information see the NIMH website section onpsychotherapy.

Some symptoms of BPD may come and go, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend to be more persistent. People whose symptoms improve may continue to face issues related to co-occurring disorders, such as depression or post-traumatic stress disorder. However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare. In one study, 6 percent of people with BPD had a relapse after remission.

Medications

No medications have been approved by the U.S. Food and Drug Administration to treat BPD. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with BPD are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective.

Medications can cause different side effects in different people. People who have BPD should talk with their prescribing doctor about what to expect from a particular medication.

Other Treatments

Omega-3 fatty acids. One study done on 30 women with BPD showed that omega-3 fatty acids may help reduce symptoms of aggression and depression. The treatment seemed to be as well tolerated as commonly prescribed mood stabilizers and had few side effects. Fewer women who took omega-3 fatty acids dropped out of the study, compared to women who took a placebo (sugar pill).

With proper treatment, many people experience fewer or less severe symptoms. However, many factors affect the amount of time it takes for symptoms to improve, so it is important for people with BPD to be patient and to receive appropriate support during treatment.

Living With

Some people with BPD experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care. Some people who develop this disorder may improve without any treatment.

How can I help a friend or relative who has BPD?

If you know someone who has BPD, it affects you too. The first and most important thing you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with the current treatment.

To help a friend or relative you can:

Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with BPD, but it is possible for them to get better over time

  • Learn about mental disorders, including BPD, so you can understand what your friend or relative is experiencing
  • With permission from your friend or relative, talk with his or her therapist to learn about therapies that may involve family members, such as DBT-FST.

Never ignore comments about someone’s intent or plan to harm himself or herself or someone else. Report such comments to the person’s therapist or doctor. In urgent or potentially life-threatening situations, you may need to call the police.

How can I help myself if I have BPD?

Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.

To help yourself:

  • Talk to your doctor about treatment options and stick with treatment
  • Try to maintain a stable schedule of meals and sleep times
  • Engage in mild activity or exercise to help reduce stress
  • Set realistic goals for yourself
  • Break up large tasks into small ones, set some priorities, and do what you can, as you can
  • Try to spend time with other people and confide in a trusted friend or family member
  • Tell others about events or situations that may trigger symptoms
  • Expect your symptoms to improve gradually, not immediately
  • Identify and seek out comforting situations, places, and people
  • Continue to educate yourself about this disorder.

Let us know if you have any more questions or need clarification on anything.

-Lina

4.17 - Night Terrors

It’s that part of the fourth season where they were like “fuck it” and just started naming episodes after diagnoses from the DSM-III (the next episode is called “Identity Crisis,” and the one after that is “Hypoactive Sexual Desire Disorder” where Riker is suddenly afflicted with only wanting to bang every other chick on board). 

Night terrors was one of the episodes that stood out from my original TNG consumption because there is some scary shit in there, especially for a nine-year-old who didn’t watch horror films. Or, you know, a thirty-one year old. WHATEVER DON’T TELL ME MY FEELINGS.

Setup: classic Enterprise happens upon a stranded/distressed ship. Everyone on board is dead, but like, from everyone killing each other? The only survivor is another Betazoid dude, who is in a persistent catatonic state.

Only the finest holographic lamé pillow will do for this captain of Grayzistan.

Is Kyle MacLachlan available for this non-speaking role? No? Okay, just get me someone from central casting who could pass for Kyle MacLachlan. The guy has some voice-overs in Deanna’s head, but other than that he just lies there. I mean, I guess it’s a comfortable way to make some money. His outfit though.

Keep reading

High functioning sociopath. Do your research

In 1952, the APA  (American Psychiatric Association) listed homosexuality in the DSM ( Diagnostic and Statistical Manual of Mental Disorders) I as a sociopathic personality disturbance. Of course, they changed cathegory to it by the second one (1968) though homosexuality was not anymore a disorder but a disturbance only by the 1974 edition of DSM II. (And not even that only in 1987 - DSM III-Revisited). I just find this interesting - how old was the shrink who diagnosed Sherlock’s sociopathy? And which DSM edition did he use? ;-) 

I did my research.