Borderline personality disorder: Difference between revisions
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**Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). | **Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). | ||
**Transient, stress-related paranoid ideation or severe dissociative symptoms. | **Transient, stress-related paranoid ideation or severe dissociative symptoms. | ||
*Completed [[suicide]] rates 8-10%, 50 times higher than general population<ref> American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry. 2001;158(suppl 10):1-52.</ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Depressive and bipolar | *[[Depression|Depressive]] and [[bipolar disorder]]s | ||
*Other personality disorders | *Other [[personality disorders]] | ||
*Personality | *Personality dysfunction due to another medical condition | ||
*Substance use disorders | *[[Substance abuse|Substance use disorders]] | ||
*Identity problems | *Identity problems | ||
| Line 27: | Line 28: | ||
==Management== | ==Management== | ||
*Treat medical complications of self-harm behavior | |||
*Consider psychiatry consult or admission if acutely [[suicide|suicidal]] | |||
*Set boundaries | |||
*Tolerate emotions but not outbursts | |||
*Be empathetic yet direct and fact-based, avoid emotionality | |||
*Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment. Antipsychotics, antidepressants and mood stabilizers can be used to control symptoms such as anger and affective instability. | *Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment. Antipsychotics, antidepressants and mood stabilizers can be used to control symptoms such as anger and affective instability. | ||
Latest revision as of 16:29, 10 October 2019
Background
- A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity
Clinical Features
- Five (or more) of the following criteria, beginning by early adulthood and present in a variety of contexts:[1]
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- 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).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
- Completed suicide rates 8-10%, 50 times higher than general population[2]
Differential Diagnosis
- Depressive and bipolar disorders
- Other personality disorders
- Personality dysfunction due to another medical condition
- Substance use disorders
- Identity problems
Evaluation
- A clinical diagnosis; however if entertaining other organic causes may initiate workup below
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
- Treat medical complications of self-harm behavior
- Consider psychiatry consult or admission if acutely suicidal
- Set boundaries
- Tolerate emotions but not outbursts
- Be empathetic yet direct and fact-based, avoid emotionality
- Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment. Antipsychotics, antidepressants and mood stabilizers can be used to control symptoms such as anger and affective instability.
Disposition
- Discharge
See Also
External Links
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- ↑ American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry. 2001;158(suppl 10):1-52.