Borderline personality disorder: Difference between revisions

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==Background==
==Background==
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity
*A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity


==Clinical Features==
==Clinical Features==
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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 disorders<br />
*[[Depression|Depressive]] and [[bipolar disorder]]s
*Other personality disorders<br />
*Other [[personality disorders]]
*Personality change due to another medical condition<br />
*Personality dysfunction due to another medical condition
*Substance use disorders<br />
*[[Substance abuse|Substance use disorders]]
*Identity problems<br />
*Identity problems


==Evaluation==
==Evaluation==
A clinical diagnosis; however if entertaining other organic causes may initiate workup below
*A clinical diagnosis; however if entertaining other organic causes may initiate workup below


{{General ED Psychiatric Workup}}
{{General ED Psychiatric Workup}}


==Management==
==Management==
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.
*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.


==Disposition==
==Disposition==
Home
*Discharge


==See Also==
==See Also==
*[[Personality disorders]]


==External Links==
==External Links==


==References==
==References==

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

Evaluation

  • A clinical diagnosis; however if entertaining other organic causes may initiate workup below

General ED Psychiatric Workup

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

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry. 2001;158(suppl 10):1-52.