A very interesting, albeit long, article by Joel Bruce Douglaswhich clears up some of the more detailed attributes of BPD:
t is common to joke that someone has a personality disorder. But personality disorders are no joking matter. Try having a close relationship with someone with a personality disorder—particularly of a narcissistic or borderline variety—and it is likely you will be in for a roller coaster ride…and worse, you will be blamed for it!
The Diagnostic and Statistical Manual (DSM) catalogues and defines psychopathology. The first two axises on its five-axis diagnostic formulation consists of Axis I, for mental disorders such as anxiety, depression, spectrum disorders of childhood, etc., and Axis II for personality disorders (PD). Often mental health care clinicians in completing their DSM list of differential diagnoses will “defer” or simply leave an Axis II diagnostic impression blank, irrespective of whether a personality disorder exists. However, those therapists who under Axis II simply identify borderline, histrionic or narcissistic traits—in contrast to a full blown borderline, histrionic or narcissistic personality disorder—ain’t necessarily telling the truth, the whole truth and nothing but the truth, or more worrisome, may not fully appreciate precisely the dynamics of the patient they have. The reason many psychotherapists are loathe to list Axis II personality disorders is 1) the condition is often directly associated, if not the cause of the Axis I symptomatology; 2) PDs—though clearly a disease—are usually not compensable by the patient’s insurance; 3) the label is pejorative, speaking volumes about the individual; and 4) someone so branded with this diagnosis bears a social stigma, however well-deserved. Indeed, though many shudder over the more commonly understood Axis I psychiatric diagnoses of bipolar disorder (manic depression) or schizophrenic—truly topping the worse psychiatric conditions—at least there are pills which can mediate the symptoms of bipolar disease and schizophrenia, dealing with neurotransmitters gone afoul, or even shock therapy. As bad as these conditions are, they are eminently treatable and there is reasonable hope to achieve some degree of functionality notwithstanding the import of these dreaded diseases. Not so with someone with a personality disorder.
Bonne Bridges Mueller O’Keefe & Nichols – Leader in Health Care Litigation