May 25 2009, 03:05 PM
According to a report presented at the American Psychiatric Association meeting, borderline personality disorder may be underdiagnosed — at least initially.
In the presentation, David Meyerson of DePaul University in Chicago reported on an evaluation of lifetime diagnostic and treatment histories in patients eventually found to have the disorder.

The substantial lag in correct diagnosis frequently results in polypharmacy with medications that are not the most effective for the disorder.

“Diagnosing borderline personality disorder can be complicated and difficult because its symptoms overlap with other disorders,” Meyerson said.

In the study, done at Mount Sinai School of Medicine in New York, Dr. Meyerson and his colleagues found that 34 percent of patients given a psychiatric diagnosis before entry into the study had been given the wrong one or sometimes more than one.


Action Points


* Explain to interested patients that borderline personality disorder can be a challenging diagnosis to make because of its close resemblance to or overlap with other psychiatric disorders.
* Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
* The most common false-positive diagnoses were bipolar disorder (17%) and depression (13%), followed by anxiety disorders (10%) and eating disorders (1%).

Another challenge for diagnosis is that “in theory, two individuals could present with only one overlapping symptom and both meet criteria for borderline personality disorder,” he noted.

These criteria include at least five of the following:


* Efforts to avoid abandonment
* Unstable, intense interpersonal relationships
* Identity disturbance
* Impulsivity
* Suicidality
* Mood instability
* Chronic emptiness
* Inappropriate, intense anger
* Paranoid ideation or dissociation


The study included 70 adults who met the criteria.

All had been given a diagnosis from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in the past and had also seen a mental health professional in adulthood or been prescribed a psychotropic medication.

Yet, 74 percent of the patients who met the criteria for the condition had never been diagnosed with borderline personality disorder in the past, despite an average of 10.44 years since their first “psychiatric encounter.”

By comparison, an average 4.68 years had elapsed since the first mental health contact for the 26 percent who had been diagnosed with the disorder prior to study entry.

Meyerson noted that the study might have underestimated the rate of false-positive psychiatric diagnoses among borderline personality disorder patients, because it did not diagnose premenstrual dysphoric disorder or attention deficit hyperactivity disorder.

Other limitations included the retrospective design that relied on participants’ memories of diagnoses and treatment, lack of interviewer blinding, and small sample size.

But regardless of the exact rate, there were clear implications for treatment, Meyerson said.

The gold standard treatment for borderline personality disorder is behavioral therapy; medication only alleviates specific symptoms, Meyerson noted.


In the study, though, 69 percent of patients whose borderline personality disorder was not identified before had previously been treated with medications for other diagnoses. And 78 percent of those given an earlier diagnosis of the disorder were given medication, although that is “not the most effective treatment for borderline personality disorder,” he said.

A prior false-positive diagnosis was associated with even higher medication rates (P<0.05 for mean number of prescribed psychotropic drugs).

A correct diagnosis — vital for successful treatment — is more likely when psychiatrists use at least a semistructured clinical interview, Meyerson emphasized.

Another clue in making the differential diagnosis is the qualitative difference in impulsivity in borderline personality disorder (difficulty planning and thinking about consequences) compared with that in bipolar disorder (racing thoughts), he said.

Suicidality also shows differences in borderline personality disorder, such as more job- or health-related triggers than seen in major depressive disorder alone, Myerson added.

One important contributor to misdiagnosis is financial compensation, he noted.
Often patients will be officially diagnosed with another disorder, such as bipolar disorder, if the patient’s insurance company doesn’t reimburse for borderline personality disorder, he noted.
However, the study was unable to determine this or any other reason for misdiagnosis.


Source: American Psychiatric Association

*************************** POTENTIAL TRIGGER **************************************





Hi Kyle,
I wanted to tell you that I understand the frustration, and being disheartened by this. I am 58 years old and just within the last three months, was diagnosed with Borderline Personality Disorder.

I have lived with depression as far back as I can remember. I have been diagnosed with having had a range of other conditions, diseases, disorders, or which ever one fits the category.

I can honestly say that when the Dr I saw who did my intake, (since I recently moved and had to find someone else to see), handed me a book and asked me to read, and then pointed down to the page, I started reading and crying, because I saw myself. He said, "I'm sorry", and I told him, "don't be, it is good to finally know what my problem is".

I do believe I have finally been diagnosed correctly. I have been diagnosed with depression, anxiety disorder, social anxiety disorder, Obsessive-compulsive disorder, the seasonal one, which at the moment, I can't recall, PTSD, agoraphobia, bi-polar disorder.
I have panic attacks, and have been treated for them as well. I have had a major length of time with paranoia. You get the picture, and that doesn't even cover phobias. However I can honestly say that it went away after the medication I was on, was changed.

I have pretty much reached the stage where I feel that the medications I take, aren't effective. I spent a good part of the day online hunting down the names of the medications that I can remember having been prescribed clear back to when I was 18 and 19. It is entirely possible that I don't remember all of them, but there are 20 different medications that I have taken.

I have every 'symptom' if that is the term to use, of a person with BPD, all of the list of abuses, the low self-esteem, the self-doubt, the whole 9 yards. I have lived with a sadness and pain that never goes away. It is always there and sometimes a line from a song, or movie, or book can set me off crying. It is awful and I hate this. I have spent the majority of my life not wanting to feel. I withdraw from people and activities. It seems safer that way.
You aren't alone in your suffering. I don't know if that knowledge helps you or not. I hope it does. Knowing that there are other survivors, (and we ARE survivors) out here, helps me and gives me strength to continue the fight.
Thanks
Lea
Lea [color="#800080"][/color]

Hi Kyle, We meet again!
I'd say that for me, finding out that I had BPD was a blessing because I finally can see how it has effected my life that seemed out of whack, but aren't symptoms of depression, anxiety or the other disorders I had been diagnosed as having. There are therapy programs and models for handling the symptoms and outcomes of BPD. Now I can finally express in words what I didn't have words for before and see clearly the reason for my roller coaster ride. I'm working on areas in therapy I've never worked on before and improving my life. There is hope!
Iowa