Personality disorder DSM-5-TR diagnostic

Full Answer Section

Therapeutic Relationship:

A therapeutic relationship in psychiatry is built on trust, empathy, respect, and collaboration. It is a non-judgemental space where the client feels safe and supported to explore their thoughts, feelings, and behaviors. This relationship is key for building rapport and facilitating change.

Sharing the Diagnosis:

When sharing a diagnosis of BPD with a client, it is crucial to do so in a sensitive and empathetic manner. The focus should be on understanding the client's experience and offering hope for recovery.

Individual:

• Start with a brief explanation of personality disorders in general.

• Acknowledge that BPD is a complex disorder that often causes significant distress.

• Avoid using labels or stigmatizing language.

• Focus on their strengths and the potential for change.

• Discuss the diagnosis in the context of their specific symptoms and experiences.

• Present DBT as a proven approach to manage their symptoms.

• Reassure them that you are committed to working with them to achieve their goals.

Family:

• Engage the family in a discussion about BPD.

• Explain the disorder in a clear and understandable way.

• Emphasize the importance of family support and the role they can play in the client's recovery.

• Provide information about DBT and other resources available.

• Address any questions or concerns the family may have.

Group session:

• Maintain confidentiality.

• Avoid identifying the client by name.

• Focus on general information about BPD.

• Highlight common experiences and challenges associated with the disorder.

• Emphasize that BPD is treatable and there is hope for recovery.

Examples:

• Learning Resources: The Learning Resources provide examples of how to communicate a diagnosis in a compassionate and empowering way.

• Evidence-based sources: The cited research studies provide evidence for the effectiveness of DBT and the importance of a therapeutic relationship.

Sample Answer

Borderline Personality Disorder (BPD)

DSM-5-TR Diagnostic Criteria:

To receive a diagnosis of BPD, individuals must meet at least five of the following criteria:

1. Frantic efforts to avoid real or imagined abandonment.

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3. Identity disturbance: marked and persistent instability of self-image or sense of self.

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and rarely more than a few days).

7. Chronic feelings of emptiness.

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Therapeutic Approach and Modality:

A highly effective therapeutic approach for BPD is Dialectical Behavior Therapy (DBT). This approach combines cognitive-behavioral therapy (CBT) with mindfulness and acceptance techniques.

Modality:

Individual therapy is the primary modality used in DBT. This provides a safe space for the client to explore their emotions, learn new coping skills, and develop a more balanced and stable sense of self.

Justification:

DBT has strong empirical support for treating BPD, with evidence suggesting significant improvements in symptoms such as impulsivity, emotional dysregulation, and suicidal ideation (Linehan, 1993; Dimeff, et al., 2006).