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Borderline PD in the ICD vs DSM


Are the disorders described in the ICD-10 and the DSM IV the same?  

7 members have voted

  1. 1. Are the disorders described in the ICD-10 and the DSM IV the same?

    • Yes, they're the same, semantics don't change the fundamental diagnosis
      1
    • No, they're different.
      4
    • Only the ICD's "Impuslive Type" does not fit, otherwise the two criteria describe the same disorder.
      1


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I was reading over the ICD-10 definition of BPD (which divides it into two subtypes, "Impulsive Type" and "Borderline Type") and it seemed really vauge (apparently it is possible to be more vauge than the DSM) and "Impulsive Type" seemed to not really encompass what I think of as BPD at all... I know this is probably just me quibbling with semantics, but I wonder if it affects who is diagnosed as "borderline" in different countries.  I got this idea because, and I hope my saying this doesn't bother anyone, the way people who are diagnosed as borderline describe their experiences seems to vary between countries (which would make sense as PDs are kind of relative to the society one lives in) but i noticed that the way people from Australia and the US describe their illness is more simmilar than how people in the US and England describe it.  (The UK uses the ICD (as far as I can tell,) the US and Australia both use the DSM.)  So, I began to wonder if the differing wording in the two criterias is different enough that they're almost not the same disorder?  I think, in particular, that the impulsive type described in the ICD doesn't resemble the DSM borderline... but I really do have a tendency to quibble over semantics and miss the big picture...

what do you guys think?

ICD-10 Criteria:

60.3 Emotionally Unstable (Borderline) Personality Disorder

A personality disorder in which there is a marked tendency to act impulsively without consideration of the consequences, together with affective instability. The ability to plan ahead may be minimal, and outbursts of intense anger may often lead to violence or "behavioural explosions"; these are easily precipitated when impulsive acts are criticized or thwarted by others. Two variants of this personality disorder are specified, and both share this general theme of impulsiveness and lack of self-control.

Impulsive type:

The predominant characteristics are emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others.

Includes:

* explosive and aggressive personality (disorder)

Excludes:

* dissocial personality disorder

Borderline type:

Several of the characteristics of emotional instability are present; in addition, the patient's own self-image, aims, and internal preferences (including sexual) are often unclear or disturbed. There are usually chronic feelings of emptiness. A liability to become involved in intense and unstable relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a series of suicidal threats or acts of self-harm (although these may occur without obvious precipitants).

Includes:

* borderline personality (disorder)

DSM IV Criteria:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 

  1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

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

  3. identity disturbance: markedly and persistently unstable 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). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

  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 only 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

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not a lot of brain power durrr, maybe i do have some i can dig out? want to respond.

1. diagnostic criteria and (from what i recall from psych anthro course long long ago) the  diagnostic guidelines (presumed to be different from what we call criterion) is also different.

2. what would be interesting is to see how much the impulsive subtype is diagnosed in other countries worldwide. basically this subtype appears to exclude the instability of self/chronic emptiness aspects to BPD, self-harm aspects, dissociation(?) aspects. given that the PD title in the ICD-10 is "Emotionally Unstable..." we have a marked difference (perhaps) in emphasis.

3. the semantics are vitally important, imo, these books are in some way entirely semantical, otherwise we would have one term/expletive? like 'looped - toss in loony bin'

4. more clearly when comapring between countries and incidence rates (i may be using the wrong term here, sorry), there would be greater difference between say, namibia and the UK, than the UK and the US. but these differences (and differing uses of the two different manuals) is important. how? my brain is mushing it around.

there is some question as to whether this dx is a culture-bound phenomenon. impulsivity, instability, these are valuative terms,

sense of self would depend on a culturally defined sense of personhood or selfhood that, if not shared, would perhaps result in very different pictures of 'self-image'.

in other words, take a north american psychiatrist and put them somewhere 'foreign' and they will diagnose a population possibly far more rampantly than would a local doctor. vice versa.

fleck - where did i pull all that shtuff out of?

good discussion topic, penny.

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i dont have the brain power for a long response since i am in the middle of writing a paper, but i dont really think they are the same.... but i am also sorta picky so i might not be trustworthy....

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OOO I've often asked myself this question.....when I was at my worst with this depression I was close to being BPD. If I'd been in the US and someone was using the DSM I could have easily been dx with BPD. But, according to the ICD-10 I didn't fit. Because I've never had a particular problem with impulsiveness.

Now I'm more recovered, I don't fit the DSM as much either....(no SH and less splitting etc....)(and anyway I have *no* relationships and never have..)

But, like, I think they need to get their act together. Its well confusing!

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