Steps Involved in a BPD Diagnosis
Why is it so difficult to diagnose Borderline Personality Disorder?
Nov 14, 2009
Why it May be Difficult to Diagnose Borderline Personality Disorder
A diagnosis of Borderline Personality Disorder is not one that is taken lightly, and is not one that comes easily. Because the symptoms of this disorder can, on their own, be the result of a number of factors, the clinician must take a detailed history of the individual in order to determine these criteria are being caused by the BPD and not some other factor. For example, wild mood swings can be a problem if the individual has an alcohol or substance abuse problem.
So, the doctor or clinician that is preparing a diagnosis of BPD must ensure that the symptoms present are not present as the result of some other problem. This can make diagnosing BPD very tricky. Some criteria of BPD may even cause other symptoms. In the example above, temper flares are the result of alcoholism. Yet alcoholism could be a sign of impulsive behavior or self-harm when it comes to BPD.
Finding out what came first, the chicken or the egg in the BPD diagnosis is a task that the clinician has before them.
How Does a Clinician Come to a Diagnosis Then?
A diagnosis of BPD does not happen overnight, and it is not taken lightly. There are a series of steps taken to discover precisely what the individual is suffering from.
The first steps in a diagnosis of Borderline Personality Disorder will be the individual’s own reports. At the time the individual decides there is a problem and seeks help, they may not even think they have BPD, or even know what it is. They will describe the issues they are having to the doctor or clinician. The doctor will create a profile from these self-reports, and will also seek reports from others the individual is close with.
This will include spouses, family, or even co-workers. A detailed family and personal history will be the first step in a series of many towards a diagnosis of BPD.
The next step in a BPD diagnosis will be a physical examination by the individual’s family doctor, or by a referred physician. This step is important, and is used to rule out the possibility that there is any medical reason that the individual is acting this way.
The doctor will look for things such as hyper-or hypothyroidism, metabolic irregularities, infection, disease, HIV, or STD’s. Most of these tests will be performed through routine blood tests. The doctor may also even order neurological work to rule out epilepsy or brain lesions. These tests will be performed by EEG or CAT scan.
Following the personal history and physical examination, the next step will be to undergo psychometric testing.
What this means is that the individual will be given a wide range of tests that will help the clinician determine if in fact their patient is suffering from a personality disorder. The lists of assessments available to a clinician is long, and what tests the clinician will use will depend on their preferences, their experiences, and the specific situation of the individual. The tests most commonly used in a diagnosis of BPD are:
The Minnesota Multiphasic Personality Assessment
Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD)
The Personality Disorder Beliefs Questionnaire (PDBQ)
The Diagnostic Interview for Borderlines, Revised (DIB-R)
The Borderline Symptom List
Following the administration of these tests, the mental health professional will have a clear picture on what is going on with the client. If a diagnosis of Borderline Personality Disorder is to be confirmed, a treatment program will commence, or the individual will be referred to a specialist for treatment of this disorder.
Additional Resources
Friedel, R.O., P.D. Hoffman, D. Penney, and P. Woodward. Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD.2004. Marlowe & Co.
Gunderson, J.G. Borderline Personality Disorder: A Clinical Guide.Washington, D.C.: American Psychiatric Press.
