Borderline personality disorder
nos...@nospam.com
There are some (Akiskal, Gunderson & Elliott) who have proposed that borderline
personality disorder (BPD) should be seen as part of the affective spectrum, but others
(e.g., Pope) who maintain that it is independent, though frequently coexisting with
affective disorder. Although much of the overlap may be on the basis of the depressive
features of BPD, Akiskal and his colleagues have emphasized the close linkage to bipolar
disorder: in a series of 100 DSM-4 borderlines, 25% met criteria for bipolar II or
cyclothymia on followup. Bipolar depression and the depressive mood of BPD patients can
sometimes be distinguished by the latter's relative high day-to-day or even hour-to-hour
variability (as opposed to distinct phases of depression with a beginning and an end),
high reactivity, and lack of changes in sleep and appetite. An occasional atypical mixed
or rapid cycling bipolar patient, however, will look very "borderline," with quite
volatile and reactive mood. All too often, bipolar features can be missed in the "sturm
und drang" of BPD, especially in adolescents, and care should be taken to rule out bipolar
disorder before prescribing antidepressants. When racing thoughts are a clear symptom, a
bipolar component should be suspected.
In sum, distinguishing the two disorders is problematic, and there is probably a subgroup
of borderlines with "bipolaroid" (predominantly mixed state) features, for whom mood
stabilizers are an important treatment modality. Lack of response to several
antidepressants may be a clue here.
cc to the evil borg: JanetV...@hmh.westsound.net, stackh...@ghc.org,
trin...@ghc.org, shul...@ghc.org, st...@u.washington.edu
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IATROGENIC
Induced in a patient by a physician's words or actions. Literally, physician-generated. (From the Greek: iatros=physician + genic=generation.) Detailed definition is provided due to a word-related learning-disability common to most MHPs-- few seem capable of grasping the meaning of "iatrogenic," particularly when a situation necessitates appending to it the word "damage," "trauma," "destruction," or "death." This occurs all too often.