Talk:Borderline personality disorder/Archive 6

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Info on family members; needs citations

Putting this info here for storage until we find citations for it; most of it is probably true, but we need references. Firecatalta (talk) 03:11, 19 July 2013 (UTC)

Family members of people with BPD often feel confused and frustrated by unclear diagnoses, ineffective treatments, and inaccurate information. Theories that post-traumatic stress disorder plays a causal role in the development of BPD (see Gender and Terminology), as well as findings that a majority of people with BPD have experienced childhood trauma (see Childhood abuse), can stigmatize family members by implying that they bear primary responsibility for this disorder, despite evidence of diverse causes (see Causes).

POV writing

Under "controversies" the article tends to support one side of the argument and then not the other. This makes for POV writing. Especially since I've seen writing from the other side. (Walking on Eggshells, for example.)

It needs to be balanced if it is a controversy instead of writing only one side.

Also, I caught a little overstating as well.

For example: - "The myth of violence" That's POV. Stating it's a myth makes it POV. If it's disputed, i.e. a controversy, there should be another side. For example, while describing "witch" part of BP on walking on Eggshells, Christine Anne Lawson *does* write about violence. http://www.psychologytoday.com/blog/stop-walking-eggshells/201109/the-world-the-borderline-mother-and-her-children

The violence also talks more on physical violence and promotes the idea that BPD people would never harm others. But there is also emotional abuse as well... and that's underplayed in the article. (Saying that harm is only to the self and never to others.)

Also underplayed in the article is the effect that BPD has on others and the difficulties family members (not just parents) and romantic partners have, blaming them for the issues and making the people with BPD, worse... which ignores the real impact that it can have on family members and again places blame through POV language. There is plenty of research to fill that section. It's kinda one-sided. It mentions that mateiral is slanted... then what is that material? Present it. If it's too long, it needs another article, be summarized not to be dropped from this one. (I saw it was edited out of earlier drafts as well, which I find just odd.)

Also, lying, I've read may be associated with the dissociation and inability to create a self identity, but this seems to be selectively cut out to say that people with BPD are thought to never lie... But where is the other side where some clinicians think they do purposefully lie?

Also deleted from the article is the difficulty on the mental health professionals dealing with BPD. Since I've seen this in Psychology Today several times, several manuals describing the disease and so on, I find this is also POV.

In another words, this article is kinda selective, while mentioning that there is a controversy, it cuts to one side and says the other side is wrong, and that breaks NPOV standards on Wikipedia.--Hitsuji Kinno (talk) 16:56, 14 July 2013 (UTC)

Hi there! If you could provide links to the sources that you've read for more background on these issues, I would be happy to help integrate them into the article, and you should of course feel free and encouraged to put them in yourself.

In the meantime, the article does mention the difficulties that mental healthcare providers face in dealing with patients who have BPD:

"People with BPD are considered to be among the most challenging groups of patients, requiring a high level of skill and training in the psychiatrists, therapists and nurses involved in their treatment.[152] A majority of psychiatric staff report finding individuals with BPD moderately to extremely difficult to work with, and more difficult than other client groups.[153]"

The article does mention those who think that people with BPD frequently lie ("Some theorists argue that patients with BPD often lie.[136]"), and I would definitely be interested in including more information about that if you can point me to reliable sources. I'll keep an eye out as well.

About the title "Myth of violence," I agree that it should be changed to clearly describe physical violence. What do you think about the heading "Physical violence"?

Lastly, I definitely agree that there should be greater information about the impact of BPD on family members. Could you let me know which drafts it was edited out of? Maybe we can use those sources to reintroduce the information. If reliable sources are not present there, then that might be why it was edited out. I'll make a note to keep an eye out for information on that topic.

Thanks, Firecatalta (talk) 17:24, 14 July 2013 (UTC)

"Witch" part of BP on walking on Eggshells, Christine Anne Lawson *does* write about violence. Here is an example from an interview she did. http://www.psychologytoday.com/blog/stop-walking-eggshells/201109/the-world-the-borderline-mother-and-her-children states that BPD people do sometimes direct their anger towards others, making the "Physical Violence" section POV by stating that it's (by the wording) always directed towards others. This may manifest in things such as neglect of animals, being directly mean when going through a down phase, or just being vindictive. In addition the book lists that not all people with BPD do physical violence. And some people do distinguish between high functioning and low functioning, where low functioning is often punctuated by suicide. The section is overstated... if it's universally agreed upon, then it doesn't belong in the controversies section... The source itself is listed at the bottom on the page and was in an earlier draft, but somehow got cut through the edits... so shouldn't it be restored and that section be balanced between people who think it's so, rather than stating it's only on television, and those that don't think it's so? (I would think the PHD would help) I can dig up other references... But the basic idea is if it's controversial, then show both sides... rather than just stating one side is wrong. If it's agreed upon and not a crackpot theory, then it belongs in the main article somewhere--usually something such as agreed upon behaviors.

BTW, not an exact expert, but Antisocial mention in that subsection should be directed to the Antisocial page rather than trying to tackle it here, since the way it's tackled here is a bit poor. Antisocial enjoy watching others suffer, but other Personality disorders and people who aren't Antisocial/don't have a personality disorder also can be physically violent. Which means it shouldn't be in the article... let the antisocial article handle it and qualify with "may be." The difference between Borderline and Antisocial is that the person who is Antisocial often is mean for the sake of the enjoyment of the act. (Handled by the Antisocial article) whereas the person who is Borderline is more likely to do it when they feel like someone is leaving them in order to garner negative attention. (from what I understand from reading the book) which isn't the same as enjoying watching people suffer. So for example, if someone pays attention to their pet more, in a rage, the BPD person *may* harm the animal, but won't enjoy the act, rather they want to feel the love of the person that they feel has been leaving them for the pet. --Hitsuji Kinno (talk) 00:00, 31 July 2013 (UTC)

Agreed; it looks like we have a lot to do on the violence section, and maybe it should eventually be moved to the behavior section. You've also reminded me of one of the points from the recommendations for edits prior to applying for GAS, which was to remove info sourced by popular books rather than review articles, treatment manuals, etc. A lot of what we currently have in the violence section is from a book meant for popular consumption, and I'm thinking we should remove those parts, or move them to the talk page for storage until we can find academic sources. Agreed also that we should link to the ASPD article, though I do think we should have a mini-blurb here about the key differences between BPD and ASPD, just like we have basic info about the differences between BPD and BD. Overall, thanks for the feedback; it's been very helpful! Is there anything else you think we should put on the agenda?

Best, Firecatalta (talk) 20:19, 31 July 2013 (UTC)

The article currently says that borderlines are very unlikely to be violent and that the perception of a link between BPD and violence is a myth. Although most borderlines are not violent, a significant minority are. Borderlines have a much higher incarceration rate than the general public. They are greatly overrepresented both as victims and perpetrators of violence, particularly domestic violence, for which many thousands of them have been hospitalized and/or imprisoned. DV perpetrators are often separated by type of perpetrator: a) antisocial-sadistic; b) borderline-dysphoric and c) other. This article needs a section on the differences and similarities between BPD and the other PDs, particularly the Cluster B ones, which are all comorbid with each other and are frequently confused with each other. In relation to DV, there should be an explanation of the different motives of an ASPD perpetrator (sadistic, predatory and exploitative) compared to a BPD perpetrator (alternates between idealization and devaluation combined with a fear of abandonment). Borderlines' very high rate of being DV victims, their vulnerability to it and reluctance to separate from a violent partner because a high proportion cannot cope without a partner need to be stated in this article. Jim Michael (talk) 23:51, 26 August 2013 (UTC)

True that a significant minority are; for instance, Linehan even notes in her treatment manual that people with BPD are more likely to throw things at her than any other patients she's worked with! However, as far as I know, the higher incarceration rates are mostly due to the higher rates of substance use and abuse among people with BPD than the general population (e.g. being arrested for possession or use of illegal substances). Still true though that the violence section needs a lot of work. Most of the info there should probably just be removed (and I say this as the one who put it in), since as mentioned previously, it comes from a non-academic source (although the info in there is sourced fairly well, still best to stay away from books meant for popular consumption). I could see the rest of it going under interpersonal relationships, and maybe we could expand the info there about domestic violence as well. What do you guys think about reorganizing (and removing some of) the info in this manner? Then we can all keep an eye out for academic sources about aggression and DV, and I'll go find the comment from M. Linehan about aggression and see what additional info there is in that part of the manual. Firecatalta (talk) 21:37, 27 August 2013 (UTC)

Emotionally unstable personality disorder

according to the ICD-10 "F60.3" is called "Emotionally unstable personality disorder" and not "Borderline Personality Disorder." "Borderline" is actually just a type of the Emotionally unstable personality disorder, just like "Aggressive" and "Explosive". I refer to http://apps.who.int/classifications/icd10/browse/2010/en#/F60-F69 the official WHO page. Also, in other languages, those types have their very own wikipedia article.

I propose that this article be renamed "Emotionally unstable personality disorder" with a redirect from "Borderline Personality Disorder", and also the three types (Borderline/Aggressive/Explosive) should each have their own section in the article.

(btw, this is my first suggestion on wikipedia, I am not quite sure if I have done this correctly) 98.230.133.110 (talk)

You've done it correctly as far as I can tell! I think it's a very interesting question about what to call this article, and it seems to come down to whether we're prioritizing the DSM or the ICD. I like the idea of switching to the ICD terminology in the service of not prioritizing the American point of view on this condition over the international one. At the same time, a lot of the research on this condition that we've reported in this article is based on the DSM definition, and we would have to check to see whether that research still applies to the condition as defined by the ICD (hope that makes sense). What do others think? Lova Falk? Firecatalta (talk) 15:55, 10 September 2013 (UTC)

I would prefer to keep the name as it is, because "borderline" is very well known by the general public, whereas "emotionally unstable" is not. A google search for "Borderline personality disorder" gives 7 930 000 results, whereas "Emotionally unstable personality disorder" gives 197 000 results - thus the DSM term is about 40 times more common than the ICD term. There is also a Wikipedia guideline about using the most common name, but I haven't got the time to find the link to it. Just my two cents... Lova Falk talk 19:38, 10 September 2013 (UTC)

Agree. Emotionally unstable personality disorder redirects here anyway. It was originally a separate article but as it is very similar to BPD it was merged.--Penbat (talk) 20:18, 10 September 2013 (UTC)

That makes good sense to me. 98.230.133.110, maybe one option would be to expand the section on how BPD is conceptualized by the ICD. What are your thoughts on that? Firecatalta (talk) 01:12, 11 September 2013 (UTC)

Good Article Status + DSM 5 criteria

Hi all,

We've spoken previously about nominating this article for good article status, and I think we're ready! My last question is, do we know if the same issues about copyright apply to the posting of DSM 5 criteria as they did to the DSM-IV criteria? If so, we'll want to edit those out prior to applying for GAS. Great job everyone!

Firecatalta (talk) 02:47, 10 June 2013 (UTC)

Hi Firecatalta you're the one who did most of the work this last year, so all credit to you¨! As the DSM-5 has the same publisher as DSM-IV I just assume that the same issues about copyright apply. Lova Falk talk 07:53, 22 June 2013 (UTC)

Couldn't have done it without some expert guidance and contributions from you and others! DSM-5 info has been fixed, and I think we're ready to go. Hurrah! Firecatalta (talk) 00:57, 26 June 2013 (UTC)

Comments

• Much of the causes section is more appropriately labeled "pathophysiology". Should be separated into these two sections.
• A number of refs are of questionable reliability including:

• The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD
• http://www.borderlinepersonalitydisorder.com
• http://www.borderlinepersonalitytoday.com/main/label.htm
• We are missing PMIDs for a lot of papers such as "Simmons, D (1992) Gender issues and borderline personality disorder: Why do females dominate the diagnosis? Archives of Psychiatric Nursing, 6(4), 219–223"
• The previous ref is also a little old. Should be mostly sources from the last 10 years.
• The link in this ref "Gunderson J, "Borderline Personality Disorder", "The New England Journal of Medicine", 26 May 2011" goes to the U of T. And is not filled out. There are a number of these
• The next two refs are from 1994 and 1985.
• The follow ref http://www.ncbi.nlm.nih.gov/pubmed/12923705 is a primary research study of 20 people with BPD. We need to base our article on high quality recent secondary sources per WP:MEDRS
• Another primary research paper from 2000 [1] and another [2]
• BPD today is used extensively [3] and is not really suitable
• More details need on this ref "Neil R.Carlson, C.Donald Heth. "Psychology: The Science of Behavior". Pearson Canada Inc,2010, p.570." Like an ISBN
• Reference formating is not consistent. Lots of refs are not using the cite template while others are. While do a further review when these issues are addressed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:18, 26 June 2013 (UTC)

Important points! I'm going to withdraw the GA nomination until we address those. Thank you for bringing them to light! Firecatalta (talk) 19:48, 26 June 2013 (UTC)

Excellent and will take another look when these are address :-) Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:25, 26 June 2013 (UTC)

(I just reverted a bot archiving these comments. I know I am not working with the comments myself, but those who do should keep them here and strike them once the're taken care of. Lova Falk talk 16:13, 15 October 2013 (UTC))

Mindfulness section

The text about minfulness added today,[4] as it is currently written and sourced, is inappropriate for Wikipedia for a few reasons:

• Possible original research: Two books are used to source the section. The referenced Kabat-Zinn book is about mindfulness, not about BPD, and is used to source a description of mindfulness meditation. The Linehan book is used to source statements about BPD, but the connection to mindfulness meditation isn't clear - it very much reads as original research to then say that mindfulness meditation as described by Kabat-Zinn is effective for the BPD-related issues described by Linehan. Remember that WP:MEDRS applies here. I think sourcing should be much stronger before listing mindfulness as a recognized treatment for BPD in this article.
• Unencyclopedic tone: The guidelines on tone say that articles should not be written from a second person (you, your) POV, and the Mindfulness section as it is currently written clearly violates that.
• Offers advice to therapists: The section about the benefits of mindfulness for therapists and coaches is not specifically relevant to BPD, is unsourced, and reads like it's from a how-to manual - and Wikipedia is not a how-to manual.

Given this I'm going to remove the section again, and I strongly encourage User:Breath in and out (and anyone else who's interested, obviously) to discuss the issues here and not to add the text back in its current form. Sourcing would be a good place to start - are there good, medical reliable sources for this? Cheers, Dawn Bard (talk) 19:21, 20 September 2013 (UTC)

Mindfulness is great stuff, and there is research proving its effectiveness in treating patients with BPD: for instance, DBT is a mindfulness-based therapy, and research shows promise for using ACT to treat BPD as well. However, I agree that the information Breath in and out added to the article, while certainly added in good faith, is more appropriate to the Mindfulness (psychology), Dialectical behavior therapy, or Acceptance and commitment therapy articles and needs better sourcing & encyclopedic wording. I've used the Manning book for other facts in this article (e.g. throughout the behavior section), as well as a Chapman & Gratz book, but while these books are certainly informative and their authors are credible (researchers in the field), these sources still need to be replaced with peer-reviewed, medical sources. That's top of my to-do list as soon as I can find the time (life has been swamped recently). Firecatalta (talk) 19:44, 20 September 2013 (UTC)

Regarding Caroline1981's recent edits, I definitely agree that this information is useful and belongs in wikipedia. However, I think this information would be more appropriate to add to the Mindfulness (psychology) article. Otherwise I think it violates wikipedia guidelines about no undue weight. That is, while mindfulness is one component of one effective treatment for BPD (that is, DBT), other approaches have been empirically shown to be equally effective, in particular MBT, which is psychodynamic. In addition, a study by Linehan and others comparing DBT to CVT (comprehensive validation therapy) indicates that the primary component of DBT is actually its focus on validation, supplemented by the mindfulness and cognitive-behavioral techniques. This link[1] only gives the abstract, and that info is in the conclusions section, but I figured it's worth linking to specify which study. Anyway, by having a full section on the benefits of mindfulness for BPD, and no discussion of psychodynamic or cognitive-behavioral principles, I'm concerned that the article would be placing undue weight on the role of mindfulness in treatment for BPD. However, there would be no such conflict if we located this material in the Mindfulness (psychology) article, where I think it would benefit the article considerably. An additional option would be to include a short sentence defining mindfulness and to direct readers to the Mindfulness article for more information. Caroline1981 (and others who are interested), what are your thoughts? Firecatalta (talk) 22:18, 20 September 2013 (UTC)

Response from Caroline1981: Dawn I'm okay with Firecatalta's helpful suggestion to include only a short sentence on mindfulness with the link to the main mindfulness article. (In fact ideally instead of mindfulness being its own section there should be a section on treatments -- and mindfulness, DBT, etc should simply each be listed there each with a link to its own article.) But when many of us have only limited time to contribute, I think you should not worry so much about removing other people's accurate and helpful contributions so quickly based on their inadequate sourcing or style or tangentialness. Instead put your effort into positive edits that preserve and improve way the facts are provided in those contributions. So for example, instead of just wantonly deleting the text wholesale, you could yourself insert the link to the main mindfulness article -- even delete all but that first sentence about it, as Firecalta suggested. If you had one something like that in the firs place, it would have been constructive and saved the rest of us the trouble of having to try to scramble to fix and respond to what you simply knocked down. Instead of removing it again in a tug of war, please at least do that. Just a friendly observation, I'm sure you meant well. Caroline1981 (talk) 23:13, 20 September 2013 (UTC)

I did mean well; I think that's pretty clear from my explanation above. What you call "wanton" deletion was done to preserve the integrity of the article and to ensure it adheres to policy, and I explained that clearly at the time - in other words, it was demonstrably not wanton at all. Also, I wasn't the only user to revert it. Verifiability and no original research are two of Wikipedia's core content policies and my edits were with that in mind. I also had WP:BRD in mind. A user made a bold edit, was reverted by several different users, so I started a discussion. I still have concerns about how much of the section is sourced to the Linehan book (do we know that it meets WP:MEDRS?) and that the section as a whole gives the topic undue weight. Cheers, Dawn Bard (talk) 23:42, 20 September 2013 (UTC)

•  Comment:. I have no interest in entering into the debate of where or whether to mention mindfulness, but as one of the editors who "wantonly" deleted "the text wholesale", in application of the "core content policies", including WP:TONE & WP:NOTHOWTO that Dawn Bard mentions above, I'd just like to point out that it was in fact copyvio of [5] & [6], which I was not aware of that at the time of reverting, nor when replying to the editor in question. Much of that content now seems to have been purged from this article, but there is still some in there that needs sorting out & I shall leave to others to check whether the related articles have also been purged of copyrighted content, others who, while they themselves claim to have "only limited time to contribute", somehow seem to find the time to censure others for "removing other people's accurate and helpful contributions so quickly based on their inadequate sourcing or style or tangentialness". But just for the record, policy is very clear on this: "The burden of evidence lies with the editor who adds or restores material,...". --Technopat (talk) 00:55, 21 September 2013 (UTC)

• Good catch, Technopat - it's definitely a copyvio. I still think the text of the section should be deleted (...again) based on the the copyright issue alone. There still aren't any policy-based reasons to support its inclusion as it is currently written, and copyvio is an important concern. Cheers, Dawn Bard (talk) 03:09, 21 September 2013 (UTC)

Hi Caroline1981 - I'm glad you found my suggestions helpful, but in fairness to Dawn Bard and Technopat, I also would have removed it wholesale if they hadn't already. I would have done so after you added it back but didn't want to push the EW further while a discussion was starting. I think it's great how much effort everyone is putting into improving this article, and to me that says we all want the article to be as good as it can be. On which note, the mindfulness section does have strong copyright violation issues (yikes, and thanks Technopat for pointing that out!), and I'm in favor of removing it on those grounds as well. Maybe we could store it on the talk page of mindfulness (psychology) until someone can incorporate its main ideas into that article, assuming they're not yet discussed there. Caroline1981, would that be all right? Firecatalta (talk) 04:33, 21 September 2013 (UTC)

• I've gone ahead and deleted the worst of the copyvio. The bottom line is that copyvio policy is one that overrides others - it doesn't matter if text is accurate or helpful or whatever; if it's been pasted in from another source, it should not stay in a Wikipedia article. Also, the text I deleted had inaccurate citations. A book was cited, but since we know the text was pasted from a website, we know that the book was not the real source. Again, I suggest that discussion take place here before it is added back. Cheers, Dawn Bard (talk) 12:32, 24 September 2013 (UTC)

Sorry I've been MIA; thanks Dawn Bard for taking care of the copyvio issue. Much appreciated. Firecatalta (talk) 13:14, 24 October 2013 (UTC)

Also, unless anyone has objections, I am going to move the rest of the Mindfulness info to the mindfulness (psychology) article. As said previously, I am a big fan of mindfulness, but giving it its own section is undue weight, and it is more directly relevant to the mindfulness article in any case. Does anyone have comments or concerns before I do so? I'll wait a few days so people have a chance to weigh in. Firecatalta (talk) 13:19, 24 October 2013 (UTC)

Hello, I'm currently taking four psychology classes at the moment and believe it would be interesting to incorporate topics from my Abnormal Psychology class as well as a neurological perspective from my Psychology of Consciousness class to this topic. It would give an insight to both the physiological perspective as well as a theoretical approach to this perhaps over diagnosed disorder. — Preceding unsigned comment added by Noraeldasher (talk • contribs) 01:56, 28 September 2013 (UTC)

Hi Noraeldasher,

Any information that is backed up by a reliable source and directly relevant to the article would be more than welcome! Best of luck with your courses, and I hope you enjoy the Wikipedia community. Firecatalta (talk) 13:12, 24 October 2013 (UTC)

Schema Therapy

I'm not impressed with the dismissal of schema therapy, with a citation we can't follow up.

In contrast I have found two studies in support of schema focused therapy for bpd:

18 Josephine Giesen-Bloo, Richard van Dyck, Philip Spinhoven, et al., “Outpatient Psychotherapy for Borderline Personality Disorder: Randomized Trial of Schema-Focused Therapy vs. Transference-Focused Psychotherapy,” Archives of General Psychiatry 63 (2006): 649-658.

19 Antoinette D. I. van Asselt and Carmen D. Dirksen, “Outpatient Psychotherapy for Borderline Personality Disorder: Cost-Effectiveness of Schema-Focused Therapy vs. Transference-Focused Psychotherapy,” British Journal of Psychiatry 192 (2008): 450-457.

cited in:

Kreisman MD, Jerold J.; Hal Straus (2010-10-25). I Hate You--Don't Leave Me: Understanding the Borderline Personality (Kindle Locations 3847-3852). Penguin Group US. Kindle Edition.

Can someone do the honours and edit the main article plese? — Preceding unsigned comment added by 87.115.195.242 (talk) 07:03, 1 November 2013 (UTC)

"Sometimes I Act Crazy" is a later publication by the same authors. When/if I get a chance, I will see what there view of schema focused therapy is in this publication? Or is some one else more qualified to do so?

Inappropriate editing of talk page

I left comments on this page months ago that are no longer here. They were highly relevant & entirely non-offensive. I'm left with the distasteful impression that someone is scrubbing this page on a regular basis under the guise of neutrality. That's shameful. — Preceding unsigned comment added by Ctnelsen (talk • contribs) 02:28, 18 November 2013 (UTC)

Hi Ctnelsen! I checked your contributions, and as far as I can see, you made some comments in June 2012. Please notice that sections on this talk page get archived automatically when they haven't been commented upon during 90 days. Lova Falk talk 15:16, 28 December 2013 (UTC)

Stupid mistake by me & point taken. Sorry for the interruption.Ctnelsen (talk) —Preceding undated comment added 15:24, 15 January 2014 (UTC)

Gender

Hi, I am not a seasoned wikipedian so please forgive the errors. I have included the following paragraph to the gender section based on Paris' "Treatment of Borderline Personality Disorder: A Guide to Evidence-Based Practice":

'Joel Paris argues that there are a number of reasons why men with BPD are misdiagnosed or undiagnosed. One factor, he maintains, is that male BPD patients are more inclined to self-harm via substance abuse and hence are diagnosed according to that behaviour. He also points to the greater frequency of suicide among men compared to women, and states that a considerable number of psychological postmortems in young male suicide cases indicate BPD.'

I will improve / add references asap, unless someone else feels more qualified to do so.

I believe that it is very important to indicate that some believe that it is more a case, or as much a case, of men going undiagnosed, as of women being over-diagnosed or negatively stigmatized, at least according to some of the main researchers in the field. I do not think the paragraph as it currently stands is good enough yet, but I think the content is necessary to balance the gender question, which is certainly a very important one. — Preceding unsigned comment added by 80.111.174.46 (talk) 15:48, 28 February 2014 (UTC)

Surprised to see that my comments above were removed, without comment. I understand the lack of references. However it is surprises me that the Gender section is once again presented entirely in terms of over-diagnosis for women, rather than the contrary view of under-diagnosis for men, without any explanation included here. Anyway, I will get busy and get references in this weekend. — Preceding unsigned comment added by 80.111.174.46 (talk) 01:38, 15 March 2014 (UTC)

Under-diagnosis in men should be stated in the article. Few men are assessed for BPD, because there is a perception that it is "a woman's thing". The most often given prevalence rate is 1% of men, 3% of women. It is unlikely that only one in a hundred men have it, especially considering the fact that it is comorbid with ASPD and NPD, which are probably the two most common PDs in men. The extreme self-destructive behavior exhibited by probable borderlines such as Keith Moon and Kurt Cobain would have led to BPD diagnoses if they had been women. Likewise, NPD often goes undiagnosed in women. Jim Michael (talk) 21:25, 20 March 2014 (UTC)

Re above: there is also the possibility that men are misdiagnosed with ASPD rather than BPD. Of course, to some extent perhaps these are all just lines in the sand.

The second paragraph of the section seems incredibly biased to me, especially as a male with BPD. The second paragraph relies primarily on one source, and reads more like feminist literature than an encyclopedia article on a mental disorder. At the very least "Women may be more likely to receive a personality disorder diagnosis if they reject the traditional female role by being assertive, successful, or sexually active." should be revised or removed, as the notion that a certified psychologist would use success as a factor in diagnosing a mental disorder (especially one that is characterized by a lack of sense of being, and therefore motivation) is simply absurd. Furthermore, sexual promiscuity is considered a symptom of BPD due to it being an impulsive behavior with readily visible consequences; being "sexually active" and "sexually promiscuous" are two incredibly different things, especially from a diagnostic standpoint. (Anything after this has nothing to do with the requested revisions.) From a personal standpoint, I can state that the reason for an underdiagnosis of BPD in men is as a result of the disorder itself. Many people who have BPD, myself included, were berated by their parents for showing emotion, or went through a similar situation. This leads to a tendency to keep your emotions to yourself, and to feel intense shame accompanied with other emotions (especially negative ones), simply for feeling them. Especially as a man, this leads to the belief that seeking help would make one weak, or in my case, that I was just exaggerating my symptoms to myself and nothing was really wrong, and seeking help would make me a coward. Just food for thought. — Preceding unsigned comment added by 2604:6000:B680:8800:8DBB:DCCF:4DC:D2A0 (talk) 08:35, 26 March 2014 (UTC)

Yes, men are less likely to be diagnosed with some disorders than women because men are less likely to seek help, medical or otherwise. Men are told that they should sort their problems out themselves and that asking for help would mean that he is "weak" and "unmanly". Jim Michael (talk) 11:21, 20 April 2014 (UTC)

To summarize the above, I might suggest that some women are reluctant to accept the diagnosis of BPD because it seems to objectify them as weak according to a sexist POV, whereas men are reluctant to accept the diagnosis of BPD because there is a general reluctance to seek help, i.e. accept any sort of diagnosis whatsoever.

Unfortunately, it strikes me that the Gender section, and the corresponding section in the comments, has become coloured somewhat by wider questions regarding feminist POV and contrary POVs. (There is a specific question re: feminists arguments against diagnosis in females that this is a misapplication of feminist theory to the wider phenomenon of reluctance of patients to accept the diagnosis, but I do not want to press that point.) Firstly, some amount of POV here seems intractable, as these represent specific world views. However, I think it would be best if we worked to address the question from within the BPD literature. — Preceding unsigned comment added by 80.111.174.46 (talk) 10:38, 22 April 2014 (UTC)

To continue from above, I have made additions to the Gender section, and shorter additions to the suicidality section re: Gender. Please do not remove or edit without providing explanation in the commentary. If there are other sources with differing statistics (particularly in later publications) please include this information etc. — Preceding unsigned comment added by 80.111.174.46 (talk) 11:11, 22 April 2014 (UTC)

Self-Complexity Section

To the relevant writer or writers, I am afraid I must say I find this section a little bit hard to follow as it stands, due to the preponderance of theoretical terms. I suggest it is well worth expanding the section with one or two brief (rough) explanations re: e.g. Actual-Ought, Actual-Ideal. As it stands it is very hard to follow when not versed in self-discrepancy theory. I suggest it might be possible to give a quick "plain English" approximation of the analysis of BPD according to this theory, while still linking to the relevant theoretical pages to allow for, and encourage, a deeper understanding. — Preceding unsigned comment added by 80.111.174.46 (talk) 16:27, 24 April 2014 (UTC)

"sexually active"

Being sexually active is normal behaviour for an adult woman. Chastity is abnormal. It does not make any sense to say that this is rejecting the normal female role. 46.208.15.223 (talk) — Preceding undated comment added 13:18, 24 April 2014 (UTC)

I agree that there is a certain degree of danger of reinforcing traditional gender stereotypes by considering high sexual activity or "promiscuity" (please note scare quotes) as a criterion for such conditions as BPD and (particularly manic stage) bipolar. However, to just take the case of women for now (to simplify the argument and since this is where the questions of stigma chiefly emerge vis a vis this behaviour), I think there is enough clinical evidence and testimony available to differentiate between the cases of women enjoying a full and various sex life out of empowerment and healthy exploration, and of women forming multifarious sexual attachments due to mental phenomena such as "splitting", delusions of emotional intimacy, re-enacting sexual abuse, and so forth. In bipolar, there is plenty of clear-cut evidence (if we really have to go and dig out references we can do so...) of women reporting marked changes in their sexual behaviour during manic episodes, where they may sleep with far more people than at other times, and subsequently regret this behaviour and consider it highly uncharacteristic. With BPD, where there is not the same clear-cut chronological partition of manic / depressive / stable phases, the inclusion of "promiscuity" as a symptom/criterion is certainly more problematic. Nevertheless, I think its inclusion is valid, as a particular example of actions according to such criteria as impulsivity, emptiness, etc. This is assuming a BPD diagnosis is made in the course of an extended psychological assessment in which the psychologist and/or psychiatrist explore the motivations underlying such actions. Also, I think DSM states more than one form of impulsive behaviour should be sought to meet the impulsive criterion (e.g. "promiscuity" and shoplifting) which would be exactly in order to pinpoint the underlying impulsive tendency rather than its particular manifestation (since "promiscuity" may be either a healthy life choice or an unhealthy impulsive reflex). But basically it's fair to say, there are plenty of women who are "promiscuous" precisely because they are happy and healthy, and plenty of women who are "promiscuous" precisely because they are not.

To that extent the importance of non-judgemental practitioners is inestimable. It seems likely that in some cases a biased practitioner might infer BPD based upon sexual behaviour which is actually irrelevant to presented symptoms e.g. regarding depression, but a good doctor and/or psychologist should be able to delineate such cases - which is also why a detailed psychologist assessment is preferable to simply filling out one or two brief questionnaires.

Many wider audience publications on BPD (eg. "Sometimes I Act Crazy") include case studies giving brief biographies of BPD people. Some of these (both men and women) exhibit "promiscuous" tendencies which clearly pertain to their condition, and these might serve as useful examples as to the kind of actions and circumstances which these experts consider symptomatic of BPD. — Preceding unsigned comment added by 80.111.174.46 (talk) 16:02, 24 April 2014 (UTC)

The article only says "sexually active" it does not say "highly sexually active". You seem to have interpreted "sexually active" to mean "high sexual activity or "promiscuity"". 31.185.255.76 (talk) 02:26, 27 April 2014 (UTC)

I assume the original writer of the relevant article section was referring to perceived high-level sexual activity, since this is the only rational interpretation. Being non-celibate is considered normal in adults, and hence no woman is likely to be diagnosed BPD as a consequence of this (and quite possibly never has been). Conversely, high or impulsive sexual activity ("promiscuity") is supplied in DSM-V as a criterion for BPD under Impulsivity: "4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)." I assume the original writer (having equal recourse to logic, and equally unencumbered by pedantry) meant "sexually active" in a similar sense, rather than in binary opposition to abstinence. I think such a reading is evident given the context.

I wrote to clarify the (surmountable) difficulties surrounding the inclusion of sexual impulsivity re BPD diagnosis. The point I have made it is that "promiscuity" may or may not be indicative of an underlying disorder, depending upon the wider personal context, and that this is recognized by competent mental health professionals and implicitly, at least in part, by DSM-V, in requiring two or more impulsive behaviour characteristics.

This is an important question regarding BPD, and is one of a number of wider perceived prejudices in DSM - or at least concerns that parts of DSM are open to a prejudicial interpretation. (For instance there are questions regarding DSM-V's Gender Disphoria, which, effectively, replaces DSM-IV's Gender Identity Disorder.)

I assumed your comment in this thread was referring to this serious matter, which leads to issues in clinical practice regarding both a) incorrect diagnoses of BPD, b) clients not accepting diagnosis due to a perceived prejudice. If you were simply indulging in excessive literalism then I offer my sincere apologies for wasting your time with a response that pertained to the wider BPD community rather than your own cognitive insensibility to context.

In conclusion I believe a) the original writer's sentence has the meaning I ascribed to it; b) this meaning is self-evident. — Preceding unsigned comment added by 80.111.174.46 (talk) 13:38, 29 April 2014 (UTC)

Suicide rate is dubious

This article claims the suicide rate among patients with BPD is 8 to 10 percent. And it claims that 1 to 2 percent of people suffer from BPD. Multiplying the most conservative numbers of two percentages (8% of 1%) reveals that .08% of all people kill themselves because of BPD. That would be 80 in 100,000 people killing themselves just from BPD. (The high end would be 200 in 100,000) The highest suicide rate in the world is 83 per 100,000 in a year. So every single one of those is from BPD? And also every other suicide is from BPD? Something seems fishy here. — Preceding unsigned comment added by Torquast (talk • contribs) 03:36, 4 May 2014 (UTC)

Yes one commonly sees discrepancies in the literature like this. Researchers often promote the disease they are interested in. They do this by using liberal criteria for how common the condition is thus one gets high prevalence rates. They then use more restrictive diagnostic criteria for calculating adverse outcomes like suicide.

Thus one ends up with situations with disease that look super common and super serious. When they might just be mildly common with only a subsection being serious. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:20, 4 May 2014 (UTC)

Does not the article need to change in some way then? The resulting dubious numbers make the verisimilitude of the entire article suspect. It seems so overstated as to make me think I can trust none of it. Torquast (talk) 11:47, 4 May 2014 (UTC)

We would need a reliable source to raise this concern. Good make a great paper. I bet one could find the same thing in dozens of other conditions. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:16, 4 May 2014 (UTC)

Doesn't the rate of 8-10% refer to the lifetime risk of suicide not the annual risk/rate? In which case the figures make sense. Woodywoodpeckerthe3rd (talk) 19:26, 4 May 2014 (UTC)

Ah yes :-) Thanks for clearing that up. Yes that is the lifetime risk. So if 1% of people have BPD and 10% die from it. That would mean 1 in 1000 people die from suicide related to BPD. About 1% of all people die from suicide. Thus BPD is 10% of these. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:26, 4 May 2014 (UTC)

Please check ref for copyvio

Nhiiix3 (talk · contribs) added some information to the sections on the hippocampus and amygdala and I'm concerned, given that a previous edit to this article by this user was a copy-and-paste WP:COPYVIO from a website, that the information added may also a copyvio. The journal article is here but I don't have access to see the text of the article. Can someone please check to see whether the text added is ok? Thanks! --Ca2james (talk) 17:36, 16 June 2014 (UTC)

Thanks for heads up. Your instincts were right: the edits are a less-coherent, slightly-modified version of the article's abstract. It does look like a useful article for us to incorporate into the Wiki article at some point, but not in this manner. I unfortunately don't have access to the full text either, but I'm looking into changing that, in which case I'll put the info in (if it hasn't been included by someone else before then). It's not exactly plagiarized though, which makes me think that these might be good-faith edits (i.e. that Nhiiix3 (talk · contribs) is trying to paraphrase and is just not doing a very good job):

• Edit: "A meta-analysis of MRI studies show that show smaller hippocampal and amygdalar volumes in both the right an left sides of adult patients."
• Abstract: "A significantly smaller volume was found in both the right and left hippocampi and amygdala of patients with BPD compared to healthy controls."
• Edit: "Results from the study raise the possibility that reduced hippocampal and amygdalar volumes are biological substrates of these symptoms of BPD."
• Abstract: "These findings raise the possibility that reduced hippocampal and amygdalar volumes are biological substrates of some symptoms of BPD."

However, I do have access to the second article that they cited (though that citation seems to have been removed from the current version - does anyone know who removed it and why?). The article, "Brain structure and function in borderline personality disorder," is the proper citation for the second two sentences. These edits need to be properly sourced:

• Edit: "Decreased hippocampus reported in BPD patients reported early traumatic experiences."
• Article 2, p. 769
• Edit: "Hippocampal volume lost have been reported in patients with PTSD and in women with a history of severe sexual abuse in childhood."
• Article 2 - can't find it in here, but maybe it is from the previous article?

Anyway, my overall conclusion is that these are good-faith edits, but they are poorly sourced and/or plagiarized. I'll remove the info momentarily and/or touch up the parts that can be salvaged. Will also post on Nhiiix3's page inviting them to join the discussion here and letting them know why I removed/edited the info. Thanks Ca2james for a good catch! Firecatalta (talk) 18:38, 16 June 2014 (UTC)

Thanks for checking! I did remove the copyvio I mentioned above because the text was copied and pasted word-for-word and the source was a website, not a journal, and so isn't a good MEDRS.

There is another edit of concern that appears to be another copyvio with material copied and pasted from this article (call it Article 3):

• Edit: "Numerous studies have demonstrated that decreased central serotonergic activity is associated with measures of impulsive aggression in patients with personality disorders. <ref name="The Neurobiology and Genetics of Borderline Personality Disorder" />"
• Article 3: "Numerous studies have demonstrated that decreased central serotonergic activity is associated with measures of impulsive aggression in patients with personality disorders (Goodman & New, 2000)."
• Edit: "Specifically, reductions of serotonergic activity have been identified, as reflected in diminished concentrations of the principal metabolite of serotonin, 5-hydroxyindoleacetic acid (5-HIAA), in the cerebrospinal fluid (CSF) of personality disordered patients with impulsive aggression. <ref name="The Neurobiology and Genetics of Borderline Personality Disorder" /> "
• Article 3: "Specifically, reductions of serotonergic activity have been identified, as reflected in diminished concentrations of the principal metabolite of serotonin, 5-hydroxyindoleacetic acid (5-HIAA), in the cerebrospinal fluid (CSF) of personality disordered patients with impulsive aggression, as well as in depressed patients, volunteers, and violent alcoholic offenders and more recently in mentally disordered violent offenders (Linnoila et al, 1989; Virkkunen et al, 1994; Lidberg et al, 2000)."

I found these edits by looking at the references as the reference was named but not described. I'm sure the editor was trying to add good information to the article but may not be familiar with copyright policy. --Ca2james (talk) 19:05, 16 June 2014 (UTC)

Yup all copyright issues. The ref "Volume of Hippocampus" was never defined that I can see. Thanks. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:00, 17 June 2014 (UTC)

"Anakin Skywalker/Darth Vader in the Star Wars films meets six of the nine diagnostic criteria"

The article does not say there are nine diagnostic criteria. 46.208.15.223 (talk) 13:13, 24 April 2014 (UTC)

Well if it doesn't, it should, because there are according to the DSM-IV. A diagnosis requires at least five of these to be met. However, I'm not sure this comment is particularly notable, I'm sure many fictional characters meet the criteria for mental illness, but if we noted them all in wiki articles they'd be very long and full of obscure references. If a character was diagnosed with the disorder and this was noted in media or a plot device it might be notable but someone's observation that a character may meet some of the criteria does not strike me as such - I don't feel this is worthy of inclusion in the article. MissKatie89 (talk) 05:13, 27 June 2014 (UTC)MissKatie89

Added

This was added in the wrong spot and is not properly formatted. Doc James (talk · contribs · email) 14:19, 6 December 2014 (UTC)

So why not put it in the right place and properly format it? Wikipedia needs more editors, and removing a person's contribution because it's not perfect doesn't seem like the best way to keep people editng. Ca2james (talk) 21:19, 7 December 2014 (UTC)

Extended content

Signs and Symptoms Symptoms include: Out-of-control emotions Unstable interpersonal relationships Concerns about abandonment Self-damaging behavior Impulsivity Frequently accompanied by depression, anxiety, or anger Also, a better definition for Borderline Personality would be: A pervasive pattern of instability or interpersonal relationships, self-image, and affect and marked impulsivity beginning by early adulthood. It's prevalent in about 5.9% of the general population More commonly diagnosed in females than in males. Defernandes94 (talk) 22:50, 7 December 2014 (UTC) Defernandes94 (12/07/2014) References Text added This text was added "Recent research show that mindfulness-based interventions bring about an improvement in symptoms characteristic of BPD, and also lead to increases in gray matter in key areas of the brain. Further, following mindfulness-based treatment, some clients no longer met a minimum of five of the DSM-IV-TR diagnostic criteria for BPD." [7] References I have two issues with it It was first time copied and pasted. Now it is closely paraphrased. It is not a particularly high quality source Doc James (talk · contribs · email) 23:07, 23 December 2014 (UTC) This Cochrane review is more balanced [8] and a much better source. Doc James (talk · contribs · email) 23:08, 23 December 2014 (UTC) It's a review article in an acceptable journal. Therefore you should include its viewpoint, in WP:DUE proportion to the prevalence on this viewpoint in the literature. The Cochrane publication doesn't seem very pointful, given that it doesn't appear to even mention meditation or mindfulness, and therefore can't tell you anything about whether or not mindfulness-based therapy is effective. WhatamIdoing (talk) 00:54, 24 December 2014 (UTC) Still need further paraphrasing though. This bit I would like a better ref for "lead to increases in gray matter in key areas of the brain" Doc James (talk · contribs · email) 01:10, 24 December 2014 (UTC) Mindfulness is a substantial component of DBT, which is included in the Cochrane Review. Woodywoodpeckerthe3rd (talk) 08:09, 24 December 2014 (UTC) To clarify this is an extra ordinay claim that requires extra good evidence ""lead to increases in gray matter in key areas of the brain"" Doc James (talk · contribs · email) 08:49, 24 December 2014 (UTC) (see below) 4."Mindfulness practice leads to increases in regional brain gray matter density"[9][10]Britta K. Hölzela,b,⁎, James Carmodyc, Mark Vangela, Christina Congletona, Sita M. Yerramsettia...?--Ozzie10aaaa (talk) 19:09, 24 December 2014 (UTC) Paraphrasing problems can be solved with a good copyedit, and probably in less than three minutes. Is the increase in gray matter discussed commonly enough that it's DUE to mention it? WhatamIdoing (talk) 23:46, 24 December 2014 (UTC) I would like to see a better ref than the ones provided. Doc James (talk · contribs · email) 11:14, 26 December 2014 (UTC) [11] this one has 5 articles, 1. [12] 2. [13] 3.[14]4. (already listed above) and 5.[15], should these not "pan-out", it might just be an "extraordinary claim" that may need "extraordinary time" to ref--Ozzie10aaaa (talk) 12:38, 26 December 2014 (UTC)