BPD: Misdiagnosed and Misdiagnosis

hi my name is dr fox licensed psychologist in state of texas an expert in the area of personality disorders and in this video we're going to talk about why bpd tends to get misdiagnosed and bpd is so often misdiagnosed that you would be surprised or you may be living that experience right and that misdiagnosis can lead to so many severe consequences not just in the wrong treatment being applied but the continuance of untreated mental illness can drive greater problems for you and those around you those that are in your life so we're going to pull back the curtain right as i identify those factors and issues pertaining to why bpd is so misdiagnosed i think you'll be surprised what you learned so stick with me let's explore it figure it out like share and subscribe so let's get into it so the first one that we're going to talk about is societal and professional stigma bpd carries with it this stigma right that's from society but even other mental health professionals and even the word borderline personality disorder bpd right affects how practitioners tolerate the actions thoughts and emotional reactions of those individuals now this can also lead to minimizing or overlooking certain strengths that the individual has so a lot of my clients are along the borderline spectrum and i think one of the problems is that a lot of folks tend to see what i call or what has been identified as the upper three percent the extreme cases of bpd now the extreme cases are exceptionally rare but the problem is is that that three percent tends to get broadened out to the 100 percent and that adds to the misdiagnosis to the to the ill conclusion what's interesting is that a lot of mental health medical providers who do run across folks with bpd if they tend to be moderate low moderate you know they have those traits perhaps not the full disorder but traits more folks are likely to have traits than they are to have the full disorder and they often miss it because they're only looking for that upper three percent and that becomes a problem because that can lead to misdiagnosis and things like that that we're also going to talk about and obviously the whole video is about misdiagnosis but there are other factors as well so i think that sort of that stigma adds to the misunderstanding of the disorder it also you know a lot of mental health providers and medical providers when they see borderline personality disorder in someone's chart or you know that they realize that that's the diagnosis sometimes they get afraid sometimes i think that mental health providers even the ones that i work with that i train my students and things like that then when we talk about bpd they have this this misunderstood kind of representation in their brain right so i remember a long time ago that i had this student and we talked about you know the client that that she was going to see and this client met criteria for bpd and when i said that the student said oh no bpd and i said whoa i said where's that coming from i said have you worked with someone with bpd before right and she said no and i knew she hadn't and i said where's this coming from i said well i heard they're just you know this this this that and i said well the problem is and then we actually explained the the data right we looked at the data i explained you know that that that's not realistic i said we have to be realistic and you know she had a great experience working with that person she helped that person a whole lot and that it's those experiences the reality of those experiences that help lessen the professional stigma and i think that it can lessen the societal stigma as well and i think that we need to be realistic about what bpd is about what it means how it's it's displayed and that's of course a big component of this channel as well is getting an understanding of mental health issues particularly bpd and personality disorders so let's get into the next component as it relates to bpd being misdiagnosed there is this belief that people under 18 can't have bpd now this is a slippery slope so make sure you got your your galoshes on collagen more for the rain do they help you stop slipping i'm not sure but you get what i mean now in the dsm-4 and the dsm-5s it specifically states that a bpd diagnosis could be applied to children and adolescents this is people under the age of 18 if they meet the symptom picture for at least one year now here's the thing and this is what i tell a lot of my students and this is also what i tell a lot of mental health providers right when when i'm doing training with them is that everyone at some point in their life right during their adolescence okay that they're likely to display bpd traits they're likely to possibly right meet criteria for bpd so we gotta be really really careful and i think the reason why this specific classification this this specific notation is in the dsm which is the diagnostic and statistical manual it's in the fifth edition now i think it's right back there oh wrong side it's right back there and the reason why it says this in there is because you have to be so careful because there is a big big misunderstanding about bpd obviously but also you have to be sure that it's evident in that individual now could they have traits sure but again they should be present for at least one year and over that year period right obviously that individual right the adolescent that teen is going to encounter different circumstances right they're going to have different issues they're going to have breakups they may be dating they may not be dating they may be isolating themselves they may you know they're still discovering who they are so unstable self-image is not uncommon you know ruptures in relationships is not is not uncommon so all of these factors you know is certainly critical many students particularly girls regretfully in their teens there's a massive increase of self-harm non-suicidal self-injury as well as suicide so and not every teen who cuts themselves and hurts themselves and things like that has bpd that's important to realize as well so we have to be really clear that over that year are these symptoms present how are they present to what extent because in many ways in many instances many adolescents teens are going to exhibit these traits but they're often going to be very specific and short-lived there may be a specific crisis that goes on the parents may getting separated there was the end of a relationship the first end of their first sexual experience whatever it may be that that can cause them to have these maladaptive reactions but once that is handled once that is addressed then they start to go back to a re-stabilization and here's the thing for those early bpd cases right those individuals is that you see that those those traits still kick up those traits are still present so that's why you have to be certain that it's over that one year period okay and you want to be really really careful okay particularly with giving a diagnosis to to an adolescent or or a teenager the next one is that bpd is a complex disorder right bpd looks like so many other mental health conditions and it co-occurs with so many as well for example research has shown that bipolar disorder and bpd are comorbid in approximately 27.6 percent of cases that's a lot of overlap right that's just over a quarter of the cases depression is also very confusing because individuals that are on the bpd spectrum or people that have a bpd that they're going to have depressive episodes but you have to be able to rule that out from the depression just those depressive episodes don't equal major depressive episode so you have to be able to rule it out that's why it's so so important that you're working with someone who knows what they're doing who's working with someone who knows what they're looking for okay because it can easily be misunderstood and people can have an agitated depression which is a lot of restlessness a lot of irritation a lot of ill responses and that could be misconstrued as bpd in some cases or could be major depressive disorder with anxious distress and with bpd traits so it has also teasing that out adhd is another component that is often confused with bpd so that's important it has to be ruled out as well where's that hyperactivity where's that inattention coming from okay is it a factor of emotional components or is it a factor of environmental response is it that individual and how they function across many different environments that's adhd there's also complex post-traumatic stress disorder and ptsd and ptsd that is not complex ptsd as well so it's about teasing those out as well so and then there's also psychosis the individuals that are at the probably high or severe or extreme level of bpd are at a greater likelihood to have psychotic breaks okay does that mean that they're schizophrenic no does it mean that it could even equal a brief psychotic episode no so you have to be aware of that so you have to be able to tease that out and the way that i i look at this is that knowing that it's a complex disorder my next book that is going to come out either later this year or early next is going to talk about this complex borderline personality disorder and it's going to talk about those co-occurring conditions right and how they manifest and how you can help to identify it and how you can find a mental health provider that can help you so i'm going to you know one of my future endeavors is going to help folks better identify those co-occurring conditions that come along with bpd so i think if we can lessen the complexity you can have greater understanding of it and that's so so important the next component is the myth that bpd is not treatable that is an old old fallacy that is 1970 data the seven i was born in the 70s so great decade but bad bad decade for for bpd because it's old old information right there are a variety of what are called empirically validated treatments that means that research supports these treatment approaches and there's a number of them i'm going to tell you some right now there's dialectical behavior therapy there's mentalization based treatment there's schema focused therapy there's transference focused psychotherapy there's systems training for emotional predictability solving and problem solving and there's even general psychiatric management so all of these have been found to be effective treatment methods in treating lessening bpd right and if you've watched my other videos you know that individuals with dpd also encounter remissions and that those remissions can last for two years or more so you want to learn those skills you want to learn to manage that core content which i talk about in other videos as well and if you can get a handle on it and you can manage it and you can lessen it that helps you but it is a treatable disorder so that's another issue that leads to that misdiagnosis and confusion the next component that we're talking about is gender confusion over bpd this is pretty prominent this is prominent in society this is prominent certainly in the professional community as well and the belief is that approximately 75 percent of those diagnosed with bpd are female the reality is it's more like 50 50 okay but let me explain it okay so there is approximately 75 percent of females that are diagnosed with dpd in clinical samples now there's more equal male to female ratio in community samples so what that means is in patient settings there's a higher likelihood to diagnose females with bpd so out in the community it's equal to male female so it's about 50 about 48 52 is is more the consistent data you know that's pretty specific but you get what i mean right so is some of that misunderstanding right where they're saying that it is clinical samples those that are inpatient is that a component of misdiagnosis well women with bpd are more likely to have co-occurring diagnoses of ptsd and eating disorders while men are more likely to have co-occurring diagnosis of substance use disorder as well as schizotypal narcissistic and anti-social personality disorder now this can be explained as gender differences in bpd may be a function of impulsivity now this may be in that men and women may differ in the specific type of disorder of impulse that may that they predominantly display for example women are more likely to use food like internalizing behaviors and men alcohol or drugs and acting out against others this is externalizing behaviors in a self-destructive manner and what happens is that this adds to that confusion so you've got two different classes so to speak right you have males females and the way that they exhibit these traits is different and i what i've encountered you know over the years is that you can have a female with antisocial personality disorder is often misdiagnosed with bpd you can have a male with bpd who's exhibiting those symptoms misdiagnosed with antisocial personality disorders so that confusion of course leads to a misdiagnosis and they are vastly vastly different okay it is so important to know that and i've heard it said and it is massively inaccurate that bpd is the female form of anti-social personality or that is absolutely positively not true there is no data to support that at all there are some folks who do overlap in both but you cannot make that gender distinction so please be cautious don't don't believe that stuff because that adds to the misdiagnosis and misunderstanding of bpd which this channel is about having greater understanding about bpd what it means and those traits that's exhibited in this video in specific about helping you identify the diagnosis you can talk to your medical mental health provider the next one is that people choose to behave in a particular way that are or includes bpd traits that bpd is a choice people with bpd would never choose to feel like they do the intensity of those negative feelings of self others in their world is so vast i have never had a client say that they choose to think feel and act the way they do along the borderline spectrum who have this intense abandonment emptiness difficulty controlling their responses right difficulty seeing the world in a more accurate way i've never had a client that's volitionally said that right imagine that you grew up in emotionally deprived environment with little options to respond feel good about yourself or see a different way of living the power of volition doesn't get instilled in you when you're growing up in this environment but torment fear impulsivity and self-contempt blossom and they intensify over the years which breeds an increased likelihood of falling into the category of bpd or developing bpd traits right bpd can also be seen as a maladaptive response to manage internal and external stressors right and inconsistencies in the world it's very very difficult very very painful disorder to try to manage and work with but we know that it is treatable a research study found that the label of bpd was enough to change the behavior of treatment providers right this is these researchers compared nurses responses to hypothetical patients with bpd and schizophrenia what they found is that a significant proportion of nurses were more likely to remain sympathetic towards patients with schizophrenia and made belittling or contradicting responses to statements made by patients with bpd it's likely that the nurse's perceptions of the underlying motives of the patients this is implying self-control influence their responses people with bpd are seen as making a choice to act that way i'm not saying that you shouldn't be held responsible for your behavior i think we all absolutely should and i understand that but what i'm saying is is that i think many times people with bpd they're like oh well you know they're doing this for this reason this is like it's planned out that it's expected and that just isn't true that it is a maladaptive response to stressors right so when when people encounter a lot of stress outside of bpd right a lot of them drink alcohol right so are they doing that because they want to purposely just destroy everything are they doing that because they purposely want to no they're trying to do is they are externally trying to manage their internal stress in a maladaptive way well choose right how you see people do you see them as as angels you see them as as devils do you see them as heroes you see them as zeros are relationships hard to maintain are you afraid of being left alone are you afraid of being empty on the inside all of these different components and people don't make a choice to feel that way so it's so important that people realize that now i think that we can lessen the misdiagnosis rate of bpd by we have to learn about it we have to confront these issues right that we just discussed if you're wondering if you have bpd find a trained mental health provider that can help you diagnosis is for treatment not for self-definition right and it's so important to identify the diagnosis so you can plan out a treatment course and by doing so that can help you move mountains it can help you change your life do things differently and that's the purpose of diagnosis to work and identify treatment not to identify the individual so i hope that you found this helpful please like share and subscribe thank you very much for your time and attention and take care bye

Channel: Dr. Daniel Fox

Views: 24,274

Keywords: bpd misdiagnosed, codependency, BPD and The Depression Difference, bipolar disorder, borderline personality disorder, bpd, bpd relationships, depression, dr fox personality, mental health, narcissistic personality disorder, major depressive episode, major depression, anxiety, dr fox bpd, mental health awareness, dr daniel fox borderline personality disorder, bpd emptiness, bpd and adhd, complex BPD, complex borderline personality disorder, eupd, misdiagnosed, mdd, dr fox

Id: iliVibigcj4

Length: 19min 24sec (1164 seconds)

Published: Sat May 15 2021