Borderline Phenomena Revisited: A Synthesis (2022)

The controversially named borderline syndrome is a chronic, recurrent and mercurial mental disorder (Paris, 1994; Sandell, 1989). Diagnosed predominantly among females (about 75%) (Widiger and Weissman, 1991), borderline personality disorder (BPD) occurs among 2% of the general population, 10% of outpatient psychiatric patients and 20% of inpatient psychiatric patients (American Psychiatric Association, 2000). The current prevalence may reflect increased incidence within the last few decades (Million, 1987, as cited in Widiger and Weissman, 1991).

Such an increase in incidence may relate to the current zeitgeist, just as the now rarely seen grande hysterie, a frequent emotional malady of young women in the 19th century, may have been related to the prevailing zeitgeist typified by oppressive attitudes and behaviors toward women.

Considerable variability exists in the course of BPD. The impairment from the disorder and the rise of suicide are greatest in the young adult years and gradually wane with advancing years (APA, 2000; Rubinow and Schmidt, 1996). Paris and Zweig-Frank (200) studied the outcomes of patients with BPD who were followed for 27 years and found that they “continue to improve in later middle age.” The cohort experienced a reduction in BPD symptoms as well as a reduction in major depression and substance abuse.


Borderline syndrome is often characterized by dramatic flare-ups. Symptoms often partially mimic other DSM-IV Axis 1 conditions that are usually considered as comorbid (Nurnberg et al., 1991). These other conditions may include depression, anxiety, panic disorder, cyclothymia, obsessive-compulsive disorder, somatoform disorder or schizophreniform psychosis (Bolton and Gunerson, 1996).

The clinical symptoms are triggered periodically by seemingly innocuous events heralding yet another new crisis. The expression of the symptoms has been attributed variously to core traits such as impulsiveness, affective instability and excessive compulsivity (Paris, 1994).

In reality, the symptoms involve all higher mental functions including cognitive and emotional functions (Paris, 1994) and those relating to the self (Pinto et al., 1996; Richards, 1989; Sandell, 1989). Additionally, the symptoms display a characteristic, often extreme, short-lived oscillation between antithetical ways of thinking, feeling and behaving (Pediaditakis, 1998; 1992). For example, severe depression and demoralization are followed often in minutes or hours by emotional effervescence and exuberance bordering on hypomania (Widiger and Weissman, 1991). Explosive temper and vituperative behavior alternate rapidly with the expression of over-restraint, over-politeness, exaggerated reasonableness and expression of prostration to the degree of obsequiousness. ironically, clinicians may misperceive this reasonableness as an indicator that the patient is recovering, since the behavior is consonant with social norms. Unfortunately, this reasonable behavior merely represents with other extreme of the oscillation and is short-lived, leaving the clinician bewildered by the change (Levine et al., 1997).

Frequently, when patients display an escalating uncontrollable rage, they may also briefly develop loose associations and frank paranoia (Pediaditakis, 1998). Heightened obsessiveness, rumination and compulsivity are followed by an outright personal slovenliness in the patient’s tasks and habits. Dissociated feelings, deja vu phenomena and self-doubt alternate with heightened clarity and focusing (an over-looked phenomenon). Sexual promiscuity alternates with strict celibacy. Binge-eating is often followed by willful fasting. Bouts of alcohol use and drug abuse are followed by total abstinence. intense idealization of important people is followed by debasement of those same people (splitting.) Periodic fearfulness about personal safety, coupled with a heightened sense of vulnerability, alternate with remarkable daring, bordering on recklessness.

(Video) Covert Borderline Predicted: Standard Model of Personality Disorders (McGill University)

There is a different emphasis on the expression of these symptoms in each crisis or flare-up. Symptom combinations also vary from patient to patient, depending on the individual’s particular mix of temperamental components that render them vulnerable to the development of BPD.

In the medical literature, these extreme pendulum-like phenomena are described by such terms as deregulation (Svrakic et al., 1991) or flawed emotional organization. These terms, being somewhat tautological, are not particularly useful in identifying possible mechanisms or causes.

Possible Mechanisms/Causes

There is an existing (albeit overlooked) mode of brain function that normally insures a coordinated smoothness and synchronism across the expression of the higher mental functions. But in patients with borderline syndrome, there is a structural abnormality that renders the brain vulnerable to a periodic loss of this synchronism. What periodically emerges is a pathological phase of rude “either-or-ness,” expressions of antithetical extremes and an overall intolerance of ambiguity (entertainment) – a kind of a “psychic-parkinsonism” (Pediatitakis, 1992).

Such oscillatory phenomena also are common in the clinical expressions of other major disorders, although not in such a stark form (Pediaditakis, 1998). This oscillatory nature in the expression of antithetical substitutes has been described in the literature as splitting, cyclothymia, yearning for intimacy and fear of aloneness versus fear of engulfment. Even though these descriptions imply oscillations, they tend to obscure the collective significance of these phenomena.

The role of Temperament. Empirical observations and recent studies show that those at risk belong at birth to a particular type of temperament that is an extreme variance of the normally occurring temperament types (Clarkin et al., 1993; Paris, 1994; Soldz et al., 1993; Trull, 1992). This temperament is characterized by the presence of a heightened intensity/reactivity that appears to trigger periodic flare-ups. Like a kindling flame, this intensity initiates escalating, crescendo-like phenomena (i.e., escalating vituperativeness, rage, depression and anxiety). For this reason, a more descriptive term for the borderline syndrome could be disorganizing hyperintensity disorder. This change would allow us to avoid the somewhat pejorative and awkward term of borderline personality disorder. This change would allow us to avoid the somewhat pejorative and awkward term of borderline personality disorder (borderline to what?) and focus instead on the crucial triggering factor of hyperintensity, with its possible therapeutic implications.

Patients with borderline syndrome also are temperamentally inner-oriented, uneasy in interpersonal interactions and aloof, experiencing notable difficulty with emotional connectedness; however, they often learn to affect a forced cordiality and sociability. This unconnectedness is perceived by these patients as “aloneness from within,” and felt as a “dread beyond telling.” Such feelings are fought with frantic thrill – and novelty-seeking activity, as if the patient is trying to cancel out the loneliness (Pediaditakis, 1991), or with frequent, intense, short-lived relationships based on idealizations. Patients also are preoccupied with themselves and have an overriding need to safeguard their own autonomy (Clarkin et al., 1993; Soldz et al., 1993; Trul, 1992).

Conversely, these sufferers tend to be conceptual thinkers, perceptive and adept at pattern recognition. While these qualities may help patients arrive at novel approaches to factual problems, when these same qualities are misapplied, patients may become paranoid. These patients also have a heightened yet oscillating compulsivity. Sociobiological attributes such as empathy, sociability and altruism are only weakly represented in these patients.

(Video) How to Mortify Borderline, Psychopath

Early Environment Factors. In young people who are at risk, the possible development of BPD depends on the confluence of certain early events within the family (Paris, 1994; Paris and Frank, 1989).

These events may include a mismatch of temperaments between the patient and the parent of the same gender. As is often the case of daughters who suffer from BPD, the mother’s temperament may be antithetical to that of the daughter. For example, the daughter is inner-directed, whereas her mother is sociable. The daughter is intense, while her mother is placid and laid-back. These differences may prevent the fulfillment of the daughter’s critical need to identify with her mother. The mother is psychologically unavailable as a role model, and the daughter may disdain and vilify her (Paris and Frank, 1989; Zanarini et al., 1997). The mis-matching contributes to the patient’s lack of inner certainty as a person, possibly contributing to the disturbance of the self (Gunderson, 1996).

In some instances, a nurturing mother will vainly attempt to help her daughter. The mother’s efforts are then labeled as over-involvement and often erroneously considered as contributory factors for her daughter’s condition (Goldman et al., 1993).

While I have consistently observed this mismatching in the patients with BPD that I treat, the clinical literature has missed this phenomenon, possibly because we usually fail to consider the role of temperament in clinical studies. A study with actual measurements of the patient’s, the mother’s and the father’s temperaments could verify or invalidate this empirically observed phenomenon.

Women with BPD often share their father’s temperament. Such patients tend to be beguiling, appealing and charming, yet, at a moment’s notice, they can oscillate from being appealing waifs to insufferable vixens, becoming cold, vituperative and demanding. These characteristics often become important factors in the development of countertransference phenomena in the therapeutic team (Gunderson, 1996; Pediaditakis, 1998).

During their formative years, patients with BPD in an unstructured environment are often overvalued and even indulged children. They end up unschooled in fortitude and perseverance. They also have an exaggerated sense of personal expectation for future, unspecified, great achievements, with the resultant periodic demoralization stemming from the underlying belief that “Unless I am the greatest, I am nobody.”

Alternatively, they may have a broken or disorganized family, marked by psychopathology and abuse (Goldman et al., 1993; Herman et al., 1989). Unfortunately, patients with BPD from a low socioeconomic background, especially males, also frequently break the law, resulting in their imprisonment (i.e., criminalization of their condition).

In either the unstructured environment or the broken/disorganized family, individuals at risk for BPD are denied the structure necessary to develop a strong sense of self with the presence of boundaries, restraint, fortitude and discipline.

(Video) From Borderline to Psychopath to Narcissist: Abused Language and Self States

As used here, structure means the presence of implied or explicit rules regarding mutuality of obligations, respect and assistance (a sense of belonging) between family members; constraints; firmness; clarity of roles; perseverance; and persistence of effort; as well as consistency and constancy in family relationships and life.

Recently, researchers have identified particular combinations of personality traits among individuals with borderline and other personality disorders (Livesley et al., 1998). It is the interaction of these traits and the possible adverse influence of the early environmental events mentioned above that serves as a matrix for the development of the disorder.

Another contributing factor may be the current social zeitgeist, which places justified and overdue value on women’s autonomy and independence. Unfortunately, young women susceptible to BPD typically misinterpret cultural guidelines. By temperament, they feel tense and uneasy in social interactions, intimacies and friendships. They easily perceive calls for female autonomy as instructions to deflect the underlying, natural need and desire for intimacy and bonding. In this way, they are further prevented from developing a normal, mutual relative interdependency with an appropriate mate. This conflict later contributes to the expression of yet another oscillatory phenomenon – the fear of abandonment followed by the fear of engulfment (Melges and Swartz, 1989).

Additionally, the advent of women’s freedom from oppressive and stifling shackles came with the abandonment or decrease of traditional supports (e.g., financial and emotional safety nets) once deemed necessary for women’s well-being. While the lack of such supports may be no problem for most women, it may be a problem for vulnerable candidates of BPD.


The therapeutic challenges of BPD are daunting. Its mercurial expressions tax our resources as humans and can induce counter-oscillatory phenomena in the therapist (e.g., recoil or moral indignation versus over-solicitousness or an intense desire to rescue the patient).

Consequently, several approaches are needed. The clinician should consider obtaining a second opinion. It is also important to assist the patient initially with simple demythologizing explanations such as, “Your intensity takes the best out of you.” The clinician must resist accommodating the felt ineptitude of the patient (entrapment in self-defeat). Both pedagogic and didactic approaches are useful for teaching the patient temperament management skills.

Some specific psychological interventions have been found efficacious for treating BPD. These include dialectical behavior therapy (DTB), psychoanalytic psychotherapy, group psychotherapy, family therapy and supportive psychotherapy. However, randomized controlled trials are rare.

(Video) Our Narcissism-driven Dystopian Future, Shedding Civilization (Tim Arnold and Sam Vaknin Convo)

Teaching patients ways to manage their temperaments can involve Marsha M. Linehan, Ph.D.’s, dialectical behavior therapy (DBT). It incorporates behavior therapy, Zen and dialectical philosophy, and it encourages patients with BPD to accept negative affects without engaging in self-destructive or maladaptive behaviors. Behavioral techniques include skills training (e.g., distress tolerance and emotion regulation); contingency management; cognitive modification (e.g., addressing faulty beliefs); and exposure-based strategies for addressing fear, anger, guilt and shame (Robins et al., 2001).

In randomized clinical trial, patients treated with DBT compared to a treatment-as-usual (TAU) control group, had significantly fewer parasuicidal episodes, a lower treatment dropout rate and fewer psychiatric inpatient days. Those gains were retained for at least six months (Linehan et al., 1991, as cited in Linehan et al., 1993).

Recently, independent investigators compared the efficacy of DBT with TAU in a U.S. Department of Veteran’s Affairs clinic. They treated 20 women veterans diagnosed with BPD and found that the DBT-treated patients had significantly greater reductions in suicidal ideation, hopelessness, depression and anger expression compared to the TAU group (Koons, in press, as cited in Robins et al., 2001.)

Recent empirical research also supports the usefulness and cost-effectiveness of psychodynamic psychotherapy for BPD (Gabbard, 2001). For example, Bateman and Fonagy (1999) compared 19 patients with BPD who were treated with psychoanalytically oriented partial hospitalization to 10 BPD patients treated with standard psychiatric care. Patients treated with partial hospitalization for 18 months showed significant improvement on both symptomatic and clinical measures.

Because patients with BPD, by the very nature of their condition, are skittish about taking medications and often noncompliant, clinicians need to provide them with detailed explanations for all medications. Clinicians also should consider initially prescribing very small amounts of antiparaphora medications (Gk., parafora means emotional turmoil and over-intensity).

Drugs in each medication class have some potential utility and are used against specific symptoms in most patients with BPD. In a survey to determine which medications were preferred by psychiatrists for treating BPD, Silk et al. (2001) found that about half of 85 respondents would use a selective serotonin reuptake inhibitor as their first-choice medication; 20%, a mood stabilizer; 20%, a non-SSRI antidepressant; and 10% would choose an antipsychotic.

Since BPD symptoms span periodically the entire range of brain function, no single pharmacotherapy should be expected to work for all manifestations of the illness. Polypharmacy is usually necessary, and clinicians should introduce each medication separately, starting at low doses.

Because of their serotonergic-enhancing properties, SSRIs have proved efficacious in reducing some of the impulsive, aggressive and self-destructive behaviors that accompany BPD (Schatzberg, 2000). Anticonvulsants have been found useful in treating specific symptoms as well. For example, Hollander et al. (2001), in a double-blind, placebo-controlled trial, found that divalproex sodium (Depakote) was more effective than placebo for global symptomatology, level of functioning, aggression and depression in patients with BPD.

(Video) Borderline's Miracle Healing

In a double-blind study, Zanarini and Frankenburg (2001) compared the efficacy of the atypical antipsychotic olanzapine (Zyprexa) with palcebo in females with BPD. They concluded that olanzapine appeared to be safe and effective, significantly affecting all four core areas of borderline psychopathology (i.e., affect, cognition, impulsivitiy and interpersonal relationships). Weight gain was modest in the olanzapine-treated group, and no serious movement disorders were noted.

The research community could further assist clinicians by conducting studies on the particular termperament of the patient; the mismatch of temperaments between patients and same gender parent; the role of the weak or absent structure early on in life; the disorganizing over-intensity/reactivity; the role of the current zeitgeist; and the oscillatory format of the clinical expressions of the disorder.


What are the 3 criteria for a psychological disorder? ›

A psychological disorder is, broadly, a condition characterized by distressing, impairing, and/or atypical thoughts, feelings, and behaviors.

Which of the following disorders was added in the revisions that led to the DSM-5? ›

Excoriation (skin-picking) disorder is newly added to DSM-5, with strong evidence for its diagnostic validity and clinical utility. DSM-IV included a specifier “with obsessive-compulsive symptoms” in the diagnoses of anxiety disor- ders due to a general medical condition and substance-induced anxiety disorders.

What is a major criticism of the DSM-5? ›

There are two main interrelated criticisms of DSM-5: an unhealthy influence of the pharmaceutical industry on the revision process. an increasing tendency to “medicalise” patterns of behaviour and mood that are not considered to be particularly extreme.

What DSM edition did the multiaxial assessment system disappear from? ›

With the advent of the DSM-5 in 2013, the American Psychiatric Association eliminated the longstanding multiaxial system for mental disorders. The removal of the multiaxial system has implications for counselors' diagnostic practices.

What is the most serious mental illness? ›

By all accounts, serious mental illnesses include “schizophrenia-spectrum disorders,” “severe bipolar disorder,” and “severe major depression” as specifically and narrowly defined in DSM. People with those disorders comprise the bulk of those with serious mental illness.

What are the 4 D's of psychological disorders? ›

Psychologists often classify behavior as abnormal using 4 D's: deviance, distress, dysfunction, and danger. Providing a straightforward definition of abnormality is tricky because abnormality is relative, but the definition has several primary characteristics.

What disorders have been removed from the DSM? ›

Some of the conditions currently not recognized in the DSM-5 include:
  • Orthorexia.
  • Sex addiction.
  • Parental alienation syndrome.
  • Pathological demand avoidance.
  • Internet addiction.
  • Sensory processing disorder.
  • Misophonia.
11 Jul 2022

What was the biggest change to the DSM-5? ›

(DSM-5) include eliminating the multi-axial system; removing the Global Assessment of Functioning (GAF score); reorganizing the classification of the disorders; and changing how disorders that result from a general medical condition are conceptualized.

What are the newest mental disorders? ›

  • Intro. ...
  • Hypersexual Disorder. ...
  • Premenstrual Dysphoric Disorder. ...
  • Binge Eating Disorder. ...
  • Post-Traumatic Stress Disorder in Preschool Children. ...
  • Learning Disorder. ...
  • Cannabis Withdrawal. ...
  • Hoarding disorder.
30 May 2013

Why is the DSM-5 controversial? ›

The DSM-5 promotes the idea that for most psychological disorders, there is a genetic component, yet there is no known gene variant for about 97% of diagnoses. The DSM-5 also perpetuates the chemical imbalance theory, which is the idea that mental disorders are caused by an imbalance of chemicals in the brain.

How accurate is the DSM-5? ›

Classification accuracy of the DSM-5 criteria, using the DSM-IV criteria as the reference standard, resulted in sensitivity = 100 %, specificity = 98 %, and hit rate = 98 %. The cut score of four performed as well or better than a cut score of five in all samples.

Is anxiety mental health or mental illness? ›

Anxiety disorders are a type of mental health condition. Anxiety makes it difficult to get through your day. Symptoms include feelings of nervousness, panic and fear as well as sweating and a rapid heartbeat. Treatments include medications and cognitive behavioral therapy.

Why did the DSM-5 do away with multiaxial diagnosis? ›

The fifth DSM axis had long been criticized for lack of reliability and consistency amongst clinicians. It was because of that lack of reliability as well as poor clinical utility that the APA chose to remove this measure from the DSM-5.

What are Axis 3 disorders? ›

Axis III: General Medical Conditions. Axis III is for reporting current general medical conditions that are potentially rele- vant to the understanding or management of the individual's mental disorder. These conditions are classified outside the "Mental Disorders" chapter of ICD-9-CM (and outside Chapter V of ICD-10).

What axis does PTSD fall under? ›

Axis I disorders tend to be the most commonly found in the public. They include anxiety disorders, such as panic disorder, social anxiety disorder, and post-traumatic stress disorder.

What is the number 1 mental illness? ›

Depression. Impacting an estimated 300 million people, depression is the most-common mental disorder and generally affects women more often than men.

What mental disorder has the highest death rate? ›

Anorexia nervosa (AN) is a common eating disorder with the highest mortality rate of all psychiatric diseases.

What mental illness gets worse with age? ›

Personality disorders that are susceptible to worsening with age include paranoid, schizoid, schizotypal, obsessive compulsive, borderline, histrionic, narcissistic, avoidant, and dependent, said Dr. Rosowsky, a geropsychologist in Needham, Mass.

What is an example of maladaptive behavior? ›

Avoidance, withdrawal, and passive aggression are examples of maladaptive behaviors. Once you recognize this pattern in your life, you can work toward finding alternative behaviors and start putting them into practice.

How do psychologists decide what is abnormal? ›

Abnormal behavior is any behavior that deviates from what is considered normal. There are four general criteria that psychologists use to identify abnormal behavior: violation of social norms, statistical rarity, personal distress, and maladaptive behavior.

What is maladaptive behavior? ›

Maladaptive behavior is defined as behavior that interferes with an individual's activities of daily living or ability to adjust to and participate in particular settings.

Which personality disorder is the most controversial? ›

Dissociative identity disorder (DID) is the most controversial of the dissociative disorders and is disputed and debated among mental health professionals. Previously called multiple personality disorder, this is the most severe kind of dissociative disorder.

What are some rare mental disorders? ›

Rare Mental Health Conditions
  • Khyâl Cap. Khyâl cap or “wind attacks” is a syndrome found among Cambodians in the United States and Cambodia. ...
  • Kufungisisa. ...
  • Clinical Lycanthropy. ...
  • Depersonalization/Derealization Disorder. ...
  • Diogenes Syndrome. ...
  • Stendhal Syndrome. ...
  • Apotemnophilia. ...
  • Alien Hand Syndrome.
10 Jul 2020

Why was Asperger's removed from DSM V? ›

The DSM is sometimes referred to as a “living document,” meaning it changes as we learn more about various mental health issues. In this case, the research indicated that there was little consistency in the way Asperger's and PDDs were applied.

What are 5 risk factors for mental disorders? ›

Common Risk Factors
  • Family history of mental health problems.
  • Complications during pregnancy or birth.
  • Personal history of Traumatic Brain Injury.
  • Chronic medical condition such as cancer or diabetes, especially hypothyroidism or other brain-related illness such as Alzheimer's or Parkinson's.
  • Use of alcohol or drugs.

How many times has the DSM-5 been revised? ›

It has been 9 years since the 2013 edition of the DSM-5-TR. Historically, the DSM has been revised every 5 to 7 years. “This information, encapsulated in the DSM text, is continually evolving. Consequently, it is crucial for the text to be kept current based on evolving psychiatric literature.

Is the DSM-5 outdated? ›

After eleven years, the American Psychiatric Association (APA) has updated the Diagnostic and Statistical Manual of Mental Disorders (DSM).

How many mental illnesses is too many? ›

More than half of people diagnosed with one psychiatric disorder will be diagnosed with a second or third in their lifetime. About a third have four or more. This can make treatment challenging and leave patients feeling unlucky and discouraged.

Can a person have two mental disorders? ›

Is it possible to have more than one mental disorder or illness at the same time? Yes, according to the National Institute of Mental Health. The organization found, in a 12-month period, almost 50 percent of adults in the United States with any psychiatric disorder had two or more disorders.

What are three of the newest treatments for mental disorders? ›

Thanks to years of research, you now have access to several exciting new types of mental health treatments.
And while hypnotherapy has been around for a while, therapists are finding new ways to utilize it in treatment.
  1. Brainspotting. ...
  2. Neurofeedback Therapy. ...
  3. Transcranial Magnetic Stimulation (TMS) ...
  4. Hypnotherapy.

What is Multiple personality disorder now called? ›

Dissociative Identity Disorder. Dissociative identity disorder is associated with overwhelming experiences, traumatic events and/or abuse that occurred in childhood. Dissociative identity disorder was previously referred to as multiple personality disorder.

What does it mean to pathologize yourself? ›

Pathologizing happens when people treat others differently or mentally categorize someone as abnormal. Pathologization can be in reference to medical or psychological symptoms. It can also be in reference to someone's physical appearance or social standing.

What disorders are most common? ›

Of those, the three most common diagnoses are anxiety disorders, depression and post-traumatic stress disorder (PTSD). These three conditions make up around 30 percent of all diagnoses of mental illness in America.

Why is DSM criticized? ›

According to its critics, in terms of problems with categories of disorder in the DSM-5, they lack (a) the reliability and validity needed for efficacious use of diagnostic categories; (b) and, therefore, their utility to clinicians is compromised.

What is a reliable diagnosis? ›

In fact the reliability of diagnosis—the certainty with which it can be predicted that different clinicians will apply the same diagnosis to the same patient—is rarely if ever absolute in any field of medicine, and in some areas it is far lower than is assumed by the health care–using public.

What is the primary reason the DSM-5 is used to diagnose mental disorders? ›

DSM contains descriptions, symptoms and other criteria for diagnosing mental disorders. It provides a common language for clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in research on mental disorders.

What are signs of high anxiety? ›

  • Feeling nervous, restless or tense.
  • Having a sense of impending danger, panic or doom.
  • Having an increased heart rate.
  • Breathing rapidly (hyperventilation)
  • Sweating.
  • Trembling.
  • Feeling weak or tired.
  • Trouble concentrating or thinking about anything other than the present worry.

What does anxiety do to your body physically? ›

Anxiety disorders can cause rapid heart rate, palpitations, and chest pain. You may also be at an increased risk of high blood pressure and heart disease. If you already have heart disease, anxiety disorders may raise the risk of coronary events.

What chemical in the brain causes anxiety? ›

Epinephrine/Norepinephrine Norepinephrine is responsible for many of the symptoms of anxiety. These hormones and neurotransmitters are responsible for the adrenaline and energy that is pumped through your body when you're stressed or anxious, and cause changes like rapid heartbeat, sweating, etc.

Which of the following was removed from the most recent edition of the DSM? ›

The DSM-IV recurrent legal problems criterion for substance abuse has been deleted from DSM-5, and a new criterion, craving or a strong desire or urge to use a substance, has been added.

What significant change was made in the 5th edition of the DSM? ›

Changes in the DSM-5 include the reconceptualization of Asperger syndrome from a distinct disorder to an autism spectrum disorder; the elimination of subtypes of schizophrenia; the deletion of the "bereavement exclusion" for depressive disorders; the renaming of gender identity disorder to gender dysphoria; the ...

What does it mean to be Axis 2? ›

1 Axis II was reserved for long-standing conditions of clinical significance, like personality disorders and mental retardation. These disorders typically last for years, are present before adulthood, and have a significant impact on functioning.

What are the two most common disorders in the United States? ›

The National Alliance of Mental Health reports that one in five adults in America experiences a mental illness in their lifetime. Right now, nearly 10 million Americans are living with a serious mental disorder. The most common are anxiety disorders major depression and bipolar disorder.

Which type of depression is the most common type of mood disorder? ›

These are the most common types of mood disorders: Major depression. Having less interest in usual activities, feeling sad or hopeless, and other symptoms for at least 2 weeks may indicate depression. Dysthymia.

What disorders have been removed from the DSM? ›

Some of the conditions currently not recognized in the DSM-5 include:
  • Orthorexia.
  • Sex addiction.
  • Parental alienation syndrome.
  • Pathological demand avoidance.
  • Internet addiction.
  • Sensory processing disorder.
  • Misophonia.
11 Jul 2022

Do people with PTSD isolate themselves? ›

Remember: PTSD is a normal response to abnormal circumstances. It's common for people with PTSD to isolate themselves. You may feel overwhelmed or unsafe in groups, quick to anger, misunderstood, or just uninterested in being around people. However, isolation can lead to loneliness, depression, and anxiety.

What is the main symptom cluster of PTSD? ›

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions.

What is the criteria for diagnosing a psychological disorder? ›

Criterion B

DSM-IV notes that mental disorders are associated with distress, disability, or a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. It also gives an example of distress and defines disability as impairment in one or more important areas of functioning.

What is the key criterion for identifying a person as having a mental disorder? ›

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or development processes underlying mental functioning.

How do we define a psychological disorder? ›

A psychological disorder is an ongoing dysfunctional pattern of thought, emotion, and behaviour that causes significant distress and that is considered deviant in that person's culture or society. According to the bio-psycho-social model, psychological disorders have biological, psychological, and social causes.

What are the criteria for judging whether behavior is psychologically disordered? ›

Criteria for defining psychological disorders depend on whether cultural norms are violated, whether behavior is maladaptive or harmful, and whether there is distress. The medical model describes and explains psychological disorders as if they are diseases.

Can you overcome mental illness without medication? ›

In most cases, a mental illness won't get better if you try to treat it on your own without professional care. But you can do some things for yourself that will build on your treatment plan: Stick to your treatment plan. Don't skip therapy sessions.

How do you get diagnosed with borderline personality disorder? ›

Personality disorders, including borderline personality disorder, are diagnosed based on a:
  1. Detailed interview with your doctor or mental health provider.
  2. Psychological evaluation that may include completing questionnaires.
  3. Medical history and exam.
  4. Discussion of your signs and symptoms.
17 Jul 2019

What is an example of maladaptive behavior? ›

Avoidance, withdrawal, and passive aggression are examples of maladaptive behaviors. Once you recognize this pattern in your life, you can work toward finding alternative behaviors and start putting them into practice.

What is the primary symptom of delusional disorder? ›

Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions. A delusion is an unshakable belief in something that's untrue. The belief isn't a part of the person's culture or subculture, and almost everyone else knows this belief to be false.

Which is a common characteristic of all dissociative disorders? ›

Dissociative disorders are mental disorders that involve experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity. People with dissociative disorders escape reality in ways that are involuntary and unhealthy and cause problems with functioning in everyday life.

What is the difference between mental illness and mental disorder? ›

Mental illness is a health problem that affects how a person thinks, behaves and interacts with others. Mental illness is a group of illnesses that are often diagnosed through standard criteria. The term 'mental disorder' refers to the same health problems.

How do psychologists decide what is abnormal? ›

Abnormal behavior is any behavior that deviates from what is considered normal. There are four general criteria that psychologists use to identify abnormal behavior: violation of social norms, statistical rarity, personal distress, and maladaptive behavior.

What do most psychological disorders result from? ›

The exact cause of most mental disorders is not known, but research suggests that a combination of factors, including heredity, biology, psychological trauma, and environmental stress, might be involved.

How do psychiatrists diagnose mental illness? ›

Psychiatrists are medical doctors and can order or perform a variety of medical and/or psychological tests. These tests, combined with conversations about symptoms and medical and family history, allow psychiatrists to diagnose mental health conditions.

Which of the following is one of the main predictors of mental disorders? ›

In both studies, the strongest predictor of an underlying mental disorder was the presence of recent stress, followed by greater number of physical symptoms.

Why does trauma cause mental illness? ›

The long-term effects of trauma

Trauma can make you more vulnerable to developing mental health problems. It can also directly cause post-traumatic stress disorder (PTSD). Some people misuse alcohol, drugs, or self-harm to cope with difficult memories and emotions.

At what point can a deviant behavior be termed as a disorder? ›

To be considered disordered, deviant behavior usually causes the person distress. Behavior that becomes disabling to the individual, and impairs or distracts them from their normal life. When this occurs, a psychological disorder is considered.


1. Borderline vs. Narcissist Idealization Fantasies
(Prof. Sam Vaknin)
2. Narcissist-Borderline (40:07): Take My Shadow, Give Me Love
(Prof. Sam Vaknin)
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