Diagnostics | Borderline syndrome

Diagnostics

Every diagnosis (and so is the diagnosis) borderline that is made in this country must be “encrypted”, if you want to do it professionally and not just from the gut. This means that there are systems in which all diseases known to medicine are more or less well recorded. So a doctor cannot simply go and distribute diagnoses until certain criteria are met that the encryption system requires.

If the criteria are not met, the diagnosis borderline cannot be made. In psychiatry in Germany we work with two systems. One is the so-called ICD – 10 System (International Classification of Diseases, according to WHO).

This is the standard system for coding and diagnosis in hospitals. This system is required by the funding agencies (the health insurance companies). Critics sometimes regard the ICD – 10 as too imprecise in the description of diseases such as borderline.

The research uses the DSM – IV system (Diagnostic and Statistical Manual of Mental Disorders) which comes from the American area. Here the descriptions of the symptoms of the disease are often actually more accurate. To be able to make a diagnosis, precisely defined criteria must be met.

Diagnostic criteria of emotionally unstable personality disorder according to ICD – 10 – criteria: A.) To be able to make a diagnosis of a borderline disorder, at least 3 of the following characteristics or behaviours must be present: B.) In addition to the borderline diagnosis, at least two of the following characteristics and behaviours must be present:

• Clear tendency to act unexpectedly and without consideration of the consequences.
• Clear tendency to quarrel and conflict with others, especially when impulsive actions are suppressed or reprimanded. – Tendency to outbursts of anger and violence with inability to control explosive behaviour. – Difficulty in maintaining actions that are not immediately rewarded.
• Unsettled and unpredictable mood. – Disturbances and insecurity regarding self-image, goals and “inner preferences”. – Tendency to get involved in intense but unstable relationships, often with the consequence of emotional crises.
• Excessive efforts to avoid being abandoned. – Repeated threats or actions that harm the self. – Persistent feeling of emptiness

The diagnostic criteria according to DSM-IV for a borderline personality disorder: In order to make a diagnosis of a borderline personality disorder, at least 5 of the following characteristics or behaviours must be present:

• Desperate effort to avoid being alone, real or imagined.

A pattern of unstable and interpersonal relationships characterised by a shift between extreme idealisation and devaluation

• Identity disorder: a pronounced and persistent instability of the self-image or feeling for oneself
• Impulsiveness in at least two potentially self-damaging areas (e.g. spending money, substance abuse, reckless driving, binge eating)
• Recurrent threats of suicide, suicide impulses or attempts or self-harming behaviour. – Affective instability characterised by a pronounced orientation towards the current mood: e.g. severe episodic depression, irritability or anxiety. – Chronic feeling of emptiness.
• Inappropriate, intense anger or difficulty in controlling anger or resentment (e.g., frequent outbursts of anger, ongoing anger, repeated fights. – Temporary, stress-related paranoid delusions or severe dissociative symptoms.