Talk:Borderline personality disorder/Archive 7

Ambiguity in Psychology section re schema-focused therapy.
I have added an ambiguous tag to this sentence: "[...] these treatments are effective for treating BPD, except for schema-focused therapy". It is not clear whether schema-focused therapy is excepted because it wasn't studied or because it isn't very effective. Quite a difference! I cannot access the source to clarify for myself. Thanks. 92.19.234.207 (talk) 12:34, 26 June 2015 (UTC)

Criticisms of categorisation.
Why is there no 'criticism' section like with most wiki articles? Thomas Szasz has repeatedly written about the fact that this classification is not only ridiculous, but there is nothing linking these apparent 'sufferers' in the brain, physically. In short, there is a large and growing community of scientists, doctors and professionals who agree that this is not only an illogical classification, but not a 'disorder'. People are very different across the board and the reasons for symptoms are so different that it is silly to band all people with similar (and very broad) symptoms together and call what they 'have' a 'disorder'. Anyway, you all do sterling work here on wiki, I just thought you may want to have some criticisms of this, especially as 21st Century investigations seem to clearly indicate that this BPD does not 'exist' physically or mentally. Thanks very much, let me know what you think! 9:18pm 8/6/14.

It could be useful to include some criticisms, so it might be beneficial if you listed some. Szasz' views are noteworthy, but I am not sure how much they pertain to BPD in particular, rather than being conventional mental disorder categories in general. Also, much of his work pre-dates contemporary understanding of BPD (as well as numerous other conditions), so I am not sure how relevant it is to the particular subject of this article. "In short, there is a large and growing community of scientists, doctors and professionals who agree that this is not only an illogical classification, but not a 'disorder'" - Is there? I thought, due to DBT, BPD is becoming more recognized by professionals because it is seen as something treatable. I cannot offer exact figures, but could point to different recent state-funded projects rolling out DBT for BPD in the wider population. You have not even offered anecdotal evidence. "21st Century investigations seem to clearly indicate that this BPD does not 'exist' physically or mentally" - I am not sure what investigations you are referring to - the article includes an abundance of 21st C references which argue for its existence, and could/should include far more. Within the standard literature, some leading experts disagree as to the precise criteria - e.g. Paris argues for more precise criteria (for similar reasons as you give, i.e. regarding the over-generality of the DSM criteria), but he does so in order to attempt to pinpoint a more precise category. Generally I agree regarding a section on categorization etc. I believe it should include much of the disagreement among BPD specialists as to the precise demarcation. Mental health researchers can still develop effective treatments given fuzzy categories. Also, categorization in 'physical' medicine is also somewhat ad hoc, so there is not the same clear-cut distinction as some people believe. — Preceding unsigned comment added by 89.100.74.53 (talk) 23:56, 8 December 2014 (UTC)


 * The use of "Criticism" sections is discouraged by wp:Criticism. There are usually better ways to deal with it than an isolated section. LeadSongDog come howl!  17:06, 10 July 2015 (UTC)

Treatment
user:Nandinik added the following to the article, and user:Doc James moved it here for discussion

Dialectical Behavior Therapy for Borderline Personality Disorder

Dialectical behavior therapy has been shown to have positive effects in patients with borderline personality disorder (Linehan et al., 2001). Dialectical behavior therapy is a cognitive behavioral therapy that treats suicidal individuals diagnosed with borderline personality disorder (The Linehan Institute, 2014). The therapy was originally developed by clinical psychologist Marsha Linehan for the treatment of borderline personality disorder (O’RAGHALLAIGH & BLENNERHASSETT, 2014). The therapy focuses on helping patients gain a more realistic sense of self, learn adaptive skills, correct dichotomous thinking, and control their impulsive behavior (Nolan-Hoeksema, 2011). This is achieved through integrating techniques from cognitive and behavioral therapy within a theological and philosophical framework for understanding borderline pathology (O’RAGHALLAIGH & BLENNERHASSETT, 2014). Through dialect with the BDP patient, the therapist establishes a balance between change and acceptance and integrates the two fundamentals (National Alliance on Mental Illness, 2013).

References:

The Linehan Institute. 2014. What is DBT? Retrieved from http://behavioraltech.org/resources/whatisdbt.cfm

Nolen-Hoeksema, S. 2011. (ab) normal psychology'', 5th edition. p. 280.

BLENNERHASSETT, R., MB, MRCPsych, FRCPI & O’RAGHALLAIGH, W., BA, MPhil, DClinPsych. 2014. Dialectical behaviour therapy in the treatment of borderline personality disorder. Retrieved from http://bjp.rcpsych.org/content/186/4/278

Freedman, J., M.D., Duckworth, K., M.D. 2013. Dialectical Behavior Therapy. Retrieved from http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/About_Treatments_and_Supports/Dialectical_Behavior_Therapy_(DBT).htm


 * Recent reviews have been less than convincing, with poor evidence due to inconsistent study designs.
 * A 2012 Cochrane review found it was more helpful than treatment as usual, but concluded
 * Turner et al reviewed DBT for NSSI, finding that
 * Kienast et al reviewed DBT for BPD with comorbid SUD, finding that
 * Bloom et al reviewed inpatient DBT for BPD, and found that
 * Care to suggest some summary wording for an edit to the article? LeadSongDog come howl!  18:40, 10 July 2015 (UTC)

Negative emotions
IMO we should follow the sources regarding the use of adjectives to describe "emotions". Thus reverted this


 * This ref uses negative emotions

Using a consistent term makes the article easier to read than using a new adjective each time. Negative emotions have a specific meaning and they include "anxiety, depression, guilt/shame, worry, anger, etc"

Using terms like "challenging emotions" or "painful emotions" does not mean the same thing IMO. The term "negative emotions" is used both in the academic and lay press Doc James (talk · contribs · email) 06:34, 31 July 2015 (UTC)


 * Though I disagree that repeating the phrase “negative emotions” 8 times makes the article easier to read, and that in reference to "emotion/s" in the context of this particular lay article, nuance is less helpful/appropriate than repetition, since I unfortunately don’t have time to find and quote the medical sources that avoid using (or overusing) this type of terminology, I propose to at least define (for our lay readership, who are unlikely to have any specific or clinical definition in mind) “negative emotions” (as meaning “anxiety, depression, guilt/shame, worry, anger, etc” per the source, though that “etc” is unfortunately still non-specific and unelucidating, but obviously a certain amount of such vagueness/lexical clumsiness can’t be avoided at the moment) in the article. If you did happen to come across a better (i.e. exhaustive) definition of “negative emotions” as an official clinical term I would very much appreciate it (and it would help improve the quality of the article, IMO, to have a truly specific definition of the term) if you'd share it. Thanks.-- Ty rS  15:46, 31 July 2015 (UTC)
 * Agree defining the term is a good idea. I will look at what more I can find. Doc James  (talk · contribs · email) 04:22, 1 August 2015 (UTC)

Jonathon Franzen's "Purity"
The new novel "Purity" by Jonathon Franzen is about a character with BPD. — Preceding unsigned comment added by 2001:558:6040:22:2DFF:2604:B1E1:7310 (talk) 15:55, 6 October 2015 (UTC)

Grammar
Good Morning and a very Happy New Year! I hope someone can cope with the following syntactical questions: "People noted to have BPD include Jim Morrison, Amy Winehouse and Michael Jackson.[180] The painters Vincent van Gogh has retrospectively been given the condition[181] as had Edward Munch.", taken from the most recent changes on the article,see https://en.wikipedia.org/w/index.php?title=Borderline_personality_disorder&oldid=697708528. Being no native speaker of English, these words in Bold text strike me as suboptimal: Shouldn`t it be "have had" (Past Perfect, since the artists are dead) and "painter" for reasons of "concord" (grammatical cohesion)and "has" instead of "had"? Correct me if I am wrong. --A whiter shade (talk) 11:56, 1 January 2016 (UTC)
 * Yes please correct it. I agree with you. Even though I am a native speaker my grammar is bad :-) Doc James  (talk · contribs · email) 12:49, 1 January 2016 (UTC)

New Image: painting by Vincent Willem van Gogh
New Years Resolution: Hope to improve my latest edits, the picture, plus Munchs "From hell", if nobody minds. --A whiter shade (talk) 11:15, 31 December 2015 (UTC)


 * Vincent Willem van Gogh has only been associated with BPD once (by one author), and that happened in Dutch only. Others have suggested many other diagnoses for van Gogh. So I deleted the van Gogh painting.--Saidmann (talk) 19:16, 13 January 2016 (UTC)

New Image: painting by Edvard Munch


Not sure what it has to do with BPD? Doc James (talk · contribs · email) 13:30, 16 December 2015 (UTC)


 * Here the answer: The image was greeted with a warm welcome on the German sister site some months ago and has not been met by one single objection since. Young persons are the major group of those affected by the disease. Here, on the painting, they are - each on their own - sitting at the border between land and sea and looking out. Munch is known for his psychologically inclined paintings. I hope this is sufficient for an explanation. Could you please reinstall the image? You would do a service to many of those affected.--Saidmann (talk) 14:39, 17 December 2015 (UTC)


 * That is insufficient support IMO. Doc James  (talk · contribs · email) 14:40, 17 December 2015 (UTC)


 * What kind of "support" would you like to read? By the way, there is an equivalent case in Major depressive disorder. Here the painting by van Gogh has been there for a long time. How can you accept the van Gogh but reject the Munch? In both cases there is an equally indirect connection between disease and painting. But that's what paintings are all about. They are indirect, but thought provoking. To use such paintings is established practice in WP, and IMO a good practice.--Saidmann (talk) 14:52, 17 December 2015 (UTC)


 * Van Gogh was depressed and this painting is about depression. Doc James  (talk · contribs · email) 14:55, 17 December 2015 (UTC)


 * Nobody can see on the van Gogh painting that the artist was depressed. It is not even mentioned in the legend. Many painters suffered from depression. Can this be a reason to put up any of their paintings? No, the reason why the van Gogh is established in Major depressive disorder is the content of the painting. If you are still certain that you must revert the edit, I will present the issue in front of a panel of experts.--Saidmann (talk) 15:08, 17 December 2015 (UTC)


 * Yes you are more than welcome to get a third opinion. Doc James  (talk · contribs · email) 15:09, 17 December 2015 (UTC)


 * agree w/ DocJames--Ozzie10aaaa (talk) 16:17, 17 December 2015 (UTC)


 * If you can find an WP:RS specifically associating this work, or at least the period in the artist's life, with BPD, then a carefully captioned image might be ok. This is probably possible. But just adding it as it was is not ok. Johnbod (talk) 17:26, 17 December 2015 (UTC)


 * Sorry, I do not understand this. In Major depressive disorder there is nothing in the caption of the van Gogh painting that might link it to depression. Nor is there anything in the text. There is not even anything in the Vincent van Gogh article that says that the artist himself suffered from the disease. And there is no knowledge about such a connection, either. The van Gogh painting has been in Major depressive disorder for at least four years. The only relation to the subject of the article lies in the image itself, nowhere else. And this relation is an indirect one, as in almost all paintings. I see no difference whatsoever between the van Gogh case and the Munch case. The service of these paintings, as placed in the articles, lies in widening the views of the readers. I can see no negative effects.--Saidmann (talk) 18:25, 17 December 2015 (UTC)


 * WP:OTHERSTUFFEXISTS Johnbod (talk) 18:29, 17 December 2015 (UTC)


 * OK, this essay suggests that the rationale of precedential value may be valid in some contexts but not in others. Anybody can agree with that. I think it is valid here, and as yet nobody has given a reason why it might not be valid here.--Saidmann (talk) 18:39, 17 December 2015 (UTC)


 * I have previously seen Munch's The Scream used to characterize both depression and schizophrenia, so I am not surprised to see another Munch painting here.


 * I am not convinced that Youth at the Sea is a suitable representation for borderline personality disorder.


 * Incidentally, I am also not convinced that van Gogh's Sorrowing old man is a suitable representation for major depressive disorder. There is no evidence to show that the painting is intended to convey that implication. Indeed there is evidence that van Gogh had bipolar depression, not major depressive disorder. (I am aware that the article has passed FAC.) However the connection between van Gogh's painting and major depressive disorder is certainly less tenuous than that between Youth at the Sea and borderline personality disorder. Axl ¤ [Talk] 22:15, 17 December 2015 (UTC)


 * I have now followed Johnbod's suggestion to describe and reference the connection between the painting and BPD in the caption. See above. I hope that the new caption will now resolve the issue.--Saidmann (talk) 17:46, 19 December 2015 (UTC)


 * What ref supports "The painting shows a typical symptom of BPD: feeling "empty" and "lost". " Doc James  (talk · contribs · email) 17:54, 19 December 2015 (UTC)


 * Feeling "empty" and "lost" is quoted from the article. I have added a (see main text). I also replaced "shows" by "suggests".--Saidmann (talk) 18:02, 19 December 2015 (UTC)


 * The painting shows young people hanging out at the beach. Who says they are empty or lost?  Doc James  (talk · contribs · email) 18:13, 19 December 2015 (UTC)


 * Images do not speak. But they can suggest something. The young people are not only "hanging out", but they also show no signs of interaction. They all look isolated, even though close to each other. The van Gogh does not say "sorrowing" either. That may be a suggestion. The man may just be tired. But - objectively - the image has the inherent quality to possibly suggest "sorrow". Likewise the Munch has - objectively - the inherent quality to possibly suggest feelings of "empty" and "lost".--Saidmann (talk) 20:15, 19 December 2015 (UTC)


 * Sources speak about images. This source says that this old man painting is showing deep depression.  Doc James  (talk · contribs · email) 03:13, 20 December 2015 (UTC)


 * The source you referenced is a book about hair loss. The author does not reference his association. He might have picked it up in WP. It appears nowhere else in the literature.--Saidmann (talk) 12:34, 20 December 2015 (UTC)


 * A reference has now been added to the caption concerning the subject of the painting.--Saidmann (talk) 19:01, 20 December 2015 (UTC)


 * Because all issues of the discussion are now resolved in the latest version of the caption and no further issues have appeared for more than 48 hours, it would seem appropriate to apply the updated version.--Saidmann (talk) 11:38, 22 December 2015 (UTC)

Try a RfC. This is not enough "According to the art historian Nicolay Stang the painting shows the “inability to make contact with one another". It does not say it shows young people with the symptoms of borderline personality disorder. Doc James (talk · contribs · email) 18:33, 22 December 2015 (UTC)


 * The art historian was not a psychiatrist. He said what the subject of the painting was. Also, in 1972 the term BPD was not yet in use. The art historian does not diagnose people on a painting, but describes a situation of difficulties as shown on a painting, which clearly is symptomatic for BPD. This is the closest connection that can be found between a painting and a mental disorder, and it is much stronger than the one in the van Gogh case. The image is now one of the best referenced ones you can find in WP. The van Gogh is not referenced at all.--Saidmann (talk) 19:55, 22 December 2015 (UTC)
 * What a great and evocative image. I agree that it shouldn't be placed prominently on this article. I would however would support its placement in eg the "Society and culture" section, where as you state an attempted and sourced depiction of BPD would be of benefit. Another article which may benefit is something like Loneliness. --Tom (LT) (talk) 19:50, 23 December 2015 (UTC)


 * Comment. The description near the top of this discussion includes the phrase "sitting at the border between land and sea". I can't tell if this is relevant while I don't understand why the condition is so named. If I heard someone say "Steve has borderline personality disorder", I would until today have thought they meant "Steve almost has a personality disorder, maybe, not quite". The article does not give any explanation for the name, but says "There is an ongoing debate about the terminology of this disorder, especially the suitability of the word 'borderline'"; and gives two references: the first is not currently accessible, and the second does not, as far as I can find, discuss the nomenclature. If I ever learn why the word "borderline" is in the name, I may feel qualified to !vote here. Maproom (talk) 09:42, 24 December 2015 (UTC)


 * The answer is in the history section. The original idea of Hughes (1884) was that there were symptons falling on a borderline between sanity and insanity. In the definitions of recent decades the term - and thus the old idea - was kept, despite modern diagnostic criteria.--Saidmann (talk) 14:50, 24 December 2015 (UTC)
 * Thank you for the explanation. I didn't see it in the History section (which I did not think an obvious place to look for it). In my view, now, the picture should be omitted, as the "border" allusion is spurious. Maproom (talk) 23:35, 24 December 2015 (UTC)

Sure I could see putting it in the history or society and culture section. Doc James (talk · contribs · email) 23:12, 24 December 2015 (UTC)
 * First, I agree that the painting makes a very powerful impression. — Preceding unsigned comment added by A whiter shade (talk • contribs) 00:29, 30 December 2015 (UTC) But I also feel its place would rather illustrate Loneliness, as Tom (LT) suggested. It might be an interseting idea to include a subcategory like https://en.wikipedia.org/wiki/Category:People_with_borderline_personality_disorder or a reference to it. The best picture for this purpose is actually not one by Munch (who, surprisingly, is not on the list), but by Van Gogh: His famous Self-Portrait with his bandaged ear: https://en.wikipedia.org/wiki/Vincent_van_Gogh's_health#/media/File:Vincent_Willem_van_Gogh_106.jpg. which is an alternative to this:  https://de.wikipedia.org/wiki/Selbstverletzendes_Verhalten#/media/File:Auto-Mutilation.JPG. In any case, I would very much appreciate some illustration. Have some nice last days in  2015! --A whiter shade (talk) 01:23, 30 December 2015 (UTC)


 * I agree with Tom (LT) that "inability to make contact with one another" is a symptom of further disorders, as well. So it may not be specific enough here, and a painting showing this trait may not be the best choice. Therefore I took a very specific trait of BPD - idealization and devaluation of others in personal relations - and selected paintings by Munch that have been associated with just this BPD trait in the professional literature. I assume that this solution will be widely considered appropriate for the opening section of the article. Thanks to all for the discussion leading to this outcome.--Saidmann (talk) 18:27, 13 January 2016 (UTC)

Study implication is not warranted
The cited study cannot imply anything about the usefulness of family members information on BPD as long as the opposite causality is reasonable to assume - or at least this limitation needs to be explicitly stated; citing from the study:

"These data are cross-sectional and we are unable to determine direction of effect from our correlations. We are, therefore, unable to know whether more knowledge leads to poorer emotional well-being or whether family members who are more depressed, distressed, and burdened are those that feel most motivated to learn what they can about the illness." — Preceding unsigned comment added by 133.1.239.222 (talk) 04:41, 19 May 2016 (UTC)

Therapy or psychotherapy
I changed therapy to psychotherapy. Seemed sensible. Was reverted. Have not reverted again. Let's get this consistent across articles. My logic is that linking to the therapy article, is too broad for readers. I see that it is simpler, but in this case it may be more beneficial to readers. Psychotherapy is very commonly understood worldwide. Can you outline your reasoning please Doc James and I will apply this consistently in future to other related articles.Charlotte135 (talk) 00:33, 20 May 2016 (UTC)
 * I changed it so that therapy links to psychotherapy. Psychotherapy is often simply referred to as therapy. Doc James  (talk · contribs · email) 00:41, 20 May 2016 (UTC)
 * Okay, I'll go with that. I changed it from therapy to psychotherapy at the DBT article too. Can you please make that link there as well and I'll revert back to therapy. Thanks.Charlotte135 (talk) 00:47, 20 May 2016 (UTC)
 * Done  Doc James  (talk · contribs · email) 00:52, 20 May 2016 (UTC)

This entry comprises several errors: the least significant is its misspelling at the beginning of "affects" (external manifestations of mood); the error is their spelling of this term "effects."

The entry's content is biased in its selection of literature; it omits the body of evidence supporting the current consensus view among psychiatrists that blp is a forme fruste of bipolar disorder. When they mention this, they do so dismissively, citing one short essay expressing their point of view that was published almost eight years ago (their reference 101, J.Paris the sole author). They do not discuss the more recent evidence that prompted the current consensus view I mention (consisting of the many studies by Hagop Akiskal and colleagues, documenting symptomatic overlap with bipolar disorder, co-inheritance with the latter, and responsiveness to mood-stabilizers that are treatments of first resort in bipolar disorder.

The medications the authors discuss misrepresent those that are the currently recommended ones. They cite first-generation antipsychotic and antidepressant agents that are rarely used today (such as tricyclic antidepressants and (as a mood stabilizer "from above," the butyrophenone haloperidol, and omit the body of evidence of the last decade documenting efficacy of better tolerated second-generation agents (with the sole exception of olanzapine).

Their definition of "splitting" is wrong. They define it as a "black and white" mode of thinking, rather than the correct definition (pertaining to imparting different information to different staff that evokes different and opposing interpretations of something done or said. As such, splitting is a dysfunctional behavior promoting discordance within and reduced morale in staff attempting to enforce limits and affect patients' behaviors with consistently imposed reinforcements.

They use the "mood cycling" and "mood swing" in a way that suggests that they are equivalent in the contexts of bipolar disorder and blp. What they in fact describe apropos of the latter is mood instability. Their assertion that mood states in rapid-cycling "usually" occur with druations of "days" rather than briefer durations in rapid cyclers and use that as a principal way of distinguishing blp from bipolar disorder. In fact, the mood instability of blp and the mood states of bipolar disorder are not the same and the authors' comparison is invalid.

this entry about blp is doubtless intended to further an agendum and does not scruple to misinform and mislead as it does so. 72.86.38.73 (talk) 19:13, 1 July 2016 (UTC)

Cleanup of symptoms
The current description of symptoms doesn't bear much resemblance to what's in the DSM-V (it bears slightly more resemblance to the DSM-IV, but there have been significant updates). I'm no expert, but my understanding of the disorder after a few hours of research is very different from the one I got from reading the symptoms described here, to the point where I would say that this article is seriously misleading as-is.

Some symptoms are over-emphasized, and some of them require more description to convey what the psychology community actually intends. Overall, it seems to be biased towards the "classic" BPD, largely ignoring the "Quiet" version.

Some examples of issues:


 * Points 1, 8, and 9 are all describing a single diagnostic criterion in DSM-V, "Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress." This over-emphasizes this point, and also doesn't do a good job explaining what it means.  The self-criticism aspect is important, since powerful emotions a core aspect driving the identity problems.
 * Point 2: Fears of abandonment are actually optional. The "Quiet" version often closes off all relationships.  Considering that we're still at the second point, I feel the article is over-emphasizing the fears of abandonment.  DSM-V also does not use the word "frantic" or anything like it.
 * Point 3 is apparently just wrong; I see nothing about splitting or anything like it in DSM-V
 * Point 4: but the DSM-V does not use the word "severe" or anything like it. As far as I can tell, in "Quiet" borderlines, impulsivity really only happens during episodes of extreme emotion.
 * Point 10: Depressivity, anxiousness, and anger/rage are each mentioned separately in the DSM-V. Substance abuse is not mentioned at all.  In each case, the DSM-V does a lot more to explain what is actually meant by these terms.  — Preceding unsigned comment added by 31.73.66.81 (talk) 19:44, 11 September 2016 (UTC)

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Coping measures?
Should some of the information from below, such as the 'best person' coping mechanism, be added to the article? http://everydayfeminism.com/2016/09/support-friend-with-borderline/ — Preceding unsigned comment added by 12.132.115.249 (talk) 22:02, 11 November 2016 (UTC)

Awkward leading in the lede
The first sentence of the lede opens the article with this rather awkward sentence: "Borderline personality disorder (BPD), also known as emotionally unstable personality disorder, is a long-term pattern of abnormal behavior characterized by unstable relationships with other people, unstable sense of self, and unstable emotions."

Does anyone else find the fourfold repetition of "unstable" verbose? Joshualouie711 (talk) 20:33, 14 November 2016 (UTC)

Source
Below is a good article found in the January 1, 2012 issue of Scientific American. It discusses some of the misconceptions - and misdiagnoses - of BPD:

SOURCE: https://www.scientificamerican.com/article/the-truth-about-borderline/   — Preceding unsigned comment added by 2602:30A:2E13:B930:7C99:5F35:21CF:522F (talk) 01:26, 18 November 2016 (UTC)

Clarify
"Some mental health professionals tend to use drugs to treat BPD, however there is no definitive studies that show that medication is an effective treatment. Treatment for BPD is the most important part of a patients life, because the wrong treatment could be dangerous to not just the patient, but to others around them as well. Medications are recommended only when treating for a crisis, but once the crisis is over it is important to get the patient off the medication immediately. Reasons for this is tied to the fact that a medication that treats depression could set a person with BPD off in a fit of blind rage, while medications that sedate a patient could cause a state of depression that would cause the patient to commit suicide. Also, due to the risky behavior and instability of the patient, medications have a higher risk of addiction and overdose. "

Which ref supports this? And why in the diagnosis section?

-- Doc James  (talk · contribs · email) 18:46, 28 November 2016 (UTC)

DUBIOUS == "Reduced capacity for empathy" under signs and symptoms is simplistic and inaccurate ==

"Reduced capacity for empathy" does not differentiate between cognitive and affective empathy, nor does it take into account empirically higher rates of social-emotional cognition in people with BPD. References: https://www.ncbi.nlm.nih.gov/pubmed/20045198 https://www.ncbi.nlm.nih.gov/pubmed/23514182 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427787/

Dubious: "Reduced capacity for empathy" in Signs and Symptoms
"A dysfunctional pattern of cognitive empathic capacity" or "Reduced capacity for cognitive empathy" (understanding the perspective of another person) would more accurately describe this Sign and Symptom. People with BPD are average to above average at emotional empathy (literally feeling what another person feels). https://www.ncbi.nlm.nih.gov/pubmed/20045198

The article cited for "Reduced capacity for empathy," Nauert, Rick. "Low empathy associated with borderline personality disorder". Psych Central, was NOT a study of people diagnosed with BPD. "For the study, Haas recruited over 80 participants and asked them to take a questionnaire, called the Five Factor Borderline Inventory, to determine the degree to which they had various traits associated with borderline personality disorder." http://psychcentral.com/news/2015/08/31/low-empathy-associated-with-borderline-personality/91612.html

Furthermore, there is evidence that people with BPD demonstrate empathic enhancement in aspects of social-emotional cognition: https://www.ncbi.nlm.nih.gov/pubmed/23514182.

Borderlines score higher on RMET tests: "The BPD group performed significantly better than the HC group on the RMET, particularly for the Total Score and Neutral emotional valences." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427787/ — Preceding unsigned comment added by Handfriend (talk • contribs) 02:07, 2 January 2017 (UTC)

Self harm image
Is it really justified to show a picture of self harm to symbolize BPD? Since the photo is on top of the page, it appears as if it was some kind of summary or universal symnbol of borderline. But actually, self harm is a maladaptive behavior which can be displayed in a lot of clinically significiant conditions. One does not have to self harm to be diagnosed borderline. So why this picture? I would rather understand if there was a picture of a famous person with this diagnosis (if there are any confirmed diagnoses). Or maybe there just shouldn't be a picture. Borderline is a complex and abstract term, it cannot be depicted in an image. If at all, I would prefer the image somewhere further down in the article next to a description of possible symptoms or so.

— Preceding unsigned comment added by 92.75.41.140 (talk) 17:55, 17 July 2016 (UTC)
 * Do you have another suggestion? I'd prefer something else as well. —PermStrump  ( talk )  00:41, 18 July 2016 (UTC)
 * There is a ref to support its use. "Recurring suicidal behaviors or threats or self-harming behavior, such as cutting"
 * Happy to hear other suggestions. Doc James  (talk · contribs · email) 01:49, 18 July 2016 (UTC)
 * Having an image of self-harm is actually going to be triggering for people with the BPD diagnosis and can be quite distressing. As it will commonly be the first place someone wanting to find out more about the disorder I would suggest replacing it with something more positive or removing it altogether. Matt Baker   —Preceding undated comment added 08:45, 18 July 2016 (UTC)
 * User:Never147 what do you suggest?
 * I have moved the image to the body of the text. Doc James  (talk · contribs · email) 20:42, 19 July 2016 (UTC)
 * The image should just be removed, it doesn't need a replacement. The self-harm picture does not need to be there. Second the 'it will commonly be the first place someone wanting to find out more about the disorder' and why as a result, this image is inappropriate. It adds no informational value to the subject of the article. Postbagboy (talk) 00:50, 28 July 2016 (UTC)
 * Personally, I don't think it needs a replacement. I only suggested because it was the lead image at the time and from past experience, it seems like the only way to get consensus about removing a bad lead image is to replace it with something better. But after Doc James moved it to the body, no one complained that there wasn't a lead image, so I guess I was wrong. My preference for this article is to keep it without a lead image and for the cutting image to be gone completely (i.e., the current state of things). —PermStrump  ( talk )  04:15, 28 July 2016 (UTC)
 * There is no reason to remove this image, it is very tame in comparison to some possible alternatives while illustrating the point accurately. The movement to being further down the page is ideal, since the page content serves sufficiently as a "trigger warning" Tianmang (talk) 22:09, 31 October 2016 (UTC)

It is one of the most commons signs of the condition in question. We often use images to illustrate conditions. Doc James (talk · contribs · email) 10:28, 28 July 2016 (UTC)
 * I'm with the other editors here that the cutting image should be removed entirely and not replaced. The article refers to self-damaging behaviour, which includes but is not limited to self-harm, so the cutting image is undue. Even if the article linked directly to self-harm, the self-harm article already includes an image of cutting so the cutting image is not needed in this article. Also, the argument that images are often used to illustrate conditions so this image should be included in this article doesn't hold water: images are not required and there are valid objections to including this particular image. For these reasons together with the ones discussed above, the image should be removed. Ca2james (talk) 17:32, 28 July 2016 (UTC)

Ref says "Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts."

In fact it is such a common part of the condition that it is part of the diagnostic criteria in the DSM5. This web site states "Many people with borderline disorder engage in self-injurious behaviors such as cutting, burning and small drug overdoses. Cutting is by far the most common act of this type of behavior."

And than we have this ref that says "Up to 70 % of patients with borderline personality disorders have reported non-suicidal self-harm."

This is one of the most common signs and symptoms of BPD so it is definitely due. Not only do the references support this position but also so does the experience of anyone who works with this patient group. Doc James (talk · contribs · email) 22:35, 28 July 2016 (UTC)
 * The article doesn't even mention cutting in the self-harm section. Even if it did, your sources show that cutting is just one self-harm behaviour, which in turn is just one of the signs and symptoms of BPD. Since cutting is a type of self-harm, it makes sense that a discussion and image of cutting belongs in the self-harm article, which is where it is. Moreover, there are only three images in the whole article. Unless images can be added to each section so that the reader doesn't think BPD is all about cutting (the article wouldn't be nearly so long if that were the case), the cutting image places undue prominence on this one behaviour subtype of self-harm in this one section.


 * I don't know why you're bringing up "the experience of anyone who works with this patient group" because unless you're talking about the papers they're writing, their personal experience is not a RS and so is not relevant here. Several editors have objected to the image, it isn't required to explain BPD (especially since a similar image is included in the self-harm article), and it's undue. I don't understand why you're arguing to keep it in. Ca2james (talk) 00:54, 29 July 2016 (UTC)
 * Add "cutting" to the text as it is the most common form of self harm. Yes images in psychology and psychiatry are exceedingly controversial on En Wikipedia, I realize that. We are an educational resource; however so hiding content that is relevant is not really what we do. Doc James  (talk · contribs · email) 07:13, 30 July 2016 (UTC)

I'm going to forego any discussion of censorship here because this image doesn't have to be here (like the issue at self-harm would be), the discussion here is if it is due. To figure this out I think we need to ask ourselves a few questions concerning the purpose of the image. If this image intends to help educate people about the condition in needs to fulfill these criteria: My answers to these questions are: I prefer this image: Even better may be an image of healed scars, this would possible be less upsetting and at least in my mind less likely to promote the practice. Carl Fredrik  💌 📧 11:31, 30 July 2016 (UTC)
 * 1) It is representative of the condition
 * 2) It is sufficiently related
 * 3) It does more good than harm
 * No, it is a pretty extreme case, we could assuredly find an image of lesser self-harm. Even the images on self-harm are of less severe cases.
 * Yes, this is very common among borderline personality disorder.
 * 1) This is the most difficult question here, because when it comes to EIPD/borderline there is a real risk that these images increase the amount of self-harm that occurs among readers. While I agree with Doc James that it is important to be aware of these behaviors — there may be other ways to promote such awareness — and I absolutely think we should include cutting in the text.
 * The new image in various stages of healing is I agree better. Doc James  (talk · contribs · email) 13:34, 30 July 2016 (UTC)
 * The SHCutsShoulder.jpg image and the one recently added to the article are both better than the original image, and I agree that adding cutting to the text is good. However, there's still the issue of a cutting image being one of only three images in the article, which is another way this image is undue for this article. Adding more images to the article would help; for example, is there an image of typical brain abnormalities in people with BPD that could be added to the Brain Abnormalities section? Are there any other ways to reduce the weight of the cutting image in the article? If not, then the image should be removed. Ca2james (talk) 15:49, 30 July 2016 (UTC)
 * That is not how Wikipedia works. One does not remove something that is appropriately in the article just because the rest of the article is not balanced.
 * The cause of BPD is unclear BTW. Doc James  (talk · contribs · email) 06:58, 31 July 2016 (UTC)
 * One does if the something is undue (which means it is not appropriately in the article): one either tries to rebalance the things related to something or one removes it. I'm well aware that the cause of BPD is unclear, but I don't see what that fact had to do with the images in the article. Ca2james (talk) 14:07, 31 July 2016 (UTC)

With respect to the argument that images can trigger people with BPD. 1) I have not seen any evidence 2) are we going to remove images from cannabis, cocaine, heroin, cigarettes, and alcohol as they might trigger those with drug use disorder? Doc James (talk · contribs · email) 02:41, 2 August 2016 (UTC)
 * From my perspective, the triggering nature of a cutting photo isn't as compelling an argument against inclusion of such an image as the coatrack and weight arguments, along with the argument that images are not required. In each of the provided examples, the image is of the subject of the article which is not the same context as the cutting image in this article and so are not good comparisons to this article. A better comparison from a triggering perspective (staying with alcohol/drugs) would be to look at the drug addiction or alcoholism articles and to check whether images of drugs or alcohol ere included in those articles. They are not: there are no images of drugs and/or alcohol in either of these articles, which strengthens the argument against having the cutting image in this article. Ca2james (talk) 16:29, 2 August 2016 (UTC)
 * There has been good points made here, including Doc James point, however no consensus seems to have been reached. I do agree with the undue weight argument made. Skin cutting as a form of self injury, seems not to meet our criteria on due weight. Could Doc James possibly clarify where this discussion currently stands please.Charlotte135 (talk) 03:04, 6 September 2016 (UTC)
 * Clarify in what way? Doc James  (talk · contribs · email) 10:26, 6 September 2016 (UTC)

I'd like to quickly refer to a recent conversation (also here) on this topic. I don't have the time right now to do anything more than make some connections. Will ping others who have been involved in this discussion, as it seems unresolved:  Airplaneman   ✈  22:57, 5 December 2016 (UTC)
 * Okay. This is a classic sign of this condition. We do not censor educational medical content. If an image of the condition triggered people than those who have this sign would be triggered when they looked at themselves either directly or in a mirror. Do people have actual evidence? I am happy with the other two examples suggested here. Doc James  (talk · contribs · email) 23:15, 5 December 2016 (UTC)
 * Some mental health problems result in physical findings. Should we not have a picture of enamel degradation in bulimia? We are an encyclopaedia. Our job is not to fall into the position of much of the rest of society that simply tries to sweep mental illness under the carpet (or depict it like in drug ads). If people do not want to read about or see depictions of difficult problems they should not look them up. We should not be censoring information for those who do want to know about the condition. This classic image could help family members diagnose and therefore get help for their loved ones. BPD is not an easy diagnosis. Doc James  (talk · contribs · email) 07:35, 16 December 2016 (UTC)
 * I get the strongest impression that Doc James is pushing a political agenda. This image does not add to anyone's understanding of BPD.  We don't even know if the subject of the photo has BPD.  This photo belongs on a different page, perhaps one about self harm.  While it does not add anything to this article to include this image, there are very real reasons not to include it that certain editors are dismissing out of hand. 135.23.124.93 (talk) 16:50, 1 March 2017 (UTC)
 * As someone who has treated many people with BPD I can say that this is fairly typical. Doc James  (talk · contribs · email) 01:33, 2 March 2017 (UTC)

New source
Hello,

There is a cochrane review on psychological therapies for people with borderline PD. It concludes that psychotherapies are beneficial. This citation could be added as an additional supplement to the section on treatment.

best, Jogunk07 (talk)Jogunk07 00:30, 6 April 2017 (UTC)