The association between borderline personality disorder, FM and CFS: systematic review

[user9876]

One of the studies (Kempke et al.) explicitly mentioned that the Personality Diagnostic Questionnaire has consistently shown to overestimate the prevalence. personality disorder. This questionnaire was used in the Johnson study mentioned above, along with the Calvo study - note "Carvo" in the article above was a typo!

As well as general concerns with the questionnaires I wonder if there are additional issues when people have other diseases as the questions are designed for healthy people.

 

[taniaaust1]

Borderline personality patients are the the most dreaded of psych patients. CFS/FMS patients are the most dreaded of medical patients. Thus you see the obvious connection.

this is so true. I have a wrong BPD diagnoses put onto me after a dr sent me to psych after psych after psych.. determined to have me diagnosed me with some kind of mental health disorder (this was a dr who didnt believe in the existence of ME/CFS). When this first didnt work, he just sent me to another and then another

but anyway.. after being suicidal over major ME issues and then going to hospital due to feeling like that and then being put into a psych ward. I actually heard the nurses behind the nurses stations being completely ridiculous over my BPD diagnoses in the file. They were actually being very dramatic and saying things like 'dont upset her, she may throw a cup of coffee over you or something". This was all over my BPD diagnoses. It was quite disturbing the possible stuff they were placing onto me due to this diagnoses.

At other times Ive been given such a hard time over having this diagnoses. How one is treated if one has this diagnoses is even worst then many drs treat CFS patients

 

[taniaaust1]

The only common symptom I can see that is found in both borderline personality disorder and ME/CFS is emotional lability (also called emotional instability, or the pseudobulbar affect).

So given this dissimilarity (ie, that there are so few symptoms in common), you probably would not expect to find much comorbidity between BPS and ME/CFS.

Here are the symptoms of BPD:


Specific Symptoms of Borderline Personality Disorder
A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:

• Frantic efforts to avoid real or imagined abandonment
• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
• Identity disturbance, such as a significant and persistent unstable self-image or sense of self
• Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
• Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, oranxiety usually lasting a few hours and only rarely more than a few days)
• Chronic feelings of emptiness
• Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
• Transient, stress-related paranoid thoughts or severe dissociative symptoms

I think may of slightly changed the diagnostic criteria since I was given a wrong diagnoses of this. I may be wrong but I thought was previously - fear of abandonment being part of the diagnostic criteria.

In fact many of the questions they ask a ME person and the answers a ME person may give.. may end up leading to a BPD diagnoses not just on the grounds of emotional instability being in both illnesses.

eg I got asked "Do you feel abandoned?" and as I dont have much support for severe ME I said yes to this. I have been abandoned by some family members. So that got me a tick on their diagnostic criteria checklist for BPD

I was seeing that psych due to trying to suicide (around the ME issues).. so that got me another tick on their diagnostic criteria for BPD checklist (cause I'd tried to suicide more then once)

I had emotional instability due to my other health issues including I do when I eat wrongly and get negatively affected by foods or if Im very crashed with my ME i get emotional instability too.. so that gave me another tick on their BPD checklist.

as ME had taken so much away from me and I feel like Ive lost the person I was (of cause like most of us I had to leave my job, had to leave my studies and so much else). They probably gave me a tick in the BPD indentity crisis area too.

I had gone impulsive when I became suicidal.. so did do once do some reckless driving while wishing I was dead and not then caring if I lived or died. So I also got a tick in that area. (Im usually not at all impulsive though unless Im having a major emotional crisis at the time and hence had had a emotional breakdown.. but anyway, they gave me a tick for that area too). oh I was impulsive if I ate wrong and caused a mood swing due to an hyperinsulinemia spike but they didnt care that it was caused by other medical conditon.

They asked about my relationships with family.. something which I gave some negative responses too just to how some of my family have been around the ME.. so I suppose they also give me a tick for interpersonal relationship issues.

"Inappropriate, intense anger "

and a ME patient storming out of a drs surgery after being told to just push harder and exercise. You could score point towards BPD diagnostic criteria as a psych view that response as being unreasonable so now you get put down as having inappropiate anger.. another point towards getting a BPD diagnoses then.

We see a lot of anger among the ME community over the ME/CFS situation in which many who do not understand this, will view as emotionally inappropriate.

In the previous diagnostic stuff, they used to look for black and white thinking and I do have that (but I had that due to Aspergers which they had missed at the time).

So in my case I ended up with a wrong BPD diagnoses due to the questions they asked and my replies,

they didnt care if the abandonment thing was true. They didnt care that one was really in true need of family support etc. They didnt consider if the person was going through anything else major which could lead to a person feeling or being suicidal. I personally believe that a high number of "severe" ME patients feel suicial at times and I guess many have tried to suicide at some point with severe ME due too too much pain or the situation of being completely housebound or bedridden.

i personally that many with ME who do not have BPD at all may be ending up with this diagnoses added to the list of diagnoses they have.

 

[Sidereal]

It's very dangerous to get a diagnosis of BPD on your medical records. All medical providers will tend to treat you as toxic waste from then on.

 

[Invisible Woman]

That's the problem with many of these diagnosis. People (especially psychobabblers) see what they want to see - and as the saying goes: "just 'cause you're paranoid, it doesn't mean someone's not out to get you".

It undermines any trust between patient and doctors, in which case: what's the point?

 

[JamBob]

"Inappropriate, intense anger "

and a ME patient storming out of a drs surgery after being told to just push harder and exercise. You could score point towards BPD diagnostic criteria as a psych view that response as being unreasonable so now you get put down as having inappropiate anger.. another point towards getting a BPD diagnoses then.

We see a lot of anger among the ME community over the ME/CFS situation in which many who do not understand this, will view as emotionally inappropriate.

There is still a lot of misogyny in medicine as there is in society. Women aren't allowed to display anger - if they do - they are pathologised as Borderline or neurotic.

Also some of the behaviour for the impulsivity factor (reckless driving, promiscuity) is seen as normal for men yet women are apparently pathologised for these behaviours.

 

[worldbackwards]

It undermines any trust between patient and doctors, in which case: what's the point?

In the case of this study, presumably the point is to justify that trust between patients and doctors will inevitably break down under the current treatment regime. Line of thought - it must be someone's fault; it can't be ours; how can we make it theirs?

 

[Snowdrop]

What I find so often seems to be lacking is Context. People do things within a specific frame of reference. Medical people don't even see the person--they see theories and act based on a huge set of assumptions. And they tend not to consider (even briefly) alternative explanations.

The hammer and nail metaphor.

Someone becomes enamoured of studying a particular aspect of human behaviour and everything is viewed through that particular frame of reference. Never mind assessing it's relevance. This kind of study suffers from a little knowledge is a dangerous thing. There is such a huge gap between what is known and what is not that there's a temptation to fill in with way too much wild speculation and call it a reasonable hypothesis.

This area of study would do with a reality check from people outside the group.

Also, a far as psych questionnaires go--they should just call them what they are (I suppose there are exceptions):
trolling polls, or trawling polls. No different from the type you get over the phone where they mold the questions to elicit responses that drive you toward a particular conclusion.

 

[Invisible Woman]

they mold the questions to elicit responses that drive you toward a particular conclusion.

That's exactly what they do.

At an appointment years ago I ended up having a huge argument with a consultant. He arrived late for the appointment and then shoved a questionnaire at me. It was full of ambiguous questions. Just one example: Do you still enjoy previous activities and hobbies? I queried what this meant - a) are you still able to do them, but don't enjoy them or, b) you are unable to do them so can no longer enjoy them, or c) you just don't want to do them anymore?

I explained to him that I still wanted to do them but was physically unable to do most of 'em (swimming, horse-riding, long walks, etc) and hoped that I would soon be able to do them again (I was young and naive). He then told me that I should tick the No box.

Then he informed me that as I had ticked No to this and because of my (guided) answers to other questions this was indicative of depression!

To this day I flatly refuse to fill in questionnaires. The whole thing was an exercise to make my diagnosis fit his bias.

 

[Woolie]

I've only just caught up with this.

As people have pointed out, there was no evidence for a link between CFS and BPD. I'm surprised by this, not because I think there's a link, but because some of the studies were so weak that they'd be hugely vulnerable to finding a false positive (an association between BPD and CFS where there is none). But still they didn't.

What is most amazing about this study, is they didn't even have a good reason for predicting an assocation in the first place. Some mutterings about how both conditions are more prevalent in females, and how "childhood trauma" is involved in both (although there is no persuasive evidence for a role of childhood trauma in CFS, and its really hard to measure it in BPD too, since the condition itself may influence reporting tendencies).

Its not okay to find nothing and then to say this:

Until more evidence is presented to either support or refute possible associations between the disorders of interest, the authors will continue to maintain an index of clinical suspicion for conditions such as fibromyalgia and CFS in patients with BPD as part of a thorough psychiatric assessment.

Your own evidence indicates that you should not be wasting your valuable clinical time. Why the hell did you do the study if you've already made up your mind and are not going to change it anyway?

 

[Woolie]

PS and yes, @user9876 is right, most self report scales have not been validated on medical populations. For example, most depression and anxiety scales include "physiological" or "somatic" items (e.g., sleep disturbance, tiredness) that make them inappropriate for use with chronic illness populations. In these populations, such scales tend to overestimtate the incidence of disorder.

I don't know these particular self-report scales though.

 

[wastwater]

Side effects of interleukin 2 sound a lot like borderline between depression and psychosis

 

[valentinelynx]

So in my case I ended up with a wrong BPD diagnoses due to the questions they asked and my replies,

they didnt care if the abandonment thing was true. They didnt care that one was really in true need of family support etc. They didnt consider if the person was going through anything else major which could lead to a person feeling or being suicidal. I personally believe that a high number of "severe" ME patients feel suicial at times and I guess many have tried to suicide at some point with severe ME due too too much pain or the situation of being completely housebound or bedridden.

i personally that many with ME who do not have BPD at all may be ending up with this diagnoses added to the list of diagnoses they have.

In making any diagnosis of a personality disorder, one should note whether the symptoms are of recent onset, because a personality disorder by definition, is a lifelong problem!

 

[taniaaust1]

In making any diagnosis of a personality disorder, one should note whether the symptoms are of recent onset, because a personality disorder by definition, is a lifelong problem!

exactly! and that is one of the things which peeved me off about this wrong diagnoses, I didnt have those symptoms they judged me on when i was younger. My mood swing symptoms only came on when I was late 30s. Symptoms from personality disorders are supposed to be there since teens.

 

[wastwater]

Personality disorder is a common misdiagnosis on the way to an autism diagnosis
As a side note does excessive IL 2 pickle the thyroid is that why so many have thyroid problems without antibodies and it must take a lot of IL-2 to make one truly hypothyroid

 

[Barry53]

The only association I've seen so far between a personality disorder and ME, is that most of the psychiatrists on the ME case seem to have one!

 

[me/cfs 27931]

I consider a diagnosis of BPS to imply that psychiatrists have given up on you responding to any of their "treatments". They've tried everything in their toolkit and you've only gotten worse.

Rather than consider the patient might have an organic illness needing medical treatment, it's easier to just slap on a "Borderline Personality Disorder" + "Treatment Resistant Depression" diagnosis and deny them any further help.

Or maybe I'm unique in this experience.

 

[IreneF]

I have major depressive disorder--mental illness runs in my family (mother's side)--so I have to assume it's biogenic. Seen lots of pdocs. Never a mention of pd.

Finding an antidepressant that worked for me had no effect on my CFS/ME.

No childhood trauma. Or at least not what I think of as trauma (violence, death, alcoholic parent, extreme poverty, abandonment ....)