A borderline personality disorder is a common occurrence in behavioral health agencies. This disorder, according to the DSM 5, occurs predominantly in females (75%) and between 1.6% to 5.9% of the country’s population. Yet it has many features that are common to those who experience bipolar disorder. So how does a clinician distinguish between them?
First, let’s look at the symptoms of borderline personality disorder. These are individuals who have difficulty with their interpersonal relationships, moods, impulsivity, and self-image. Some of the symptoms are efforts to avoid abandonment; suicidal behavior, gestures, or cutting; feelings of emptiness; low self-image. But a major component is what DSM 5 calls, “a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.”
Bipolar disorder has two different categories. For bipolar disorder I, the client could have manic episodes plus either hypomania (less severe manic episodes), and/or major depressive episodes. For bipolar II, the client would have the hypomania episode and the major depressive episode. Either way, the client has a history of mood swings that usually are endogenous (biochemical) and exacerbated at times by stressful external events.
If a client experiences mood swings, how does a clinician determine if they should be treated as a client with bipolar disorder or borderline personality disorder? The difference has to do with the mood swing episodes themselves. Whereas a client with bipolar disorder will have mood swings that could last hours or days, a client with borderline personality disorder could have mood swings that last minutes. Also, borderline personality disorders tend to be functions of the environment and exogenous, rather than due to a biochemical imbalance. Finally, clients with bipolar disorder may have strong relationships that are tested during their mood swings, but the cause of the problems is due to the mood swings. Whereas a client who experiences borderline personality disorder continually has interpersonal relationship difficulties. Even if they are in a long-term relationship, it is tested due to their personality, not their moods.
Looking at the differences between borderline personality disorder and bipolar disorder requires the clinician to identify if the behaviors the client shows are long-term (personality) vs. acute (bipolar).
Praxes provides training in personality disorders for clinicians. For more information, please contact us.
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Dan Thorne has unique perspectives on the field of mental health. As a clinician, he has had over 40 years of experience working with clients in the Southern California area. After obtaining his Bachelor’s degree from the University of California at Irvine, he worked with children in the Orange County Juvenile Hall. Here he honed his earliest techniques on at-risk children. After that, he obtained his Master’s degree in Counseling from California State University, Fullerton.
In the 1990’s, Dan turned his attention to the clinical and administrative side of behavioral health organizations. For three years, he was the Assistant Administrator of Starting Point, a chemical dependency facility in Costa Mesa, CA. In 2001, he took an opportunity to be the Director of Harbor View Community Services Center in Long Beach. When he arrived, the Center had only 80 clients and 13 staff. When he left, there were over 400 clients and 75 staff. Dan created several programs through their contract with the Los Angeles County Departments of Mental Health and Child and Family Services. Under his guidance, Harbor View became one of the leading providers of children’s services in Los Angeles County.
While improving the results of the client’s parents at the Center, Dan reflected on his experiences as a parent. His children themselves had special needs such as mental and intellectual challenges, and Dan knew the toll it takes on the parent. In order to help the child, the parent has to be healthy. From this concept, he created his parenting program. After years of refining it, teaching it to his staff at the Center, and then taking the results and comments from these efforts, he became the developer of the current PRAXES program. It is a culmination of Dan’s personal trials and tribulations as a parent along with empirical results and research of over 40 parenting programs.
Our vision at PRAXES is to advance the strength of parents and caregivers of children with special needs (mental health, intellectual, or physical) through education, support, and empowerment. Thus, they can live healthy and functional lives while caring for the child.
Apogee is a clinical decision software designed to help behavioral health practitioners with their treatment and patient engagement. It provides evidence-based and research-based components. Not only do they consist of elements from such practices as Cognitive Behavior Therapy, Seeking Safety, Dialectical Behavior Therapy, Motivational Interviewing, Functional Behavior Analysis, but also the Intensive Models for Parents, Youth, and Children.
PRAXES has over 30 years of accreditation experience. We know what it takes to get your organization accredited. Whether it’s Joint Commission, CARF, or COA, our team can provide an evaluation of your current status and review the standards which need improvements. We will assist you with the policies, documentation, and training required to be accredited.
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