My 24 year old has been diagnosed with PSA for the last 5 years. On perphenazine and lithium. His mood swings are dramatic. Multiple moods during the day, often changing within minutes. (I have told PDocs in the past that the “mood issues” long predated the SZA) The slightest rejection/question/complaint can send him crashing into depression. (such as, “will you hand me those dishes, please?”)
Has not been able to hold a job as any correction,etc, will create anxiety, then panic, then depression.
He just switched PDOCS. (Old one moved away). New doc thinks this might be borderline personality disorder with psychosis. (He has NEVER been violent. No fights in school)
Does this even make sense? They are suggesting something like “dialectical behavior therapy.”?
The mood reactivity and lability you describe could be related to Borderline Personality Disorder. We would have to know a lot more to make that diagnosis. But, it is possible. Dialectical Behavior Therapy (DBT) really cannot hurt to try, in my opinion. DBT is about learning skills to cope with moods, anxiety, relationships, and distress tolerance. When I was 17 I was living in an adolescent residential treatment center and all the adolescents either had substance abuse treatment or DBT. I did not use substances, so I had DBT. I do not have borderline PD, but the DBT was helpful for me in learning how to manage some symptoms of my schizoaffective disorder. I’m not advising you to jump in head first because I don’t know what your son is like, but investigate DBT online (There is a ton of info out there, look at Marsha Linehan) and see if it sounds like it could help your son whether he has borderline PD or not.
BPD is a fluctuation between neurosis and psychosis, as you said in the case of your son moods in people with it change rapidly, they can get impulsive, which doesn’t necessary mean violence it can come in many forms; self harm, sexual promiscuity, substance abuse etc. It’s presentation can vary but as said DBT is very effective for bpd.
We can’t diagnose as malvok said, but listen to what the doctor has to say, it may be after getting to know him more he’ll come to a different conclusion. Bpd is a label that’s thrown around rather a lot particularly if people don’t respond to medication, at least that’s how it is here in the uk. I was diagnosed with it in hospital because my psychosis didn’t dissipate with atypicals then I went into adult services and they saw something was clearly wrong as I didn’t match the pathology and after being assessed by a psychosis specialist was put on chlorpromazine and it worked so I was given the schiz label.
I wouldn’t worry too much, a label doesn’t matter, as long as they’re getting the right treatment is what matters.
I hope your son gets on well with this pdoc, try not to over think it, take care,
Meg.
Borderline personality disorder (BPD) is common in patients with schizophrenia and has a negative effect on disease course and outcomes, study results show.
Previous research involving patients with affective disorders had shown that comorbid BPD has a significant negative impact on interpersonal functioning and affective stability, explain Amber Bahorik and Shaun Eack from the University of Pittsburgh in Pennsylvania, USA.
But they add: “Little is known about the prevalence of BPD in schizophrenia, and the degree to which BPD comorbidity portends a debilitating course in the disorder.”
To address this, the team studied 142 patients, aged 18-40 years, with schizophrenia or schizoaffective disorder who participated in the MacArthur Violence Risk Assessment Study, which was designed to assess the risk for violent behavior in mental health patients.
The participants were assessed at hospitalization (baseline) for BPD using the Structured Interview for DSM-III-Revised Personality (SIDP-R).
General psychopathology, and positive, negative, and affective symptoms were assessed at baseline and after 1 year using the Brief Psychiatric Rating Scale (BPRS), while functioning before and after follow-up was assessed using the Global Assessment of Functioning (GAF) and the Activities of Daily Living Scale (ADLS).
Overall, 17.6% of the participants tested positive for the presence of comorbid BPD - a significant proportion, say the researchers.
My therapist likes to dismiss certain personality disorders in her patients, especially borderline. I suspect that I may have some borderline traits - if not the full comorbid diagnosis - I am more focused on my bipolar/schizophrenia, but borderline is a serious illness to have on its own
My sister was diagnosed with BPD a long time ago. It’s basically a love-hate disorder from what I have experienced, my sister goes from being clingy and dependent on people to outright despising them. She is quite selfish and doesnt do anything out of kindness, she has to be reimbursed.
BPD is not to be confused with bipolar disorder. My sister supposedly has bipolar disorder but she functions too highly for me to believe it. Bipolar is overdiagnosed, people who come into psych hospitals on drugs just get slapped with bipolar. I have met real bipolar people. They were clearly different from normal people.
Dialectical behavior therapy requires cooperation from the patient, lots of it. It is very effective if the patient is compliant.
How odd to me. I don’t know if it’s because your on the very opposite side of the nation, or what other circumstance, but with my youngest brother; they put him in detox and rehab first. When he finally came up with clean blood test, then the doctors started to untangle the mental health issues. He was diagnosed after he was drug free.