Features and Comparison of Various

¶ … features and comparison of various mental disorders such as schizophrenia, borderline personality disorder, etc. The paper has eight

Psychopathology - Questions & Answers

Discuss some of the major defense mechanisms in Borderline Personality

Disorder and their impact on relationships. (two part question- please discuss both)

A.J. Mahari notes that while "most people react to their fears through the use of defense mechanisms," people with borderline personality disorder do it with such intensity more than the "situation calls for" (2003). He states that they "appease their many fears" through use defense mechanisms, in particular, "splitting, projection, transference and the like become second nature to the borderline" (Mahari, 2003).

On the Borderline Personality Disorder Web-site, they note the assumptions made by persons with this disorder:

must be loved by all the important people in my life at all times or else I am worthless. I must be completely competent in all ways to be a worthwhile person

My feelings are always caused by external events. I have no control over my emotions or the things I do in reaction to them.

Nobody cares about me as much as I care about them, so I always lose everyone I care about-despite the desperate things I try to do to stop them from leaving me will be happy only when I can find an all-giving, perfect person to love me and take care of me no matter what. But if someone close to this loves me, then something must be wrong with them can't stand the frustration that I feel when I need something from someone and I can't get it. I've got to do something to make it go away..." (Assumptions Held, 2003).

The use of the defense mechanism "splitting" would come into play in alternately "idealizing" and "devaluing" the person they are having a relationship with. No shades of gray in judging a person a mixture of positive or negative qualities would be allowed. One moment they would see the person as perfect and what they have been searching for, and the next moment they could be in a rage over being hurt and acting as if they despised the same person.

In the defense mechanism of projection, the individuals are attributing to others those unacceptable traits they possess but wish to protect themselves from being aware of. Someone with Borderline Personality Disorder after sexual indiscretions related to the impulsivity of their affliction may accuse their significant other of being unfaithful or immoral.

In transference, the patient makes their therapist the receiver of an 'emotional response" which is "appropriate to other persons important in the patient's life history" (?). Therapists would then be subject to the idealization, devaluation, anger outbursts through this defense mechanism.

Having a close relationship with someone suffering from Borderline Personality Disorder would be extremely difficult. Their moods would fluctuate based on externalities (DSM-IV, 2000). They would exert frantic efforts to avoid "real or imagined" abandonment (DSM-IV, 2000). They would be angry frequently. Their alternation between "extremes of idealization and devaluation" would be very disconcerting as there would be no predictability (DSM-IV, 2000). Their "marked impulsivity" (DSM-IV, 2000) could lead to debt problems in the case of impulsive spending, and promiscuity in the case of impulsive sex.

As the DSM-IV notes, Borderline Personality Disorder "frequently co-exists with....addiction" (DSM IV, 2000). As such, another feature present would be denial of the addiction.

Compare and Contrast Bipolar 1 with Schizophrenia

Bipolar I Disorder is the classic form of manic depression, with full Manic Episodes and Major Depressive Episodes. (a person does not need to experience depression to qualify as Bipolar I: see Unipolar Mania.) the lifetime occurrence of Bipolar I Disorder is estimated between 0.4% and 1.6%" (?).

Several similarities between schizophrenia and bipolar disorder are noted here:

The irony of schizophrenia and bipolar disorder is that we understand how to treat these diseases a lot better than we understand how they actually work. We do know that they are both chronic and often devastating brain disorders that affect a significant portion of the population. According to the National Institute of Mental Health, more than two million American adults have bipolar disorder in any given year, and approximately one percent of our population will suffer from schizophrenia in their lifetimes (Bardi, 2003)."

The Mayo Clinic source notes that the primary features in schizophrenia include "delusions, prominent hallucinations for much of the day, incoherence, lack of emotions or inappropriate display of emotions, bizarre delusions, trouble functioning at work, in social interactions and with personal hygiene..." They further note that agitation may be present or a "catatonic (trancelike, immobile, unresponsive) state" can appear (Mayo, 2003).

They can also "behave normally." The emotions are "dulled" with a "lack of expression" or "inappropriate emotions (laughing while expressing terrifying images)" (Mayo, 2002). They state that "the most common hallucination in schizophrenia is hearing voices." The delusions of schizophrenics most commonly are "paranoid," where the person holds "irrational beliefs that others are persecuting...or conspiring...against you (Mayo, 2002)."

This can be compared to Bipolar I

The differences between Bipolar I and schizophrenia include.

It should be noted that ferreting out whether an individual has bipolar disorder or schizophrenia presents challenges:

Many individuals with schizoaffective disorder are originally diagnosed with manic depression. If the person experiences delusions or hallucinations that go away in less than two weeks when the mood is "normal," bipolar disorder may be the proper diagnosis

Distinguishing between bipolar disorder and schizophrenia can be particularly difficult in an adolescent, since at that age psychotic features are especially common during manic periods. Because schizoaffective disorder is so complicated, misdiagnosis is common" (Schizoaffective, 2002).

The prognosis varies between these disorders as well:

The prognosis for individuals diagnosed with schizoaffective disorder is generally better than for those diagnosed with schizophrenia, but not quite as good for those diagnosed with a mood disorder....Mood disorders, including depression and bipolar disorder, are chronic illnesses in which the person's mood may return to "normal" between depressive or manic episodes" (Schizoaffective, 2002).

Sutliff, Thomas et. al's studies indicate that there are differences between bipolar disorder and schizophrenia even at the "molecular and cellular" levels (Schizoaffective, 2002).

3) Dysthymic Disorder is a very common diagnosis. Comment and discuss.

According to the DSM-IV, "The essential feature of Dysthymic Disorder is a chronically depressed mood that occurs for most of the day more days than not for at least 2 years" (2000). It notes that in "children and adolescents, the mood can be irritable and duration must be at least one year" (DSM-IV, 2000). According to the DSM-IV "at least two of the following must be present:

poor appetite or overeating;

insomnia or hypersomnia;

low energy or fatigue;

low self-esteem;

poor concentration or difficulty making decisions;

feelings of hopelessness" (2000).

Additionally, the symptoms "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (DSM-IV, 2000).

Another site notes that the incidence of dysthmic disorder in the general population is "approximately 6%" (no date). They further note:

When someone has had Dysthymic Disorder for two years, he or she may be diagnosed as having Dysthymic Disorder and Major Depressive Disorder, at the same time, if the criteria are met. This is sometimes called double depression, as the patient suffers from the worst severity and longest duration of both" (another site, no date).