UNDERSTAND DISORDERS TO OVERCOME PREJUDICES: BORDERLINE DISORDER, BIPOLAR DISORDER AND SCHIZOPHRENIA.

How many times have you used these terms to label someone without really knowing these disorders? 

Have you ever called someone Schizophrenic just because they had a moment of “madness” or Bipolar because they quickly changed their mood? 

Could you tell what the difference between Borderline disorder and bipolar disorder?

With this article we try to shed some light on some of the most common mental disorders that they have become commonly used terms to label behaviors or individuals in a derogatory way.

To fully understand and know the nature and spectrum of mental disorders, it’s necessary to refer to DSM V, the Diagnostic and Statistical Manual of Mental Disorders, periodically updated by the American Psychiatric Association.  The manual provides a detailed description of the disorders, reporting the diagnostic criteria, symptoms and any psychotherapeutic/ pharmacological treatments.

The Borderline Disorder

Borderline Disorder is included in the section dedicated to Personality Disorders, which are characterized by the fact that subjects present “behavior patterns that deviate markedly from the expectations of the individual’s culture” and may involve the modalities of perceive and interpret oneself, others and events. The disorder is characterized by a picture of instability in interpersonal relationships, self-image and mood and a marked impulsiveness. The onset generally occurs in adolescence or pre-adolescence.

To diagnose borderline personality disorder, people must have at least five or more of the following symptoms: ¨

  • Desperate efforts to avoid real or imagined abandonment.
  • Unstable interpersonal relationships, characterized by alternating between extremes of hyper-idealization or devaluation. 
  • Alteration of identity.
  • Impulsiveness in different functional areas of daily life (economic, sexual intercourse, substance abuse or food binges).
  • Recurrent suicidal threats and behaviors.
  • Chronic feelings of emptiness or senseless and unmotivated anger.
  • Paranoid ideation or dissociative symptoms.

The Bipolar Disorder

Bipolar Disorder is characterized by abnormal changes in mood and activity level over a certain period of time. It corresponds to a manic / depressive psychosis and who presents this disorder manifests, alternately, periods of time of great excitement (elevation mood) followed by depressive episodes.  In the DSM-5 the specific chapter of bipolar disorders foresees different forms of the disorder including bipolar disorder type I, II and cyclothymic disorder.

As for the symptomatology, this is divided into maniacal and depressive symptoms. 

The maniacal symptoms include:

  • Decreased need for sleep.
  • Hypertrophic self-esteem or grandiosity.
  • More talkative than usual.
  • Easy distraction.
  • Increase in purposeful activity or psychomotor agitation.
  • Excessive involvement in activities that have a high potential for harmful consequences.

Depressive symptoms include:

  • Constant depression of mood or despair;
  • Severe reduction of interest or pleasure in all or most activities.
  • Loss or increase in body weight or appetite.
  • Fatigue or loss of energy.
  • Feelings of inadequacy, guilt and / or loss of self-esteem.
  • Inability to concentrate and make decisions.
  • Thoughts of death or suicide.

For this disorder, pharmacological treatment is a must, and the psychotherapist can play an important but not a substitute role. 

The clinical psychologist can, in fact, help the patient to accept his own illness, reach a realistic assessment of the limitations that the disorder entails, cope with the depressive or manic phases, restructure the projects of life, enhance the patient’s skills, and help the family to cooperate in drug compliance.

Schizophrenia

Schizophrenia is a complex and multifaceted disorder, there are several types: paranoid, disorganized, catatonic, undifferentiated and residual.  It is often referred to as one of the most debilitating and most widespread mental disorders in the collective imagination. 

In fact, numerous novels, films and TV series have often used the disorder to build captivating characters, devoid of emotion and empathy, especially killers and multiple murderers.

This disorder can be highly disabling and limit the autonomy of those who suffer from it both in social relationships and in normal daily activities.  The patient’s family is usually extremely involved and faces a heavy burden of worry.

The onset tends to be young, between the ages of 15 and 35, with an average value between the ages of 22 and 23.

Psychotic symptoms are grouped into two broad categories and the diagnosis of the disorder requires the presence of at least two of the positive and negative symptoms. 

Positive symptoms reflect greater cognitive distortion or overly dysfunctional behaviors and are:

  • Hallucinations.
  • Delusions.
  • Disorganized speech.
  • Grossly disorganized or catatonic behavior.

Negative symptoms reflect a decrease in mood and a deficiency in some cognitive functions and consist of:

  • Flattening of affectivity.
  • Alogia
  • Abulia.

The line of treatment includes pharmacological therapy, which involves the administration of atypical neuroleptics, combined with psychotherapeutic interventions. 

Early intervention is essential with subjects in the first psychotic episode: programs for an early diagnosis of schizophrenia allow for more timely intervention that can prevent the psychotic crisis and make the evolution of the disease less dramatic.

From the analysis carried out on these three different disorders, it emerges that these differ from each other in symptomatology and manifestations resulting, at times, markedly different from how they are commonly imagined.

Therefore, the aim of this article is to raise awareness of mental illness and its manifestations, overcoming, at least in part, the prejudices and stereotypes related to mental pathologies. 

It’s important to understand and remember that mental disorders can be disabling for the individual and that they often constitute a source of suffering and discomfort for the person. 

It‘s necessary to recognize the severity and seriousness of these pathologies, of the impairments with respect to the functioning of the individual in different areas of life and of how the psychophysical well-being of the person is affected to ensure that the social stigma towards people suffering from disorders of mind be arrested

Written and translated by Selene Amonini

Bibliography

   Cortina, R. (2013). Manuale Diagnostico e Sttistico dei disturbi mentali- 5° edizione. DSM-5. Tr.it. Milano, 2015: American Psychiatric Association.

   Sanavio, E. & Cornadi, D.(2017). Psicologia CLinica. terza edizione aggiornata al DSM-5. il Mulino. Bologna.

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