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Dear Doctor,
My daughter, who is 18, has recently been diagnosed with depressive disorder and borderline personality disorder in axis II. Can you please explain what is multiaxial diagnosis and please elaborate on bpd?
- Confused

You have every reason to be confused because all this medical jargon would make no sense unless you learn more about it. Multiaxial diagnosis is a holistic approach in evaluating a patient in psychiatry.

In the Multiaxial system- Axis I denotes presence of any psychiatric disorder listed in DSM (e.g. Schizophrenia, Depressive Disorder, etc.), Axis II- indicates personality disorder (e.g. Borderline personality disorder, Histrionic personality disorder, etc.) and presence or absence of mental retardation, Axis III- contains physical illness (e.g. Ischaemic Heart Disease, Diabetes Mellitus, etc.), Axis IV- tells about possible psychosocial stressors contributing in current mental condition (e.g. unemployment, divorce, etc.) and Axis V is the global assessment of functioning level (it depicts social, financial, familial and all other relevant areas of day to day functioning level.).

Any loss of functioning is assessed against a time frame to indicate its durability.

Presence of any physical illness that could be a contributory factor or came as a consequence of mental illness is usually mentioned either or both in Axis I and Axis III (e.g. Hypothyroidism and Depressive Disorder, Alcoholism and Cirrhosis of Liver, etc.).

It is probably worth mentioning here that a human being is not just the sum total of the faculties and functional abilities that s/he can demonstrate at a given point of time, there is actually more than that. A good clinician tries to use well-trained clinical eyes to see a person beyond these superficial limits.

I'm assuming that you mean Borderline Personality Disorder and not Bipolar Disorder by the abbreviation bpd (besides I've already written about Bipolar Disorder few times in this column).

Borderline Personality Disorder carries a cluster of symptoms (personality traits) that fall in the border of psychosis and neurosis. Although brief, fleeting episodes of psychosis may be noticeable but they are usually at a sub clinical level and not enough to qualify a diagnosis of psychosis.

The main features of this personality disorder are a pervasive pattern of instability in interpersonal relationships, extreme mood swings, problems with self-image and impulse control.

Emotional deregulations, such as explosive emotional outbursts or extreme mood swings are quite common. They tend to swing between love and hate in their significant relationships.

Despite the fact that they demonstrate different range of emotions, on asking, they mostly complain of a depressed mood. A feeling of emptiness, a real or imaginary fear of abandonment and distorted self-image seem to overwhelm them from time to time.

Women are diagnosed with this disorder twice as often as men. Prevalence rate is about 1-2 percent in a given population.

From a feminist perspective, this diagnosis often comes under fire as an attempt to label women's normal emotional reactions as pathological. It has also been criticised that a prompt diagnosis of Borderline Personality Disorder allows professionals who are insensitive to women's issues to overlook women's oppressed status in the society and downplay the impact of socio-cultural discrimination on women's overall mental health.

I personally believe enough precaution should be taken before diagnosing an 18 year old with Borderline Personality. Excluding age related mood swings and behavioural features, a thorough examination of socio-cultural factors involved and family dysfunction playing any role in the manifestation of the symptoms are crucial.

In my personal work I often find women's childhood history of trauma gets overlooked.

Keeping bpd as a preliminary diagnosis to come up with a treatment plan, using it as a tool for easy and quick communication between professionals or using it as an objective guideline to monitor the prognosis or progress in treatment are the positive sides of this diagnosis.

However any unfair attempt to misuse this diagnosis to disqualify or victimise a person should be resisted from all fronts. Some family members find the diagnosis of a mental disorder or addiction far more frightening and certainly more stigmatising and isolating than any physical illness that might beset the family. There is a compelling need for support among the family members to deal with the situation.

Psychotherapy is the treatment of choice, DBT (Dialectic Behaviour Therapy) can be quite useful in selective cases. Major tranquillisers and anti-depressants are often used for symptom relief.

I hope that answers the question.


Swine Flu and you

MUCH of the information provided has been collected from the Centre of Disease Control, USA.

H1N1 commonly termed as Swine Flu, is a new influenza virus causing illness in people. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

Transmission of Swine Influenza Virus from pigs to humans is not common. People who work with pigs, especially those with intense exposures, are usually at risk of catching swine flu.

The current outbreak in humans that is widely known as "swine flu" is due to a new strain of influenza A virus subtype H1N1 that was produced by reassortment from one strain of human influenza virus, one strain of avian influenza virus, and two separate strains of sine Influenza Virus. The origin of this new strain is unknown, and the World Organization for Animal Health reports that this strain has not been isolated in pigs.

However, at this time, there is no evidence that swine in Mexico, or any other part of the world are infected with this new virus. Most of the time, these viruses do not infect people, but influenza viruses can spread back and forth between pigs and people.

This new H1N1 virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people.

The symptoms of this new influenza A H1N1 virus in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue.

A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus.

Spread of this H1N1 virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza.

To prevent the spread of the disease, first and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

As of 3 May 2009, Swine Flue has not been detected in Bangladesh. As a nation we are not accustomed to consumption of pork or rearing of swine on a large scale and it can reasonably be assumed that chances of such modes of transmission from animal to human is slim.

However, the virus strain may easily be carried to Bangladesh by people from other parts of the world. Although there is still no reason to panic but precautionary measures must be taken to reduce chances for the spread of the disease.

The Government has already taken steps to counter the threat but it is better to be safe. Swine Flu is not incurable. Medication is available to fight the disease but like any other form of illness, prevention is better than cure.

As symptoms of Swine Flu are similar to the seasonal common flu there may be a reason for alarm. Take advice from health care officials and doctors; follow them strictly. As far as the situation in Bangladesh goes, there are still no reasons to panic.

-LS Desk

Painted desert

THese were nights and days of the painted desert. These were nights and days of unbelievable endurance, Native American poverty, red coral necklaces made by the Navajo to hug the sound of my voice. These were the days when turkey and cheese sandwiches could sustain you day after day, when food was never a worry, when love was always the first thing that came to mind after waking up. Not just in human forms but in the forms of everything, from nature, god to crawling caterpillars.

These were the days when beauty was rediscovered, when the earth seemed like another planet, when driving for days seemed like the only thing one was suppose to do and would do. When hiking mountains was necessary to live and life was dependent on the freedom to wish.

These were the days when you bathe in lakes made by men, who drowned many stranded villages to build dams. These were the days when water's vibrant blue would stain your body after dipping in it, for weeks. These were the days when desert sand cleaned you, when mornings and nights came early yet the days seemed limitless.

These were the days when wine was drunk in tin caps, when fires were built with wood and newspaper was only used as kindling and never for news. These were the days when you stopped caring about how you looked and how you sounded; you only cared about how tall your shadows were and if your feet ached.

These were the nights when you saw more stars than you ever thought existed, when you fell asleep on bare grounds which you found softer than mattresses. These were the days when your hair became darker and your lips became fuller and redder.

These were the days when every person you bumped into carried a piece of you, every face you saw reminded you of yourself and your own reflection looked like someone else's. These were the days when you no longer thought about people but only what they had made you into, against the theory of evolution.

These were the days when you wanted to name your first-born Zion, your second born Iman and your third, if you had one, Maya. These were the days when you bumped into children from all over the world adopted by parents from all around the world. These were the days when curly haired, olive bodied girls watched you while you filled up your water bottles at random parks. When you looked back at them they smiled a half smile and their faces got sketched into your heart and you called them Venessa and Yani.

These were the days and nights you had forgotten what could be possible again, these were the times when you floated right between the ground and the sky in a perfect balance. You tilted to the right; you tilted to the left and sat up straight. These were the days, which will soon seem impossible, and then you will only have photographs to look at the yellow of Palo Verde trees and smell the freshness of juniper and her berries. These were the days and nights that April brought once, and I religiously lived it carelessly.

By The Way

To make the walls of your arteries twice as flexible as those of a couch potato, just walk briskly for 30 minutes, 5 days a week.
With age, blood vessel walls tend to stiffen up like old tiresthe main reason two-thirds of people older than age 60 have high blood pressure. Exercise keeps vessels pliable. Mild exercise also reduces the risk of diabetes, certain cancers, depression, aging of the skin, maybe even dementia.



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