Talk:Borderline personality disorder

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This is the talk page for discussing improvements to the Borderline personality disorder article.
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Good article Borderline personality disorder has been listed as one of the Social sciences and society good articles under the good article criteria. If you can improve it further, please do. If it no longer meets these criteria, you can delist it, or ask for a reassessment.
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Contents



[edit] GA pass & FA fail

Does anyone know the dates when this article was nominated to GA status and when it failed FA nomination? I was going to switch out those banners on GA & FA for a milestone banner... Chupper 20:12, 6 June 2007 (UTC)

UPDATE - I found its FA Fails, and found the revision ID for a supposed GA pass, but I cannot find who reviewed it and approved it for GA and where this happened. Can someone point in the right direction? Chupper 20:32, 6 June 2007 (UTC)
Doesn't matter. All this happened way before the article got a complete overhaul in late 2006. A better way to go would be to compare article structure to schizophrenia, a Featured Article, which just underwent a Features Article Review successfully. cheers, Casliber (talk · contribs) 19:24, 28 June 2007 (UTC)

[edit] DSM criteria

Someone messed with the DSM criteria, adding in their own suggestions of examples of the criteria. Those should not be there as that section is a direct copy from the DSM-IV-TR. —Preceding unsigned comment added by 24.63.6.49 (talk)

[edit] A character disorder is not a mood disorder

But I'm not going to waste time on this as the whole Psycholgoy category is a mess anyway -- an embarrassment. --Mattisse 01:01, 8 September 2007 (UTC)

User:DashaKat, thank you for removing the Category:Mood Disorder. I was getting nowhere with my attempts. --Mattisse 14:36, 8 September 2007 (UTC)

[edit] GA Pass

This article has been reviewed as part of Wikipedia:WikiProject Good articles/Project quality task force. I believe the article currently meets the criteria and should remain listed as a Good article. The article history has been updated to reflect this review. Regards, LaraLove 04:22, 24 September 2007 (UTC)

Do you (or anyone) have any suggestions for what the article needs to take it up to Featured Article?
It seems like the intro needs to summarise the whole article, at the moment it doesn't mention several sections. EverSince (talk) 20:38, 24 January 2008 (UTC)
Should be straightforward then. cheers, Casliber (talk · contribs) 02:40, 25 January 2008 (UTC)
PS: I was planning to take this, as well as bipolar disorder. There is a major issue with how we present material from DSM IV on wikipedia which dampened my enthusiasm significantly....anyway, lead first. cheers, Casliber (talk · contribs) 02:42, 25 January 2008 (UTC)

[edit] One link PLEASE

So far the article is very nice and encyclopedic. But the real power of wikipedia used to be that, in comparison to "ordinary" encyclopedias it had a practical side. Unfortunately with all the current "quality" hype that's rapidly disappearing. (Back to: "Nothing exists until a white male has written about it in a book") To make this a truly "great" article there should be at least one (or two) links to free information for sufferers and dependents. The current link via the British Institute of Health leads to a maze of ads for buying all kinds of stuff. thanks. —Preceding unsigned comment added by 80.171.253.37 (talk) 04:58, 28 October 2007 (UTC)

There's a plethora of information available in the article and in the references. Google can help those looking for free information from other sites. I don't think expanding the external links section isn't going to improve the quality of the article. Lara❤Love 05:05, 28 October 2007 (UTC)

[edit] Info on treatment of BPDs' families?

BPDs' impact on their families can be very severe due to the "anger" symptom, which results in abuse. In addition, many BPDs are also addicted. Consequently, treatment of BPDs needs to include therapy for family members. Should appropriate studies/links be included in this article? The downside is that, unlike families of alcoholics, there's not a huge amount of peer-reviewed study on BPDs' families, even though it's a common situation that comes up in therapy.3Tigers 07:55, 2 December 2007 (UTC)

++ COMMENT++ —Preceding unsigned comment added by 66.25.59.192 (talk) 19:16, 30 January 2008 (UTC) This point shouldn't be overlooked as the majority of individuals researching this subject are those that are collaterally affected by the disease; parents of children with BPD, children of parents with BPD, and someone in a relationship with BPD. Because BP are hypersensitive to criticism, and emotionally volatile, individuals with BPD tend cope by deflecting their feelings on others to avoid facing their own disability. This leaves the family members to deal with real issues like, how to you introduce a person with mental illness to treatment, how do you respond to the deflection in a way to support the person with BPD and not be emotionally injured by it.

Common human reactions to borderline behavior are often counterproductive with a borderline individual - cause problems for the family and the borderline person.


[edit] BPD is now a Featured in es.wiki

It's been a long job to achieve it, but now here it is. This article and also the German one have been the basis for the Spanish article. Some things have been changed (i.e. the order of sections it's more like our nosographical criteria). Also we had to split it into two more articles (history, personality analysis) and also a non-encyclopedic supportive section with a quick guide and also a recorded wikipedia, because of the very large size of the article. Maybe the originality is the big space devoted to neurobiological approaches and also an important analysis on anti-psychotic medication. Let's say that it has been a "trilateral" achievement (Germany, Spain and USA). Thanks you all. --Gustavocarra (talk) 21:10, 20 February 2008 (UTC)

[edit] why split

i dont get why List of further reading on Borderline personality disorder is separate.. it's only linked from list of psychology topics —Preceding unsigned comment added by 74.12.96.150 (talk) 21:06, 6 March 2008 (UTC)

This is a good point. Why does this have it's own article? Lara❤Love 04:36, 7 March 2008 (UTC)
Well, we can't ask Zeraeph, who seems to be the one who split it off, at least she started the article anyway...oh wait, looks like it was a temporary holding bay, judging from this diff.
In any case, I have not used further reading bits in articles I have read, I guess hoping the person reading the article would look at the references and go from there. The BPD article is a hefty 73 kb and could get up to 100 by the time it gets to FAC...which I am planning to do one day...when I am feeling fully charged with loads of time. Casliber (talk · contribs) 07:06, 8 March 2008 (UTC)

[edit] Missing Information

Therapy Anew type of therapy developed by gregory, et al. (2008) known as dynamic deconstructive psychotherapy (DDP) has been developed specifically for BPD with good empirical support and needs adding to this page, as it is a competing treatment od DPT (Linehan) —Preceding unsigned comment added by 143.210.122.132 (talk) 11:31, 15 May 2008 (UTC)

Two main points are missing from this article. The first being an important part of the diagnostic criteria for BPD - "every person on this earth experiences some or all of the above at some time in their life but it is the frequency and intensity that distinguishes BPD." (www.mjtacc.com http://www.mjtacc.com/frameset.html?mintroduction.html~mainFrame)

And secondly is the four divisions of BPD, which are extremely important when an individual is classified as having the BPD -


Four Divisions of BPD A first-level distinction along the Borderline continuum

There are four generally accepted divisions within Borderline. It is theorized that the next version of the Diagnostic and Statistical Manual of mental disorders will distinguish the four major categories, similar to how other disorders such as Bi-Polar have been categorized.

Quadrant A) Low-Functioning, Out-Acting: generally unable to hold a job, pay bills, live unassisted; generally acts inappropriately to others, screams, yells, makes groundless accusations, engages in extreme projection.


Quadrant B) Low-Functioning, In-Acting: generally unable to hold a job, pay bills, live unassisted; generally directs frustrations inward in the form of self-mutilation, extreme negative self-talk.


Quadrant C) High-Functioning, Out-Acting: generally able to hold a job, keep things together; generally will "keep their cool" in a public forum like the workplace but will lash out at loved ones or those who "should be able to take it."


Quadrant D) High-Functioning, In-Acting: generally able to hold a job, keep things together; generally will "keep their cool" in a public forum like the workplace but will lash out him or herself in private over their anger and frustrations unspoken.


This is taken, in part, from http://www.bpdrecovery.com/modules.php?name=Content&pa=showpage&pid=9 and is discussed at length in the DSM-IV-tr, as well as http://www.mjtacc.com/index.html —Preceding unsigned comment added by 58.165.174.17 (talk) 02:06, 29 March 2008 (UTC)

  • It's a very complex and poorly understood condition. As with any mental illness, there are varying degrees of functioning and morbidity. I wish I had more time to help, but I don't.KGBarnett (talk) 02:25, 15 May 2008 (UTC)

Rough summary: - I note you say you are not prepared to discuss further - I wish to say and ask a few things - I would be pleased for a reply - But only if you wish to - No rush – think about it - reply if you wish - when you not in a hurry:

1: I did not pick bpd randomly as place to put that passage. Any one with an overview of what is going on [the debate in the mental health arena] will know why I chose bpd: i) It is, and has long been, the most controversial label [schizophrenia is catching up now though]: ii) It is within established texts that bpd teaches us something about mental illness definitions and personality disorders: iii) It is paradoxical in that the more extreme the case the less visible it is – unique and curious and of great difficulty to explain within the field of psychiatry: iv) Other reasons too technical for me to bother you with:

2: Can you tell me how many people are going to be logging in to discuss on bpd page. I WILL POST THIS THERE THOUGH ASWELL AS ELSEWHERE I GUESS:

3: I feel inclined to expose the emails I sent you – compelled actually. Openness in a dispute that someone has become sulky in is important I feel - It helps heal ALL of tribe: I emailed you out of consideration – but I prefer no secrets!!!:

4: Can we put article in with references – it does imply it is or may be a minority view. If not can I put disclaimer for wiki of any mental illness caused by reading a narrow received opinion?:

5: We could put it at bottom of article – I could add more – but NOTE AT HEADER TO SEE BOTTOM OF ARTICLE FOR ROUNDED VIEW WOULD BE ESSENTIAL? I could put the passage in anti psychiatry (which I did not know existed) BUT WOULD INSIST ON A LINK FROM ALL PSYCHIATRIC LABELS we can manage: This paragraph or a link must come near top (I did not put it at very top – I put it where it would be seen and where the following text ran seamlessly onward from it) AND BE CLEAR – see next point:

6: Wiki is not considered a reliable source for the technical – [despite a recent brilliant piece on bbc radio 4 ‘thinking allowed’ where a member of public compared wiki with Britannica on a varied selection of topics of which they were well versed – conclusion “the cathedral is dead - long live anarchy” TO PARAPHASE] – despite this rousing recommendation your reputation falls foul in others’ eyes of what you similarly wield then at others you see as beneath you - it would appear – THUS THE MAJORITY OF READERS WILL NOT EVEN KNOW OF BALANCING VIEW – MANY WILL BE SUFFERERS I SUSPECT – THIS IS DANGEROUS FOR BPD SUFFERERS AND CARERS – AS A POSSIBLE FIRST PORT OF CALL:

7: I AGREE WITH ALL THAT YOU HAVE SAID (see below point 8) - EXCEPT THE INSULT THING - YOU DEFINITELY STARTED IT - I BELIVE HUMOUR IS THE (one of) BEST MEDICINE - ADMITTEDLY THERE ARE at least TWO SIDES TO THIS ARGUMENT AND JOKES CAN HIDE AWFUL ABUSIVE MEMES – I THINK YOU WILL FIND YOU ARE PROJECTING AT ME FROM YOUR HIPPOCAMPUS AND HYPOTHYLAMUS etc STUFF THAT YOU HAVE PATTERNED FROM STARING AT SO MUCH VANDALISM OVER THE COURSE OF YOUR TIRELESS WORK - NO DOUBT - HUMOUR ASKS US TO SEE THINGS DIFFERENTLY - AT BEST IN A VERY CONSTRUCTIVE WAY - IF WE ARE too aloof & ARROGANT TO LOOK IT, CAN FEEL LIKE AN INSULT or we miss the point:

8: I have been very patient with you. You have ended up playing the ‘card’ you should surely have played first (and I would have expected first) last: i.e. That the article should be placed elsewhere or is not a majority view and so deservers little billing:

Of course this would mean that years ago gay would be a vicious attack on people as an entry: That ‘blacks’ should be whipped into slavery would be standard unquestioned stance in your wiki:

So I hope you see that in some articles wiki should be ahead of the game for reasons of GOOD WILL TO ALL (WO)MEN and children etc. MORAL compass etc:

9: you do not mention that some administrators (I have found one straight away) may agree about progressively fostering genuine sub cultural anthropology etc (please don’t suggest I stick it in anthropology section) – it is probably, world wide across time, a majority view – can site examples if you wish and that wiki encourages opposing views for balance:

10: The issue of verifiability here is going to be important for the reasons of the ethics of the victor writes the rules. I cite modern historical study as moving toward accepting this paradox and trying to allow for it:

11: I have my own model of the universe as does everyone including you:

12: I note your use of the word OUR wiki in a sentence that excluded me:

13: I have not reviewed your biographies as yet but I URGE you to stop and thinkfeel - In this article, I want, (if you say I do sir), though I don’t feel I ask for it, an exception - Not for me as YOU INSULTINGLY put it more than once. But for the people the very entry is defining:

Who are you to dictate wiki policy in a conflict of rules and interest situation? Stop playing games and god? What is knowledge for? Let form follow function IN THIS ARTICLE?:

14: I would prefer to leave the body of the article untouched and add this paragraph (you exclude point blank with a litany of bias within wiki world of rules) to article but I could go and justifiably with citation spend (waste) hours hacking it to pieces if you prefer. The omissions and lack of emotional balance in society are everything in the bpd world my friend! All humans share the bpd traits - let not wiki - if only in this article! Think of bpd and other negative labels as actually people carrying the load under sensitivity that you don’t feel:

15: We have proved you don’t like labels. I rarely label a child or any for this reason. I say not you are an idiot. I say is that not an idiot thing to do or idea? QED. This entry MATTERS. If you don’t like it - why should a fascist’s entry not have proportionate balance in terms of effect - not your personal view of wiki hierarchy?:

16: Example: Should one place a ‘proven’ negative about someone everyone says is good ‘ GOD ’ like - at the very top of article - say a judge or the bloke the Catholics recently dug up and put in a glass box for all to (file/’phile’ past) bow to and made a saint – yet he seems to have been an abuser and had a personality disorder:

Similarly should a positive view of someone everybody wants to negatively label be put forward when individually they may have done only ‘ GOD’s ‘ work.

Tricky entries my friend - Need love? - Children are reading wiki as source - The study of the cult of psychiatry (psychology is clearer but needs to be seen in a wider context) has in my experience driven sensitive searching people over the edge as it is not an answer to the human condition as commonly thought and is presented but is a system of management or at least view which does not ‘add up’? All systems are imperfect so it is (can only be) perfect within its framework? THIS IS IMPORTANT:

17: For the record - Social anthropology devours psychiatry and psychology as foundations - I do not like or dislike them - I am impartial - BUT I AM partial to love - I am a shrink - A psychologist - Child psychologist - And more and less:

18: I give thanks: .-) (22catch (talk) 02:15, 24 May 2008 (UTC))

Dear 22catch. Some points you make are valid, but it is important to (a) write in a neutral manner and (b) avoid speculation. Talk of future classifications is just that. Another school of thought questions the vailidity of all personality disorders and noting the overlap between them. In this way ASPD, NPD, HPD and BPD have much in common. more later. Cheers, Casliber (talk · contribs) 02:29, 24 May 2008 (UTC)

[edit] Mnemonics in Wikipedia?

I find it strange to see mnemonic devices in an encyclopedic context. Though many contributors are likely students or professionals in psychology or medicine, and find these useful, it seems out of place in a matter-of-fact article. The mnemonic adds no new information to the article, it just repeats the diagnostic criteria. In addition (and this is why I've moved this here without discussing first) I find this particular mnemonic somewhat insensitive considering patients and their loved ones probably come here for help in understanding the diagnosis. --shingra (talk) 12:52, 27 May 2008 (UTC)

[edit] Mnemonic

A commonly used mnemonic to remember all features of borderline personality disorder is AM SUICIDE[1]:

A - Abandonment
M - Mood instability (marked reactivity of mood)
S - Suicidal (or self-mutilating) behavior
U - Unstable and intense relationships
I - Impulsivity (in two potentially self-damaging areas)
C - (lack of) Control of anger
I - Identity disturbance
D - Dissociative (or paranoid) symptoms that are transient and stress-related
E - Emptiness (chronic feelings of)
I actually agree with this and would rather this was off the page than on it...Cheers, Casliber (talk · contribs) 13:34, 27 May 2008 (UTC)
I was surprised to see the mnemonic in the article to begin with and agree with removing it to the talk page. –Mattisse (Talk) 13:55, 27 May 2008 (UTC)
I agree as well. Not only is it out of place, but if someone who has been diagnosed with BPD, or the family of such a person, comes here to get information, AM SUICIDE is not really appropriate. It can give the inaccurate impression that everyone who lives with BPD has suicidal tendencies, which is not the case. Lara❤Love 15:08, 27 May 2008 (UTC)

[edit] New sections: (1) controversies (2) history

This is an excellent article but I would like to suggest two additions:

  1. Contentious issues / controversies in relation to BPD, such as feminist peerpectives on gender and diagnosis; the stigma of BPD diagnosis and use of the BPD diagnosis to dimsmiss and deny care to 'difficult' patients who evoke powerful countertransference reactions. This would expand some of the points in the "terminology" section.
  2. The history of PBD, tracing the development of the concept from moral insanity to hysteria and on to borderline schizophrenia, pseudoneurotic schizophrenia etc, to borderline personality organisation and Gunderson's formalisation of ther concept - touching on Deutsch, Klein amd Winnicott on the way
  3. Under treatment, a section on Mentalization based treatment would be good

Comments? --Anonymaus (talk) 12:30, 3 June 2008 (UTC)

Strongly agree. I will be deveoping this article further at some stage this year on a march toward FAC. Hold me to this if I haven't done so already. Feel free to add material with references. if you ue a book I'd be really grateful got pages :) Cheers, Casliber (talk · contribs) 13:13, 3 June 2008 (UTC)
Ok, good. I'm happy to write one of the above but I dont want to duplicate what other are doing. A short paragraph on MBT will be easy, and I could do a 'Controversies' section by, say, end of June. The 'History of BPD' is much harder as it will require a lot of reading. --Anonymaus (talk) 00:35, 4 June 2008 (UTC)::
I think a history section as well as a section deliniating controversies is a good idea as many people come to this article with various distorted views. Perhaps a history and controveries section can put it all in perspective. People can see from where their view stems. –Mattisse (Talk) 01:44, 4 June 2008 (UTC)
Fantastic. I am just confirming I ma not doing anything proactive with this article currently (apart from the film stuffI just added, and modelling the bottom section similarly to those in schizophrenia and major depressive disorder. Go for it and we'll keep an eye out and offer plenty ot 2c worth :) Cheers, Casliber (talk · contribs) 02:35, 4 June 2008 (UTC)
So would you agree with a heading Controversies and Contentious issues, with subheadings
  1. A feminist position discussing BPD as a gendered diagnosis, and the view that it is a form of oppression of female abuse victims by male psychiatrists (I'm simplifying here obviously)
  2. Patients that services don't like discussing the stigma of BPD, pejorative use of the label, the idea of it being untreatable being used as a reason to deny people treatment, and the idea that the term says more about the therapist or the 'therapeutic dyad' than it does about the patient
  3. Is Borderline the best word, maybe move some of the discussion of the term "borderline" from the Terminology section --Anonymaus (talk) 09:11, 4 June 2008 (UTC)

(outdent) - the themes are good - generally headings are more succinct but nothing jumps to mind. Maybe a broader Gender issues for the first one above, rather than feminism per se. Second one is wordy and I will think on it. Third can be just left in terminology I'd have thought, as the issues are part of that subsection. The great thing is things can change and evolve as material is added. Make a start and we can discuss as we go. I generally agree with the ideas overall. Cheers, Casliber (talk · contribs) 14:03, 4 June 2008 (UTC)

I would prefer that the headings be less contentiously worded and more aimed an educating those who come to the page that, as in any diagnostic criteria, there are additional considerations that may not have been included for various reasons. For example, I agree that Gender issues is preferable to a feminist label as it is less political and plays less into stereotyped notions from my point of view. Besides, there may be other gender issues than just feminine ones. My concern is that the approach lean toward the educational rather than argumentative, if that makes sense. –Mattisse (Talk) 14:19, 4 June 2008 (UTC)
Agree - I think maybe just placing the Is Borderline the best word material in terminology would be best with a subheading maybe controversies in terminology or..well, jsut add away and we can play it from there. I did think that Patients that services don't like maybe best labelled as negative connotations which is essentially what the term has been encumbered with, and detail the development and arguments within. Cheers, Casliber (talk · contribs) 14:22, 4 June 2008 (UTC)
I'm not sure why the term Borderline has been retained, since I don't think there is now any attempt to explain that it is on the borderline of any category. A discussion of what would be a good term might be interesting in the light of current conceptualizations. The issue of negative connotations is also interesting. Many diagnostic categories have negative connotations e.g. antisocial personality disorder but this ones seems to have a constituency of those so diagnosed whose voice is heard. –Mattisse (Talk) 16:16, 4 June 2008 (UTC)
Thanks for all that, I wil start playing in my sandbox. BTW, can you give some feedback on my bold editing of Group psychotherapy?--Anonymaus (talk) 23:19, 4 June 2008 (UTC)
My general impression is that borderline has been used fairly egregiously (I always wanted to use that word in a sentence!) - I haven't looked into the published literature and am interested to see what has been published in peer-reviewed journals on the matter. Cheers, Casliber (talk · contribs) 23:31, 4 June 2008 (UTC)
My guess is that after they realized the condition was not "borderline" anything, the term continued to be used because in general everyone knew what was meant. So it was easier to keep the term than settle on a new one that all would agree to. –Mattisse (Talk) 00:26, 5 June 2008 (UTC)
Sorry I meant egregiously WRT its pejorative nature. The initial 'borderline' concept was one on the border between neurosis and psychosis. Not sure if it will be renamed or what will happen. ICD10 has a more descriptive name. Cheers, Casliber (talk · contribs) 03:01, 5 June 2008 (UTC)

Sounds good. Just to note that no.1 as you describe it would also be covering content already in the Services and Recovery section regarding staff attitudes, difficulties in therapy etc, as well as the content in the terminology section. Be good to have more history on how the concept came about. EverSince (talk) 12:20, 11 June 2008 (UTC)

[edit] Globalize

With respect to Eduardo1971, the addition of "Licensed Clinical Social Worker (LCSW),Psychiatrist (MD), Clinical Psychologist Ph.D)" under Diagnosis seems very USA-specific, because (a) it would not be common practice in the UK or Australia for social workers or indeed clinical psychologists to make DSM diagnoses, and (b) the term "MD" is enttirely specific to the USA; in UK and in Australia we would say MBBS and/or MRCPsych or FRANZCP. I suspect LCSW is also a USA-specific qualification. Request permission to take out MD, PhD and LCSW as superfluous to the substance of the paper, and add "(in the USA)" after Social Worker?--Anonymaus (talk) 08:34, 11 June 2008 (UTC)

Yep. sounds good to me. Cheers, Casliber (talk · contribs) 08:55, 11 June 2008 (UTC)

[edit] Diagnosis

I'm unhappy with the Diagnosis section. I was following up the [citation needed] for EEG and CT scan, and there is nothing on lab investigations in the assessment of BPD in the New Oxford Texbook of Psychiatry (a very big book), and this made me think that, no, all this talk of calcium, thyroid, epilepsy and brain lesions is really irrelevant to BPD (admittedly it does form part of a standard in-patient assessment protocol, but not for BPD specifically) -- and there is NO WAY any clinician is going to confuse BPD with (say) epilepsy. So I suggest we delete the lab investigation / EEG / CT paragraph, as adding nothing to this article, and potentially confusing to readers with a BPD diagnosis, and instead add a paragraph on structured psychological assessments such as the SCID, MCMI and SNAP. --Anonymaus (talk) 07:12, 12 June 2008 (UTC)

Erm...in general, everyone gets a one-off organic screen whichever way they come into psychiatry. It thus depends on how inclusive or exclusive the article is supposed to be. I put this material in the first place, with the idea of making sure it was clear it was a part of general psych. protocol and generally negative. I usually diagnose on clinical grounds and very rarely call for any structured interview/psychological assessments, however they are good for research and epidemiology. Cheers, Casliber (talk · contribs) 07:27, 12 June 2008 (UTC)
Fair enough and no offence intended to your contributions or your practice. I guess my points would be -- does the special investigations bit actually tell the reader anything about BPD? And is it actually standard practice to do Calcium and EEGs and CTs in the assessment of BPD? Maybe it is, but we need some supporting evidence. You're right about the structured assessments not being used clinically much, but for completeness they should perhaps be somewhere in the article? --Anonymaus (talk) 10:38, 12 June 2008 (UTC)
Absolutely. Go for your life on a para or the assessments. I guess my idea was education to a layperson, so there will generally be some baseline physical tests. Just like mentioning that most treatment these days is outpatient-based etc. etc. Cheers, Casliber (talk · contribs) 11:13, 12 June 2008 (UTC)
I thought the same thing and agree it should include something on the psych assessments used. Though I think it's right to mention that medical screening tests may be done. Routine practice varies by service and country...it is the case, and there are studies showing, that especially in the typical underfunded generalist service "diagnosis" is often just an intuitive judgement made after some informal interview and observation, albeit with reference to official criteria. EverSince (talk) 12:26, 12 June 2008 (UTC)