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The Psychiatrists perform a very careful and thorough medical exam to rule out any other possibilities, including a brain tumor- Which in rare cases can affect personality. Even after everything medical related is ruled out, it is still very difficult to diagnose BPD. The reason for that is, this mental illness has a lot of co-occurring disorders. A lot of the symptoms will overlap, making it sometimes extremely difficult to pick out BPD amongst the other disorder(s) the patient may have.
“According to the NIMH-funded National Comorbidity Survey Replication...about 85 percent of people with BPD also suffer from another mental illness.” (NEABPD) The most common co-occuring mental illness is major depressive disorder, with 60% of BPD sufferers also suffering from that. The other common co-occuring mental illnesses are Dysthymia (70%), Substance abuse (35%), eating disorders (25%), Bipolar disorder (15%), Antisocial Personality disorder (25%), Narcissistic personality disorder (25%), and self injury, which is a whopping