Ensinando diagnóstico diferencial com Anakin Skywalker: o duelo entre transtorno da personalidade borderline e transtorno bipolar

Carvalho, Lucas de Francisco; Miguel, Fabiano Koich; Pianowski, Giselle

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Estudos de Psicologia (Campinas)

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Sumário

Theoretical article – Health Psychology • Estud. psicol. (Campinas) 40 • 2023 • https://doi.org/10.1590/1982-0275202340e210047 copiar

Ensinando diagnóstico diferencial com Anakin Skywalker: o duelo entre transtorno da personalidade borderline e transtorno bipolar

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo:

Publicações de outrora utilizaram um dos principais fenômenos da cultura pop, Star Wars, para ensinar diversas questões sobre psiquiatria, demonstrando que usar os filmes da série para ensinar tais assuntos pode facilitar a compreensão de temas desafiadores. O objetivo deste artigo é aprofundar as questões do diagnóstico diferencial de dois transtornos psiquiátricos.

Métodos:

Nós examinamos e comparamos as especificidades do transtorno de personalidade borderline e transtorno bipolar à luz do personagem fictício dos filmes Star Wars, o vilão Darth Vader/Anakin Skywalker.

Resultados e Conclusão:

As considerações sobre o diagnóstico de Darth Vader devem ser interpretadas como um exercício acadêmico com dois objetivos principais: discutir o diagnóstico diferencial entre transtorno de personalidade borderline e transtorno bipolar de forma ilustrativa, suave e lúdica; e ensinar como relacionar os comportamentos com critérios diagnósticos, neste caso, especificamente relacionados ao transtorno de personalidade borderline.

Palavras-chave:
Diagnóstico; Filme; Transtornos de personalidade; Método de ensino

Programa de Pós-Graduação em Psicologia, Pontifícia Universidade Católica de Campinas Núcleo de Editoração SBI - Campus II, Av. John Boyd Dunlop, s/n. Prédio de Odontologia, 13060-900 Campinas - São Paulo Brasil, Tel./Fax: +55 19 3343-7223 - Campinas - SP - Brazil
E-mail: psychologicalstudies@puc-campinas.edu.br

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[1] Correspondence to: L. F. CARVALHO. E-mail: <lucas@labape.com.br>.

Biomarkers, early events, symptoms, and traits	BPD vs. BD	Anakin Skywalker			Disorder recommendation
Biomarkers, early events, symptoms, and traits	BPD vs. BD	Childhood (8 years old)	Youth (18 to 22 years old)	Adulthood (46 years old)	Disorder recommendation
Biomarkers (Phelps, 2014Phelps, J. (2014, September 15). Bipolar disorder and borderline personality disorder: what’s the difference? PsychEducation.org.https://psycheducation.org/diagnosis/bipolar-disorder-and-borderline-personality-disorder/#Overlap_between_diagnostic_criteria https://psycheducation.org/diagnosis/bip... )	None	High levels of Midi-chlorians^a			None
Early life stress^b (Leibenluft, 2014Leibenluft, E. (2014). Categories and dimensions, brain and behavior: the yins and yangs of psychopathology. JAMA Psychiatry, 71(1), 15-17. https://doi.org/10.1001/jamapsychiatry.2013.2810 https://doi.org/https://doi.org/10.1001/... )	BPD > BD	Slave; abandons his mother; orphaned of a father			BPD
Emotional lability	BPD ~ BD		Love-hate relationship with his wife and with his mentor (epi. III)	Love-hate relationship with his son and with the Emperor (epi. VI)	BPD/BD
Impulsiveness	BPD > BD		Hidden and hasty marriage (epi. II)	Tells his son that he is his father and attacks him (supposedly, killing him) (epi. V)	BPD
Aggressiveness/hostility	BPD > BD		Kills all Tusken Raiders (epi. II) and all the Jedi placed in the Jedi library (epi. III)	Kills those who are under his command when expectations are not met (epi. IV, V)	BPD
Harm avoidance (De la Rosa et al., 2017De la Rosa, I., Oquendo, M. A., García, G., Stanley, B., González-Pinto, A., Liu, S. M., & Blanco, C. (2017). Determining if borderline personality disorder and bipolar disorder are alternative expressions of the same disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 78(8), 994-999. https://doi.org/10.4088/JCP.16m11190 https://doi.org/https://doi.org/10.4088/... ; Phillips & Kupfer, 2013Phillips, M. L., & Kupfer, D. J. (2013). Bipolar disorder diagnosis: challenges and future directions. Lancet, 381(9878), 1663-1671. https://doi.org/10.1016/S0140-6736(13)60989-7 https://doi.org/https://doi.org/10.1016/... )	BPD > BD		None	None	None
Depression	BPD > BD		None	None	None
Anxiety (Leibenluft, 2014Leibenluft, E. (2014). Categories and dimensions, brain and behavior: the yins and yangs of psychopathology. JAMA Psychiatry, 71(1), 15-17. https://doi.org/10.1001/jamapsychiatry.2013.2810 https://doi.org/https://doi.org/10.1001/... )	BPD > BD		Unable to stop worrying about his mother (epi. II, III)	Constantly worried about the future of the Empire (epi. V, VI)	BPD
Manic episodes (Fornaro et al., 2016Fornaro, M., Orsolini, L., Marini, S., Berardis, D., Perna, G., Valchera, A., Ganança, L., Solmi, M., Veronese, N., & Stubbs, B. (2016). The prevalence and predictors of bipolar and borderline personality disorders comorbidity: systematic review and meta-analysis. Journal of Affective Disorders, 195, 105-118. https://doi.org/10.1016/j.jad.2016.01.040 https://doi.org/https://doi.org/10.1016/... ; World Health Organization, 1992World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines.)	BD-I > BPD		None	None	None

Diagnostic criteria	Anakin Skywalker		Is the criterion present?
Diagnostic criteria	Youth	Adulthood	Is the criterion present?
1. Efforts to avoid real or imagined abandonment	Cannot bear the thought of losing his mother and wife (epi II, III)	None*	Yes
2. Unstable and intense interpersonal relationships, including idealization and devaluation	Love-hate relationship with his wife and with his mentor (epi. III)	Love-hate relationship with his son and with the Emperor (epi. VI)	Yes
3. Identity disturbance	“I’m not the Jedi I should be.” (epi. III)^b	Oscillates between defending the empire and destroying his son (epi. VI)	Yes
4. Impulsivity with self-damaging	Hidden and hasty marriage (epi. II)	He tells his son that he is his father and attacks him (supposedly, killing him) (epi. V)	Yes
5. Suicidal behavior, threats, or self-mutilating behavior	None	None	No
6. Affective instability (e.g., irritability, anxiety)^a	Unable to stop worrying about his mother (epi. II, III)	Constantly worried about the future of the Empire (epi. V, VI)	Yes
7. Chronic feelings of emptiness	None	None	No
8. Intense anger	Kills all the Tusken Raiders (epi. II) and all the Jedi that were in the Jedi library (epi. III)	Kills those who are under his command when expectations are not met (epi. IV, V)	Yes
9. Stress-related paranoid ideation or severe dissociative symptoms	None	None	No