Treatment of Borderline Personality Disorder - Essay Example

Abstract Recent knowledge on borderline personality disorder, though apparently prevalent, is largely insufficient, specifically on its etiology, treatment and prognosis. Additional literatures must be integrated to provide a broader understanding on this matter. This paper will further explore the nature of borderline personality, on its etiology, symptoms, treatment and prognosis. A literature search strategy will identify potential studies containing valuable information on borderline personality disorder using the database of Google Scholar, PubMed, CINAHL, TRIP databases, and metaRegister of Controlled Trials (mRCT). Data will be analyzed and will be summed up as a comprehensive literature review. Conclusions and recommendations will be discussed. Purpose of the Study The purpose of the study is to further explore the nature of borderline personality beyond what is currently known about the disorder. Background of the Study Many literatures are available to describe and diagnose borderline personality disorder, but more literatures should be considered. No treatment modality was found to be effective in treating the disorder. Moreover, no evidence-based data was available to describe the prognosis of the condition. Further research on borderline personality disorder is proposed as an attempt to fill in the literature gaps pertaining to this disorder. Objectives of the research To further explore the nature of borderline personality disorder, additional objectives will be met by this paper: 1. Resolve the issues on the etiology of the disorder. 2. Provide accurately identification and diagnosis to the disorder. 3. Investigate a possible single or combination treatment regimen for the disorder. 4. Identify the prognosis of the condition whether there is good, poor or none at all. Review of Related Literatures Borderline personality disorder is presently a cluster B (dramatic, emotional, erratic) personality disorder showing unstable interpersonal relationships, self-image and affect and impulsivity (DSM-IV-TR). The International Statistical Classification of Diseases and Related Health Problems 10th Edition (IDC-10) alternatively named the disorder as “emotionally unstable personality disorder” under the subtypes impulsive and borderline. The etiology of borderline personality disorder is still debated due to the controversial use of the term “borderline”. The condition was originally seen as intense moods of anger, depression and elevated mood. Bonet (1684), cited by Millon et al (2004) termed the condition as manic-melancholic insanity (literally translated from French), and then later on described by Kraepelin (1921), cited by Millon (1996), as “excitable personality”. The term “borderline” possibly began from Stern (1938) as somewhat between neurosis and psychosis. The DSM-II introduced the terms “borderline schizophrenia” and “borderline affective disorder”, then later on as “borderline personality disorder” in DSM-III, and still remained at DSM-IV-TR. However, many suggestions were made on revising the term, such as “impulse disorder” and “interpersonal regulatory disorder” (Gunderson and Hoffman, 2005) and “post traumatic personality disorganization” (Quadrio, 2005). It is notable to mention the alternative term of ICD-10 as “emotionally unstable personality disorder”. It is uncertain whether the term “borderline personality disorder” will be retained to the soon-to-be-published DSM-V. Borderline personality disorder requires five or more of the following symptoms: avoidance of abandonment, alternating extremes of idealization and devaluation, identity disturbance, impulsivity on at least two potentially self-damaging areas, suicidal or self-mutilating behavior, reactivity of mood for a few hours to a few days, chronic feeling of emptiness, poor anger management and presence of dissociative symptoms (DSM-IV-TR, 1994). As per DSM-IV guidelines, presences of avoidance of abandonment and/or impulsivity on at least two potentially self-damaging areas are not counted if suicidal or self-mutilating behavior is present. Treatment of borderline personality disorder includes psychotherapy and the use of medications. Dialectical behavioral therapy is the most common treatment for borderline personality disorder which reduces impulsive, self-mutilating and suicidal behavior (Koerner and Linehan, 2000; Verheul et al, 2003; Linehan et al, 2006). Schema therapy, psychoanalysis and mentalization-based treatment was also found to be significantly effective for borderline personality disorder (Nordahl and Nysaeter, 2005; Searles, 1994; Steiner, 1993; Bateman and Fonagy, 2001; Bateman and Fonagy, 2008). The use of medications like antidepressants, antipsycholitics and mood stabilizers for borderline personality disorder can be used only with the presence of co-morbid symptoms (National Institute for Health and Clinical Excellence, 2009; Binks et al, 2006). There is no literature to date providing evidence of complete recovery from borderline personality disorder but simply symptomatic management, making no support to prognosis using available evidences. Methodology The literatures required for this study (minimum of 10 but maximum of 30 per category) shall be obtained using a search strategy which will pass the inclusion and exclusion criteria. Inclusion criteria are those literatures published from year 2000 – 2010 (ten years span), those that contains the key terminologies of the study, and English articles. No exclusion criteria were needed as long as they pass the inclusion criteria. Limits shall be applied to apply those criteria in the search strategy. Literatures shall be searched from the databases in Google Scholar, PubMed, CINAHL, TRIP databases, and metaRegister of Controlled Trials (mRCT). The selected literatures shall be conveniently selected based from their relevance and usefulness for the study, and will be cut down with a minimum of 10 but maximum of 30 per category, taking into consideration of reliability and validity of the findings. Significant qualitative and quantitative data shall be extracted from the literatures to be plotted and/or recorded in notes, tables, charts, etc. the data gathered will be analyzed and summed together in a form of a more comprehensive literature review with in-depth analysis of all the data gathered. Conclusions and recommendations will then be discussed. Conclusion Further research on borderline personality disorder will be conducted by this paper for a number of reasons. Its etiological issue about the term “borderline” is still unresolved and might anticipate future revision of terminology. As of now, no psychotherapy or medication therapy regimen was found to cure borderline personality disorder completely. There is no single effective treatment modality so far for borderline personality disorder and no cure was available other than symptomatic management, and no data to support the prognosis of the condition. The paper will further investigate these literatures to provide additional information on what current knowledge may have missed. Personnel No additional personnel are needed to be involved in this research. Budget No additional funding is necessary for this project. References American Psychiatric Association (2000). Borderline personality disorder. Diagnostic and Statistical Manual of Mental Disorders (Fourth edition Text Revision) (DSM-IV-TR). Bateman, A. and Fonagy, P. (2001). Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. American Journal of Psychiatry, 158, 1, 36–42. Bateman, A. and Fonagy, P. (2008). 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. American Journal of Psychiatry, 165, 5, 631–638. Binks, C.A. et al (2006). Pharmacological interventions for people with borderline personality disorder, Cochrane Database Systematic Review, 1. National Institute for Health and Clinical Excellence (2009). CG78 Borderline personality disorder (BPD): NICE guideline. Nice.org.uk. Gunderson, J. & Hoffman, P. (2005). Understanding and treating borderline personality disorder: a guide for professionals and families. Arlington, Virginia: American Psychiatric Publishing, Inc. Koerner, K. & Linehan, M.M. (2000). Research on dialectical behavior therapy for patients with borderline personality disorder. The Psychiatric Clinics of North America, 23, 1, 151–167. Linehan, M.M, et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 7, 757–66. Millon T. (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley & Sons. Millon T. et al (2004), Masters of the mind: exploring the story of mental illness from ancient times to the new millennium. John Wiley & Sons. Nordahl, H.M. & Nysaeter, T.E. (2005). Schema therapy for patients with borderline personality disorder: a single case series. Journal of Behavioral Therapy and Experimental Psychiatry, 36, 3, 254-64. Quadrio, C. (2005). Axis one/axis two: a disordered borderline. Australian & New Zealand Journal of Psychiatry, 39, 1, 141-156. Searles, H. (1994). My work with borderline patients (master work). Northvale, N.J.: Jason Aronson. Stern, Adolf (1938). Psychoanalytic investigation of and therapy in the borderline group of neuroses. Psychoanalytic Quarterly, 7, 467–489. Steiner, J. (1993). Psychic retreats: pathological organizations in psychotic, neurotic and borderline patients. New York: Routledge. Verheul, R. et al. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. British Journal of Psychiatry, 182, 135–40. World Health Organization. Emotionally unstable personality disorder. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). Read More