Borderline personalities and its impact on relationships - Term Paper Example

Borderline personalities and its impact on family ties, friendships, and relationships Borderline personalities are classified as lower-functioning/ conventional types characterized by self-destructive behavior, which may require dependent healthcare. The other type includes higher-functioning/invisible type characterized by normal functioning within social contexts, however, there is the tendency to overtly act out or cause tantrums. Borderline Personality Disorders (BPD), as described by the DSM-IV, falls in cluster B of personality disorders. The DSM-IV defines BPD as an emotional condition predominantly characterized by a variation in the depth of moods, for example, heightened anger, loneliness, and irrational abandonment fears among others. As a result, the ICD-10 WHO provided an alternative name for the disease - Emotionally Unstable Personality Disorder. As a result, individuals suffering from BPD mostly have dysfunctional relationships with those closest to them. Addressed below is a summary of what BPD entails: recommended treatment and the impact BPD has on relationships (Roy 115). The DSM-IV mandates that an individual must meet five of the nine guidelines provided in the diagnostics manual. These include: avoidance behavior when dealing with reality or imagined abandonment, pattern of unstable interpersonal relationships, identity disturbance, impulsive behavior, recurrent suicidal behavior, chronic emptiness feelings, severe dissociative symptoms, unreasonable bouts of anger, and affective instability. The DSM-IV clearly states that health practitioners must ensure a thorough background check occurs before assigning any of the said diagnostics to an individual believed to be suffering from BPD. It is also necessary to note that because BPD borders between neurosis and psychotic disorders with regard to the symptoms manifested by afflicted patients, diagnosing proves extremely difficult. Therefore, the ways used in differentiating between neurotic and other psychotic disorders presenting similar symptoms include: clinical observations and intensive family history checkups. The following presents an outline of BPD symptoms: feelings of boredom and emptiness which are chronic compared to usual feelings of emptiness and boredom. There are also frequent outbursts of anger, for example, physical and verbal fights. Variations of moods present themselves more than all other symptoms. Episodes of hallucinations, impulsive thoughts, self-mutilation, negativity or sadistic tendencies also manifest themselves. The DSM-IV also states that diagnosis of BDP occurs between the late adolescent years and the early adulthood years. However, diagnosis is difficult because symptoms presented appear similar to those present in other psychological disorders (Paris 156). Treatment of BPD either involves therapy or medication. However, it might involve both methods simultaneously. Therapy can either be individual or group therapy depending on the therapists’ expert recommendation. The role played by therapy includes helping both patients and those closest to them. Patients benefit from therapy by learning how to deal with self-destructive behaviors in an efficient way which prevents the possibility of self-infliction of injuries. On the other hand, family and friends of BPD patients benefit from therapy through receiving encouragement and advice on how to cope with loved ones suffering from BPD. Examples of psychotherapies used include Dialectical behavior therapy (DBT) and Mentalisation-based therapy (MBT). DBT assists patients by helping them accept their emotions while trying to eradicate feeling of worthlessness and guilt. MBT helps with the realistic evaluation of one’s thoughts and beliefs in order to come to terms with the implications brought about by a BPD diagnosis. Only in extreme cases do psychiatrists recommend the use of medications to help level mood swings. Psychotropic drugs, such as antidepressants, help to stabilize individuals suffering from emotional reactions caused by BPD. Most experts recommend the use of psychotherapy first before medication when dealing with different medications. In addition, they put emphasis on the relevance of family and friends learning more about BPD in order to learn how to handle a BPD patient better (John 117). Feelings of self-worthlessness and loneliness, shame and guilt, are common among BPD patients. This explains why an evaluation of an individual’s self-concept happens through carrying out a thorough background check on an individual before diagnosing them with BPD. Establishment of an identity plays an integral role in the way one views them. In addition, it also affects the way people relate to those around them. Patients suffering from BPD have extremely poor self-concepts. This is because BPD affects the way an individual analyzed personal thoughts and beliefs about different situations in their lives. Developmental psychologists, Freud, and Erikson establish in their psychodynamic theories of development that the establishment of an identity occurs in the adolescent stage of development. According to both psychologists, identity plays an immense role in the way an individual perceives their surroundings and how they relate to them. In addition, personality psychologists like Carl Rogers also emphasize on the importance of establishing a strong self-concept of oneself. They all agree that failure to do so leads to an individual with a low self-esteem, which translates into the formation of poor relationships with those around them (Paris 99). Before the onset of BPD symptoms, a child predisposed to suffering from the disorder faces a variety of challenges when trying to cope with the social, emotional, psychological aspects of their life. From an early age, they are able to perceive limitations in their capacity to deal with day-to-day obligations. As a result, they seek out responsibilities which prove to be superficial and guarantee quick gratification. Therefore, as a grown adult diagnosed with BPD, such an individual opts to live in fantasy land where they avoid real responsibilities despite being an adult. On the other hand, children exposed to adult like challenges at a tender age might also grow up with considerable psychological imbalances, which might also predispose them to suffering from BPD. This is because the responsibilities force them to rush through the development stages leading to fixation. Freud’s explanation for this involved the development of defense mechanisms, which help an individual to cope, for example, regression, projection, and displacement among others (Roy 66). Despite the defense mechanisms, the ability to help an individual cope with real-life situations, long-term negative effects arises. Individuals suffer from repressed thoughts, which seek to surface in the consciousness. This might lead to inaccurate establishments of self-identity causing breakdowns in relationships. It is, therefore, very important for an individual to establish a proper self-identity to reduce the chances of suffering from BPD. Just like other psychological disorders, BPD affects the emotional, social, psychological and physiological facets of an individual’s life. However, of all these facets, the social facet suffers considerably. This is because of the interpersonal relationships that exist in this facet. BPD has no cure, however, the disorder can be managed throughout a person’s lifespan. The recommended forms of management treatment include therapy and psychotropic medications depending on the disorder’s severity. Previously founded and new relationships are both put to test when an individual is diagnosed with BPD. Emotions and feelings undergo a whirlwind of trials. Symptoms like identity disturbance, unstable interpersonal relationships and feelings of imagined abandonment contribute to the formation of dysfunctional relationships. This is because of patients diagnosed with BPD feel the compulsive need to engage in indiscriminate sexual behaviors with the goal of reaffirming their worth. They also seek approval through these dysfunctional intimate relationships because of the constant feelings of imagined abandonment that constantly plague them. These relationships also play a part in trying to establish their self-identity. However, this proves not to be the case because these relationships only provide quick self-gratification. The relationships also fill a void within patients suffering from BPD created by feelings of guilt and shame. Erikson attributes feelings of shame and doubt to the incompletion of a mandatory stage of development where a child tries to resolve the conflict of initiative Vs shame and doubt. If a child develops initiative as a result of encouragement from those around them, self-confidence persists and plays an important role as development progresses. Erikson also noted that children who do not receive the encouragement they need during this psychosocial stage of development, develop into dysfunctional adults. These individuals do not take the initiative because of the constant feelings of inadequacy brought about by shame and self-doubt. From this, it becomes clear that patients suffering from BPD struggle to commit fully to an intimate relationship. They prefer unsteady, casual relationships whereby, they maintain a certain sense of aloofness because they rely on keeping people at arm’s length (Paris 176). Experts find it difficult to pinpoint the exact cause of BPD. However, they are all in agreement that a number of factors intricately combine and play a role in causing the disease. They include: Genetics, Neurotransmitters, neurobiology, neurological injuries and environmental factors. Genes inherited from either the mother or the father might predispose an individual to BPD. On the other hand, a change in the levels of certain neurotransmitters might have an adverse effect on a person’s moods and behaviors, which characterize BPD. In some rare cases, neurological injuries in early childhood might also increase a person’s chances of suffering from BPD. Abnormalities in the structure and functioning of the brain might affect the neurobiology of an individual; hence increase the likelihood of an individual receiving a BPD diagnosis. Finally, environmental factors affecting an individual especially in early childhood, such as family and society, might lead to a BPD diagnosis in adulthood. This is because traumatic events experienced in certain aspects of the environment during the formative years of development might impact negatively on an individual’s psychological, emotional, physiological and social well-being. Despite the fact that BPD’s diagnosis occurs in late adolescence or early adulthood stages of development, the impact of both environmental and genetic factors during childhood plays the most prominent role in the onset of BPD symptoms. Freud, Erikson, Piaget and other developmental psychologists further posit that the childhood stage of development remains the most important of all the outlined stages. This is because all aspects of development, for example, cognitive, physiological and psychological among others, occur at accelerated paces in this stage. In the worst case scenarios, BPD patients fall prey to self-infliction of injuries due to the intense feelings of self-worthlessness and loneliness. If left unmanaged, these feelings might get out of hand and eventually prove fatal. Statistics shows that BPD patients suffer 8% to 10 % chance of inflicting self-injuries upon themselves which might result in attempted suicides. These extreme cases of BPD continually put the patient’s life and the safety of those around them in constant danger. This is because such patients might experience a surge of extreme anger, which might cause them to erupt into a violent outburst guaranteed to endanger the lives of anyone present. This might prove detrimental to already established relationships. The formation of relationships and their maintenance for an individual suffering from BPD proves to be extremely difficult. This is because most patients suffer from extraordinarily instable mood swings which prove detrimental to the relationships formed with those around them. As a result, relationships crumble whether at work or at home. Therefore, efforts by both patients and those closest to them must occur to be able to preserve relationships. It is also necessary to consider the implications had in the formulation of relationships from as early as childhood. This allows for proper steps to be taken especially when raising children in families afflicted with BPD. The first interaction with the post-uterine environment relies on the formation of a bond between a mother and her infant. Therefore, the attachment pattern formed between the primary caregiver and the infant lays the foundation for other relationships formed in the future. Ainsworth, a psychologist dealing with the Attachment Behavioral Theory classifies attachment styles into three categories. She posits that 70% of infants fall under the category of secure while the remaining 30% fall under the avoidant category. In situations where BPD is a main challenge, the latter category proves to increase the chances of a child receiving a BPD diagnosis in his adult life. This is because a child’s self-perception and that of those around them relies on the attachment first formed with their first, primary caregiver. Therefore, establishment of a secure attachment type proves beneficial in the maintenance of future relationships. Development psychologists consider adolescence as the stage in development where people learn to form intimate relationships. The perfection of this art continues into adult-life, and most of these relationships result into committed life-long relationships. In the case of patients diagnosed with BPD, relationships tend to crumble because of the manifestation of childlike relationship aspects. A relationship previously based on mutual compassion, respect, understanding son transforms into one where mood swings dominate and eventually interfere with the relationship. Patients diagnosed with BPD require understanding and tolerance despite their inability to reciprocate similar efforts. Unaffected spouses and other family members also ought to learn about the disease in order to equip themselves with better ways in which they can handle their afflicted loved ones. Of all the symptoms manifesting themselves in a BPD patient, instable mood swings present a greater challenge. The instable moods make it hard to reason with a BPD patient. The regressive state into childlike behaviors increases their unreasonableness, therefore, increasing the intensity with which their moods manifest themselves. In the end, keeping relationships becomes almost impossible especially when interacting with uninformed individuals (John 241). Among the symptoms present in BPD patients, irrational fear, for example in the form of paranoia, manifests themselves frequently. As a result, these patients live their lives mistrusting those around them making it hard to form relationships which require the trust to last. Severe insecurity dominates their day-to-day behaviors making them vulnerable perceiving everything as a potential threat to their sense of well-being. These feelings of insecurity worsen their other symptoms and might result in aggressive acts which might prove dangerous. Researchers are of the opinion that BPD patients’ behaviors cannot be characterized as random; instead, they posit that their behaviors result from an instinctive reaction to protecting themselves from perceived threats. In conclusion, relationships become stressful to manage when BPD dominates the life of an individual because it affects a person’s self-identity making them irrational in their thoughts and further burdens them with instable moods and emotions. These moods and emotions prove difficult to control because of their random, impulsive nature (John 34). As a result, those around them must learn to deal with the variation of moods and other symptoms if they hope to maintain their relationships with afflicted patients (Gina 189). Both the affected and unaffected individuals must also learn to live under the constant possibility of dangerous, aggressive bouts of angered reactions. The fact that indiscriminate relationships dominate the lives of people diagnosed with BDP during early adulthood, makes lasting relationships harder to maintain. On the other hand, those in committed relationships suffer from the constant pressure of dissolution of the relationship. This is because of the constant need to isolate and push everyone away by the patient suffering from BDP. Despite this, many individuals have found solace in the advanced forms of psychotherapy and psychiatric medications which have made it easier for people living with BPD to live healthy, normal lives with their loved ones. Relationships have, therefore, become easier to manage and the vast, easily accessible research information on BPD (Gina 115). Works Cited Gina M. Fusco, Arthur Freeman. Borderline Personality Disorder: A Patient's Guide to Taking Control. New York: Norton, 2004. John F. Clarkin, Elsa Marziali, Heather Munroe-Blum. Borderline Personality Disorder: Clinical and Empirical Perspectives. New York: Guilford Press, 1992. John G. Gunderson, Paul S. Links. Borderline Personality Disorder: A Clinical Guide. Chicago: American Psychiatric Pub, 2008. Paris, Maxwell. Borderline Personality Disorder.. New York: American Psychiatric Pub, 1993. Roy Krawitz, Wendy Jackson. Borderline Personality Disorder. London: Oxford University Press, 2008. Read More