The diathesis stress model of borderline personality disorder - Essay Example

The Diathesis Stress Model of Borderline Personality Disorder There has been a lot of research focusing on individuals with personality disorders. A particular area of interest for clinicians has been to assess the development of Borderline Personality Disorders. There is recognition that among the clinical population with personality disorders, 30% to 60% are diagnosed with BPD (American Psychiatric Association, 2000). To start with, Borderline Personality Disorder, a Cluster B Personality Disorder, stands on the “border between neurosis and psychosis,” (American Psychiatric Association, 2000; Johansen, Karterud and Pedersen, et al., 2004) and is described by an odd and erratic affect, mood, behaviour, object relations and self-image. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the diagnosis of Borderline Personality Disorder can be made by early adulthood (2000). Patients with BPD almost always appear to be in a state of crisis. Patients can be argumentative at one moment, depressed at the next, and later complain having no feelings. Patients may have short-lived psychotic features and in disassociation (American Psychiatric Association, 2000; Medina, 2004; Oldham, 2004 ).Their behaviour is highly unpredictable, and they may often resort to repetitive, self-destructive acts such as self-mutilation, suicide attempts to express anger, and to numb themselves to an overwhelming affect (Brodsky, Malone, Ellis, et al.1997). Because they feel dependent and hostile, patients with BPD have chaotic interpersonal relationships. They have low self- esteem, and they fear being alone. To ease loneliness, they may accept a stranger as a friend or behave promiscuously. These pervasive personality traits present are maladaptive, dysfunctional and often produce impairment and distress in the family, occupation and personal life (Lis, Greenfield and Henry, et al., 2007). Conceptualization of the Development of Borderline Personality Disorder No exact cause of Borderline Personality Disorder has been found. But numerous studies believe in the interaction of both genetic and environmental factors that precipitated this disorder. Biological and Genetic Factors Research has indicated that Borderline Personality Disorder is related with genetic abnormalities. There are certain brain procedures bringing about mood instability such as aggression, anger, impulsivity and negative emotion (Goodman and Siever, 2005). Studies suggest that people prone to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The amygdala, a significant structure inside the brain, is in charge of regulating expressions of emotions (Bogod, 2000; Lis, Greenfield and Henry, et al., 2007). People with BPD display extreme emotions of aggression, inappropriate anger and excessive fear of abandonment. The automatic reaction, which is a hysterical respond to avoid abandonment and loneliness includes impulsive actions such as self-mutilating and suicidal tendencies. In addition, the relationship between a dysfunctional amygdala and Borderline Personality Disorder has been established in studies. Results revealed people suffering from BPD has a reduced volume of amygdala than those people without any mental illness (Berlin, Rolls, and Iversen, 2008; Bogod, 2001). With neuroanatomical considerations, both symptoms associated with BPD and biological research findings support the hypothesis that this disorder involves pathology of the limbic system, the basal ganglia and the hypothalamus. People with abnormalities of basal ganglia and the limbic system are likely to show unstable affect (Bogod, 2001; Lis, Greenfield and Henry, et al., 2007). The limbic system and the basal ganglia are intimately connected, and the limbic system may well play a major role in the production of emotions. Patients’ dramatic shift and display of intense emotions such as dysphoria, despair or anxiety may suggest dysfunction of the hypothalamus (Goodman and Siever, 2005). Another theory about the biological etiology of Borderline Personality Disorder looks at the role of serotonin and norepinephrine, the neurotransmitters in the brain that are known to play a part in mood (Lis, Greenfield and Henry, et al., 2007). Drugs such as Serotonin-norepinephrine reuptake inhibitors (SSRIs) have a huge effect on the treatment of emotional symptoms associated with Borderline Personality Disorder. (Berlin, Rolls, and Iversen, 2008). Besides the fact that SSRIs are effective in the treatment of disorders connected with mood, other data indicate that depletion of serotonin may precipitate depression, and some people with BPD who have suicidal impulses have low concentrations of serotonin metabolites and low concentrations of serotonin uptake sites on platelets (Goodman, New and Siever, 2004; Lis, Greenfield and Henry, et al., 2007). Existing literature notes a familial pattern for BPD. As stated in DSM-IV-TR, “Borderline Personality Disorder is five times more common among fist degree biological relatives” (2000). Further, recent twin studies uncovered evidence where incidence of Borderline Personality Disorder more prevalent among the identical twins of BPD patients than in the general population (Goodman, New and Siever, 2004). These findings show the implication of biological and inherited genetic factors and their contribution to the development of BPD. Environmental Stressor A very powerful theory links BPD with history of early childhood trauma. Although childhood trauma is not conclusive to all patients with Borderline Personality Disorders, strong evidence from research findings notes a high incidence of childhood abuse among patients with BPD. More than 50-80 % of these patients suffered unresolved traumatic experiences such as sexual abuse (American Psychiatric Association, 2000; Barone, 2003; Goodman and Siever, 2005). It has also been shown how the psychological effects of sexual abuse can be devastating and long lasting. Children tend to lose self confidence, and become more mistrustful of their surroundings. This is a significant predisposing factor to later symptom formation of Borderline Personality Disorder. Patients with BPD tend to become excessively alert to external aggression as shown by their inability to deal with their own hostile impulses toward others (Barone, 2003). Adolescents who have undergone sexual abuse are said to have poor impulse control and self-destructive and suicidal behaviors. Signs of dissociation are described when patients do not feel pain or feel that they are somewhere else. According to DSM-IV-TR, patients perform self mutilating acts to “bring relief by reaffirming their ability to feel” (2000). The link of suicidal behaviors and Borderline Personality Disorder was studied by Brodsky, Malone and Ellis, et al., (1997). Results show a total of 214 patients diagnosed with BPD having a history of childhood trauma and current suicidal behaviours. This finding implies the significant association of childhood abuse with the high rate of impulsive acts characterized by suicide attempts. In addition, literature from research highly correlates physical abuse and child neglect with Borderline Personality Disorder. Patients who were physically, emotionally maltreated and abandoned in the past often exhibit disturbed self perception and social relationships, both considered symptoms of BPD (Barone, 2003; Goodman, M., New, A., and Siever , L., 2004). During the course of the traumatic experience, the child becomes bewildered, confused and frightened of rejection, often projected through feelings of low self- esteem. Inappropriate fears of abandonment and separation may be constant and repetitive, putting tremendous strain in personal relationships (Read, Perry, and Moskowitz, et al., 2001; Zubin & Spring, 1977). The Diathesis Stress Model of BPD There seem to be a link among the factors discussed in relation to BPD. To fully understand the interaction, it is useful to explore a psychological theory widely used to explain various types of psychopathology and their development: The Diathesis-Stress Model. The Diathesis–Stress Model describes a person’s behavior as both a result of the predisposing variables such as biological and genetic (diathesis), and life events (stress). When an individual has abnormalities or impairment in the amygdala, limbic system or frontal cortical areas, he may be more vulnerable or at risk to emotional and mood imbalance. Further, the presence of childhood trauma such as sexual, physical abuse and abandonment causes more stress and contribute to the development of an early onset of BPD (Nemade, Reiss and Dombeck, 1995). In a Diathesis stress framework, emotional imbalance or vulnerability caused by biological and genetic factors is the diathesis, and childhood trauma as the environmental stressor. When individuals at risk of emotional imbalance encounter childhood trauma, their fears, poor self perception and negative view of the world are likely confirmed by social experiences. In the absence of childhood trauma, individuals at risk of emotional imbalance may be inclined to have distorted feelings toward the self and society. These imagined negative perceptions may often lead to depression, however, in the course of treatment, they may be able to overcome their fears because these fears have not been reinforced by social experiences. According to the model, the greater the vulnerability, the lesser stress is required to produce the disorder. On the contrary, where there is a lesser vulnerability, the greater environmental stress is needed to trigger the BPD (Monroe and Simons, 1991). Further, not all individuals with a diathesis towards Borderline Personality Disorder will acquire the disorder. The overall involvement of genetic and biological vulnerability and environmental stressors to an individual’s disorder would be more than the total of their individual effects because of the diathesis stress process (Walker and Diforio, 1997). 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