Borderline Personality Disorder - Research Paper Example

One of the personality disorders that psychiatrists and clinicians encounter often among their patients is Borderline Personality Disorder (BPD). This is type of disorder that affects a significant percentage of people because of the unfriendly experiences them underwent in childhood. These experiences in turn affect their self-image, external structure and interpersonal relationships. However, a large percentage of people suffering from BPD do not know what exactly is affecting them. In actual sense, their current reactions to injures or situations are an unconscious expression of the things they experienced in childhood or adolescent stage but were suppressed. It could also be due to the influence of their genetic constitution. There is therefore a need to understand all the causes of BPD, their prevention and treatment measures and the cultural issues around it. Borderline Personality Disorder Introduction Borderline personality disorder (BPD) is a personality disorder characterized by persistent disturbance of the personality function of the affected individual. Its main feature and manifestation is a pervasive pattern of instability of the emotions, moods, self-image and interpersonal relationships in the affected person. The disorder can also manifest in devaluation and idealization episodes. The disorder mainly occurs in early adulthood (Grohol, 2007). The Diagnostic and Statistical Manual of Mental Disorders (DSM) has classified BPD as a personality disorder. Its specific criteria given by DSM IV-TR, is that the perception of impending loss of external structure, rejection or separation can lead to profound changes in the affect, cognition, self-image and behavior. These individuals experience intense inappropriate anger and abandonment fears even when faced with unavoidable changes in plans or realistic time-limited separation. They are extra sensitive to environmental circumstances. Historical context Since the existence of the earliest record of in the history of the medical field, writers such as Aretaeus, Hippocrates and Homer recognized the coexistence of intense, divergent moods within people. Aretaeus in particular described the vacillating presence of melancholia, mania and impulsive anger within a single person. The concept was revived by Theophile Bonet, a Swiss physician in 1684 after its medieval suppression. His observations were supported by other writers who realized the same patterns in people. These include writers like Hughes, the American psychiatrist in 1884 and Rosse in 1890 who in their writings, described “borderline insanity.” In 1921, Kraeplin identified an “excitable personality” which resemble with the borderline features described in the current concept of borderline. The first important psychoanalytic work to utilize the term borderline was written in 1938 by Adolf Stern. He used the term to refer to patients he thought were suffering from mild form of schizophrenia. This is a condition on the borderline between psychosis and neurosis. The term gained popularity for the next decade both in colloquial and popular use. In 1960s and 1970s, there was a shift from thinking of this syndrome as borderline schizophrenia into perceiving a borderline affective disorder, also called mood disorder, on the fringes of cyclothymia, manic depression and dysthymia. The term borderline was used psychoanalytics like by Otto Kernberg to refer to an intermediate level of personality organization that lies between psychotic and neurotic processes. A standardized criteria for distinguishing BPD from affective disorders was later developed. With the publication of DSM-III in 1980, BPD was made a personality disorder diagnosis. The final terminology that is currently used by DSM was decided by the DSM-IV Axis II Work Group that belongs to American Psychiatric Association. Causes of BPD There are various causes of BPD and history of childhood abuse and trauma is one of its possible causes. According to Aviram, Brodskyand Stanley (2006), many studies have shown that there is a strong correlation between various forms of child abuse, especially sexual abuse and the BPD development. A significant number of patients with BPD reported to have undergone such abuses by caregivers of either gender. BPD development among maltreated children is supported by attachment difficulties. Research indicates that many women with BPD have reported a history of neglect during childhood. Many state that they were neglected by a female caregiver and were abused by a male caregiver. Researchers have also suggested genetic predisposition, environmental factors, neurobiological factors and brain abnormalities as other potential causes of BPD. According to Grohol, (2007), there is evidence which suggests that BPD is closely related with post-traumatic stress disorder (PTSD). Stressful maturational events occurring during adolescence can trigger the development of BPD. Otto Kernberg developed a theory of BPD based on the premise of inability to develop in childhood. He argued that the failure to overcome split personalities increases the risk of developing BPD (Kernberg and Michels, 2009). There is also evidence of gene-predisposition to the development of a BPD. Existing research and literature indicate that genes influence the traits related to BPD. a major twin study revealed that one identical twin met the BDP criteria while the other twin met the BDP criteria in 35% of the cases. people with gene-influenced BPD normally have a close relative with the disorder. sibling, family and twin studies reveal a partially heritable ground for impulsive aggression (Grohol, 2007). Treatment approaches According to Leichsenring, Leibing, Kruse, New, and Leweke (2011), the main treatment for BPD is psychotherapy and the treatments given to patients with BPD should be based on the presentation of the individual case. Examples of psychotherapy treatments for BPD are psychosocial interventions. These include cognitive-behavioral and psychodynamic treatments. Cognitive-behavioral treatments are schema-focused and dialectical behavioral whereas the two psychodynamic treatments are transference-focused and mentalization-based. According to Paris (2010), these four comprehensive BPD interventions were reviewed in 2009 and they were all found to reduce the severity of BPD or some of its elements, mainly physical self-harm. When administering these treatments, psychotherapists should take into consideration negative attributions of the sufferer and so they should be flexible instead of making quick interpretation of the projections. The benefits of using psychotherapy to treat BPD is that it also helps to deal with other personality disorders and lead to a general improvement in the mental health of the person. This treatment type does not have any side effects compared to medications. A review conducted by Cochrane collaboration indicates that in BPD treatment, medications plays a little role and has not found wide support. In fact, hospitalization of people suffering from BPD has not been found to prevent suicide or enhance patient outcomes as compared to the community care. Medications are mainly useful when there are comorbid conditions. At such times, medications like antidepressants, second-generation antipsychotics and mood stabilizers are important. Because of the serious side effects of certain drug therapies, the UK National Institute for Health and Clinical Excellence-NICE) (2009)gives a recommendation on the management of BPD. NICE recommends that when managing BPD, drug treatment should not be used specifically be used for BPD or individual behavior or symptoms associated with the behavior. Instead, the drug treatment should be considered in the treatment of cormobid conditions. Prevention The prevention measures of BPD are aimed at minimizing the exposure of individuals to the factors that cause it for example trauma. Parents should make sure they give their children maximum care, especially the care of a female caretaker. This will prevent the occurrence of BPD as a result of neglect, attachment problems or sexual abuse by a male caregiver. According to Johnson, Cohen, Chen et al (2006)mothers should be consistent in childbearing to ensure that each child gets sufficient maternal care and avoid over-involvement in some. Children who have undergone any form of abuse should be counseled so as to help them to forget about the incidence. If this does not happen, the child will always see the unfairness and injustice in the society and will never feel safe in it. Children should be helped to identify and develop their unique values, vocational aspirations and goals to ensure they transit well from adolescence into adulthood. They should also be helped to develop a stable personality to avoid suffering from a split personality that could lead to BPD. Another intervention is to develop stress coping skills. This will ensure that a person expecting some form of separation or change of plans will be able to take it positively. Development of optimism is also important in preventing BPD. Optimistic people are more likely to perceive things positively including separation. This is unlike the pessimists who are more likely to interpret that the abandonment is because they are bad. Cross cultural issues pertaining to BPD Knowledge of the cultural background of a patient with BPD is important for the purpose of assessing the severity implied by the symptoms presented by the patient. This is because different cultures ascribe different meanings and severity symptoms to various conditions including mental conditions in relation to their cultural norms. Some could also have tendency of ascribing symptoms of mental conditions like BPD to a supernatural etiology. Cultural perceptions of BPD can cause a patient to deny referral to a psychotherapist as directed by a clinician. It also have the power to influence the type of treatment that can be used by psychotherapists when dealing with BPD. From an assessment of the various treatment options in relation to their cultural norms, the patient can accept some form of treatment and not others. Cultural background provides a base for measuring against the achievements made by the patient for example the expected level of self-image and self-expression. In some cultures, the expected level of self-expression among different genders is different. In a secular society, women have a high level of freedom for self-expression compared to the conservative ones. This means the measure for the level of confidence and positive self-image gained will vary. For example, a woman from a secular society will start becoming more free, outgoing, open and cheerful. On the other hand, the one from a conservative culture may not do these things because in such cultures, women have to be seen before being heard. Biblical Worldview From a biblical point of view, the main causes of BPD is vengeance and inability to forgive. This is, repaying evil for evil. As noted, one of the characteristics of this disorder is impulsivity in self-damaging acts like substance abuse, recklessness and even promiscuity. This means the person wants to hurt others by engaging in these activities so that they can also reach out to others in a bad way for example violence. It is also caused by lack of faith. We ought to believe that Christ promise to be with us until the end of ages and therefore there is no particular day in which we are alone. Even when our parents, spouses or friends die, he remains and thus we should never feel empty. One best way of preventing BPD is to forgive, let go and pray for the salvation of those who hurt us. One of the treatment strategy outlined in the bible is always to remind oneself of the intense suffering of Christ even to the point of death. In all this, he was still able to forgive those who hurt him, including his closest friend peter who denied him at the most critical hour. The Holy Bible in 1Peter 3:8-9a advices that we should not pay evil for evil, but blessing. It says “Finally, all of you, be of one mind, sympathetic, loving toward one another, compassionate, humble. Do not return evil for evil, or insult for insult; but, on the contrary, a blessing. . . .”This means we should stop reacting out of rage or engaging in self-hurting activities because of the pain in us. We ought to surrender our unconscious satisfaction as victims and instead, we give to other what our parents failed to give to us. Conclusion BPD is a personality disorder that should be responded to immediately and appropriately because it has the potentiality of destroying the self-image of a person and blocking them from achieving to their fullest. It also makes it difficult for them to adjust to the environment or any changes. The major causes of BPD are history of child abuse, PTSD, failure to overcome split personalities and stressful maturational events. Genes play a part if there are close relatives with the disorder. There is no medical treatment for BPD. In order to help the patient accept that the past is gone and know the positive side of life was also meant for them, they have to undergo psychotherapies like cognitive-behavioral and psychodynamic treatments. These will enable them to build new patterns of reactions, behavior and perceptions. Future research in this topic should focus on the degree to which the name Borderline Personality Disorder reinforces the existing stigma. This will form the basis for maintaining the name or changing it. References Aviram, R. Brodsky, B. and Stanley, B. (2006). “Borderline personality disorder, stigma, and treatment implications.” Harv Rev Psychiatry. (5) pp 249–56. Grohol, J. (2007). “Borderline Personality Disorder.” Psych Central. Online: http://psychcentral.com/lib/2007/symptoms-of-borderline-personality-disorder/. Viewed on 14th, October, 2011. Johnson, J. Cohen, P. Chen H, et al (2006). “Parenting behaviors associated with risk for offspring personality disorder during adulthood.” Arch Gen Psychiatry. (630) pp 579-587 Kernberg, O. F., and Michels, R. (2009). Borderline Personality Disorder. American Journal of Psychiatry. (166) pp 505-508. Leichsenring, F. Leibing, E. Kruse, J. New, A. and Leweke, F. (2011). “Borderline personality disorder”. Lancet (9759) pp 74–84. Paris, J. (2010). “Effectiveness of Different Psychotherapy Approaches in the Treatment of Borderline Personality Disorder.” Current Psychiatry Reports. (1) pp 56–60. The Holy Bible. King James Version. The UK National Institute for Health and Clinical Excellence -NICE) (2009). Clinical guideline for the treatment and management of BPD.” Online: http://www.nice.org.uk/nicemedia/live/12125/42900/42900.pdf. Viewed on 14th October, 2011. Read More