Borderline Personality Disorder
Introduction
Internet and on-line libraries offer variety of materials related the research of the borderline personality disorder (BPD). In this research paper works of Grohol, Winston, and Paris were used to address the current issues of BPD research progress. The main issues addressed in the paper are: the definition of borderline personality disorder, symptoms of the disease, current statistics of BPD, treatment, and current developments regarding new treatment methods.
1. Borderline Personality Disorder (BPD) Definition and Background
In accordance with National Collaborating Centre for Mental Health (NCCMH) (2009) research, the term “borderline personality disorder” was first introduced by Otto Kernberg in 1975 which described mental instability. The term was adapted in the U.S. and then spread to the U.K. (NCCMH, 2009). Borderline personality disorder (BPD) is a mental illness which is characterized with instability of interpersonal relationships, emotions, and wrong self-appraisal. It is considered to be one of the most controversial diagnoses in today psychology. Contemporary researches do not know much about the reasons of BPD occurrence. Grohol (2010) mentioned several theories regarding BPD causation. Researches of BPD usually mark out biological and genetic factors among the most frequent reasons of BPD. Some of them refer to psychological factors. For example, negative experience in childhood, such as sexual, emotional, physical abuse or emotional and physical neglect when describing the causes of BPD was mentioned (Grohol, 2010).
2. Symptoms of BPD
Usually borderline personality disorder is characterized with the following symptoms: feeling of abandonment, inability to develop adequate interpersonal relationships, identity disturbance, feeling of emptiness, suicidal propensity, paranoid thoughts, impulsive behavior, and intense anger (Grohol, 2010). The cases of BPD are often diagnosed in early adulthood period (after 18 years), but sometimes the illness occurs in an earlier age.
NCCMH (2009) reported that BPD is characterized by frequent changes of mood, tendency towards self-harm, total despair, and changeable self-image. Patients can often feel rejection and abandonment, display psychotic symptoms such as hallucinations and delusions.
3. BPD Occurrence Statistics
In general, from 1% to 3% of the world population are affected by this mental disease. In accordance with statistics data given by National Institute of Mental Health (NIMH) (n.d.), 1.6% of the U.S. population suffers from BPD. Interestingly, there is no any sex or race linkage to the percentage of borderline personality disorder cases. Besides, 42.4% of the patients in the U.S. are receiving an appropriate treatment (NIMH, n.d.). BPD is typically diagnosed by psychologists and psychiatrists, i.e. trained mental health professionals. General practitioner or family physician could hardly diagnose this disease because of insufficient training (Grohol, 2010). Unfortunately, one tenth of the patients actually succeed in committing suicides. Thus, such patients require constant attention and support (Paris, 2005).
4. Treatment of BPD
Treatment of BPD includes various methods, such as pharmacological treatment, psychological interventions, art therapy, group therapy, and many other methods. As BPD is often accompanied by depression, substance misuse disorder, bipolar disorder, or psychosis, pharmacological treatment includes using specific drugs, such as mood stabilizers, antidepressants, and antipsychotics which are common in traditional practice (NCCMH, 2009).
Psychological intervention is a joint approach of the U.S. and U.K. scientists which is also called “talking treatment”. No specific method is applied using this therapy. Specialists are trained to work flexibly depending on the situation (NCCMH, 2009).
Art therapies are widely used in the U.S. and Europe as a part of BPD treatment program. Art therapies include dance movement therapy, music therapy, dramatherapy, and other associated therapies. The work of the therapist in the framework of art therapy is similar to the psychoanalysis interpretation. Art therapy can be used only for slight forms of BPD because more serious therapy is needed for severe forms of the disease (NCCMH, 2009).
Winston (2000) describes another method called therapeutic communities which is considered a very effective therapy. Patients with BPD diagnosis are involved in social group process together with therapeutic intent.
5. Recent Developments in BPD Research
There are many variations of individual and group therapies, such as group analytic therapy, systemic therapy, dialectical behavior therapy, nidotherapy, schema-focused cognitive therapy, psychoanalytic psychotherapy, interpersonal therapy, and cognitive-analytic therapy (Winston, 2000; NCCMH, 2009). Various group therapies usually bring good results.
Dialectical behavior therapy considers BPD as deficit of interpersonal communication skills and is aimed at teaching patients these skills. This could be an individual or a group therapy based on the therapy sessions and telephone contacts with the therapist. Dialectical behavior therapy brought good results in reduction of self-harm, hopelessness, and depression. The therapy is sometimes considered as a high level of support but not a medical treatment (Winston, 2000).
Psychoanalytic psychotherapy is another approach to the treatment of BPD which combines self-psychology, medical treatment, and “conversational model” of Hobson. The psychotherapy showed good results in violent behavior, instability and impulsivity improvement, but only a minority of patients benefited from this treatment method (Winston, 2000).
Interpersonal therapies, for example, structural analysis of social behavior, aimed at modifying interpersonal behavior. The method was originally designed to treat depression but later was adapted in BPD patients’ therapy. It requires certain preparation and can be applied after the patients are morally ready for it. This method is designed to identify maladaptive interpersonal patterns and then uses an eclectic mix of certain techniques, including free association, analysis of dreams, assignments, and role playing. The affect of this therapy is not studied enough for now (Winston, 2000).
Cognitive-analytic therapy is a kind of individual therapy which aimed to develop links between early experience and current behavior to compare two models of behavior. Self-states identification is designed to help the patient experience healthy way of building relationships with outer world. The method is very promising and is effectively used in clinical practice.
Schema-focused cognitive therapy is designed to identify and modify maladaptive schemas which have the origin in childhood experience and are not easily changeable, such as, rejection, disconnection, impaired performance, limits and autonomy, inhibition, other-directedness, and excessive vigilance. The therapy is in identifying core schemes and further discussion of the images (Winston, 2000).
6. Prognosis of BPD Treatment
Dealing with BPD diagnosis patients could sometimes be onerous because of recurrent suicidal attempts. It sometimes happens that a patient cannot respect boundaries and could become overly attached to his or her therapist.
However, most of the patients show significant progress after therapeutic arrangements. In accordance with statistics given by Paris (2005), 75 percent of patients with BPD diagnosis recover by the age of 35-40 years. Almost all of the patients (90%) recover by the age of 50 despite of the fact the mechanism of recovering is not understood (Paris, 2005).
Despite of significant improvements in BPD therapies, there is a room for further research. While many of BPD patients proceed to be treated by general psychiatrists, alternative therapies had shown essential results in BPD treatment and improvement patients’ condition.
7. Mental Health Services for BPD Patients
Borderline personality disorder poses an essential challenge to a healthcare system. The illness does not have “acute” phases, thus, some researches doubt the responsibility attributed to the healthcare system in this case. For the purposes of regulating the treatment of such patients, National Institute for Mental Health in England developed guidance for people with BPD. The main idea of the document is to assist people with BPD, help them in accessing clinical care and find mental health specialist; to address BPD patients’ offending behavior providing necessary treatment; to ensure the patients receive proper forensic services; to establish education for mental health specialists and provide effective management in the sphere (NCCMH, 2009).
Social services also provide a wide range of services for people with mild and severe mental health problems, including BPD. Care provided by social services is less medicinal and determined by the patient social needs. It is less influenced by the diagnosis and allows achieving significant improvement in social adaptation of BPD patients (NCCMH, 2009).
Conclusion
Borderline personality disorder is a mental illness which requires serious treatment and a lot of attention from the therapist’s part. There are many methods of BPD treatment which bring good results despite of the fact that BPD patients are sometimes difficult to treat because of the inclination for committing suicide. Fortunately, the quantity of the patients is minor and usually they quickly recover. Mental health services are constantly improving offering necessary training for the specialists.
References
Grohol, J. (2010, June 1). Borderline Personality Disorder. Retrieved from
http://psychcentral.com/lib/2007/symptoms-of-borderline-personality-disorder/
National Collaborating Centre for Mental Health (NCCMH). (2009). Borderline Personality Disorder. Available from http://www.rcpsych.ac.uk/files/samplechapter/BorderlinePDSC.pdf
-978-1-85433-477-0
National Institute of Mental Health. (n.d.). Borderline Personality Disorder. Retrieved from
http://www.nimh.nih.gov/statistics/1Borderline.shtml
Paris, J. (2005, June 7). Borderline Personality Disorder. CMAJ, 172(12), 1579-1583.
Winston, A.P. (2000). Recent Developments in Borderline Personality Disorder. Advances in Psychiatric Treatment, 6, 211–218.
