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Borderline Personality disorder diagnosis is an important topic in the mental health that needs to be continuously reflected on. In this paper, we will discuss in detail matters affecting the disorder, diagnosis and the relevant education as spelt out by Dr Linehan. Family therapy is one of the recommended therapies for patients with this disorder and will also be deeply reflected in this paper.
Borderline Personality Disorder Assessment
Borderline Personality Disorder (BPD) can be defined as a cluster B of the personality disorders. In this class are other types of disorder like antisocial personality disorder, histrionic personality disorder and Narcissistic personality disorder. Disorders in cluster B have been defined as an emotional, dramatic and erratic cluster. People with this disorder have been observed to be intense, and their moods and emotions have been reported to be unstable with quick reactions, (Hoermann, Zupanick & Dombeck, 2016). People with this disorder have been said to be judgmental on others and themselves and tend to be always oscillating between all bad and all good situations.
Patients with Borderline Personality Disorder (BPD) mostly see nothing good in the world. This can be explained to be the reason for their angry outbursts and impulsive tendencies. Due to this disorder patients tend to engage in risky behaviors like substance abuse, binge eating, drug and substances abuse or unsafe sexual relationships. Patients have also been observed to always be inconsistent on issues like jobs, homes, relationships and goals. They also experience an unstable sense of which they are, (Hoermann, Zupanick, & Dombeck, 2016).
People with BPD think of either getting nothing or all. This makes them have a hard time controlling their emotions. This is due to their extremism as they have to deal with distress. This has been attributed to the self-destruction behaviors and impulsivity reported in their actions. Socially patients reported to have BPD have been noted to be harmful to their peers and are dangerous to be around. When triggered they can become insatiable thereby harming their friends. They react without much thought and are hard to please.
DMS-5 diagnosis method. The DMS-5 is a criterion that is used to describe a person with Borderline personality disorder. The criteria checks if an individual has marked impulsivity or a pervasive pattern of an unstable self-image. In many of the reported and observed pattern, this begins from childhood, (American Psychiatric Association, 2013). The DMS-5 criterion has nine ways to diagnosis BPD whereby one is required to have at least five of the nine criterions to be declared to have the disorder. These criteria are;
- Puts a lot of effort to avoid imagined or real abandonment
- The pattern of intense and unstable emotions that are torn between devaluation and idealization.
- Unstable sense of self-image that is deemed persistent.
- Self-damaging impulsivity in expenditure, binge eating, sexual activity, reckless driving or substance abuse. One needs at least two of these.
- Suicidal behaviors and other dangerous activities that is recurrent. This could also include threats, cutting and burning themselves.
- Instability when faced with moods such as anxiety, irritability and intense episodic dysphoria. In some cases, this could last for hours or a few days.
- Feeling empty which is chronic
- Increased anger and difficulty in controlling it
- Stress-related paranoia and severe dissociation symptoms.
Treatment for Borderline Personality Disorder
Currently there are no known medications that can cure BPD. However, the available medications can be used to treat other conditions that come with the illness. These conditions include anxiety, impulsivity and depression. Many a times patients are given numerous medications, however there is no a clear indication on the effectiveness or necessity of this. It is recommended that patients ensure that they have a discussion with the prescribing doctor on the possible side effects and what to really expect from the prescribed medication.
Borderline Personality Disorder treatment involves therapy like the structured cognitive therapy, e.g. Dialectic Behavioral Therapy. This therapy is not administered as the first line of medication to symptoms such as anxiety, panic and depression. One of the most used medications in the treatment for BPD is serotonin reuptake inhibitors. The medications are basically used to reduce the edge in the symptoms mentioned, (Gunderson, & Berkowitz, 2003).
Dialectic Behavioral Therapy (DBT) was conceptualized by Dr Linehan and is the first successful method of treating patients with this disorder. One of the major differences between DBT and Cognitive behavioral Therapy (CBT) is that while DBT emphasizes validation of the uncomfortable thoughts and behaviors. The patient and the therapist work towards acceptance of the different way of reaction of the patient. The term dialectic, in this case, has been applied to mean finding a solution through a compromise by the use of incompatible things.
Dr Linahan in 2012 stated that DBT was conceptualized to address five functions of treatment that is successful, motivation, capability, the generalization of gains, and structuring enhancements to support clinical progress. Dr Linahan further explains that patients who undertake the therapy have to undergo five areas of psycho-education training. They are taught skills such as mindfulness, emotional regulation, conflict management and distress tolerance, (Bell, Van Pelt, & Kridzelis, 2014). This therapy can be offered to an individual or as a group session and also applied to both inpatient and outpatient settings.
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The standard way to administer this medication/therapy is through the application of the evidence based system. This, therefore, means that there will be documented results of people who have been treated through the use of DBT. Dialectic Behavioral Therapy has since undergone some improvements as time progresses. However, the original concept of DBT as conceptualized by Dr Linehan has five functions;
- Enhancing patient`s behavioural capabilities.
- It modifies reinforcement of contingencies thereby improving the motivation for change in the patient.
- Enables a client to gain new capabilities that become part of their environment.
- Structures the environment that the therapy is administered to the comfort of both the therapist and patient.
- Enhances the motivation of the patient and the capability of the therapist to treat BPD.
The therapy is administered to patients as either a component of individual, group or family therapy. (Dimeff & Linehan, 2001). The therapy is administered in a four stage step. The first step involves helping the patient to stabilize and also gain behavioural control. This is done to reduce extreme tendencies like suicidal behaviours and other behaviours that might interrupt the therapy sessions. The first step also helps patients to improve their social, behavioral skills. To achieve this, the therapist assists the patient to learn skills such as emotional regulation, mindfulness, distress tolerance and self-management skills.
In the second stage of DBT, the objective of the therapist is to replace the desperation that exists quietly. This desperation is to be replaced with experiences that are non-traumatic. Stage three of the therapy aims to help the patient achieve ordinary happiness or unhappiness to reduce issues and any other ongoing disorder that may affect their day to day living. The last stage of the therapy involves what can be said to be the consolidation of the achievements so far. The patient is taught how to become happy and is also helped to solve their sense of incompleteness.
When attempting either biological or psychological treatment it is advisable that this is combined with social means of treatment. Patients should be advised to take up self-care activities. These activities include: good sleeping habits, prescribed medications, taking nutritious diet, regular exercising and healthy stress management. Through the application of these procedures a patient will be able to reduce the occurrence of common symptoms such as impulsive behaviors, mood changes and irritability.
While studying BPD it is important to take into consideration the biopsychosocial model. This is a broad view that suggests that disease outcome is as a result of intricate and variable interaction of various biological factors, social factors and psychological factors.
Research recently found out that BPD is caused by genetic abnormalities to a level of 60%. The genetic abnormalities were found to affect the functioning of the brain pathways that peocess the behavioral functions. These functions include processing emotion information, cognitive activities such as reasoning and perception and impulse control. There is currently no discovered specific gene for BPD. Due to this it is hypothesized that people who already have the disorder pass it on. People with other related disorders like bipolar disorder, ADHD, depression and posttraumatic stress disorder could also be responsible for BPD.
Some of the psychological factors that have been tested to cause BPD include moods, thought and behaviors. Whereas these have been found to form symptoms of BPD they have not been confirmed to be the likely causes of BPD. It is important to note that patients with BPD find it hard to control these factors and therefore their classification as symptoms and not causes.
The most critical of the social factors that puts a person to having a BPD are those related to poor or uninformed parenting. Some of these factors include repeated emotional, physical or sexual abuse, early separation from both or one parent and unsupportive and inconsistent care. Poor parenting is wide as it includes failure to protect a child from abuse from some close or an outsider. It is also possible for children who have not been exposed to these traumas to develop BPD. This therefore suggests that children who have experienced these traumas have a higher likelihood of developing the disorder.
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Borderline Personality disorder (BPD) is an illness that affects the brain o an individual. People with this disorder find it difficult to manage their emotions and impulses. This makes it hard for them to maintain a stable self-image. People suffering from this disorder can be highly distressed and eventually this shifts to also their close family members. This disorder can be confusing and is widely misunderstood however this is a treatable condition.
It is estimated that 1-4% of the population is already suffering from this condition or have suffered from it at a certain point of their life. The symptoms of this disorder appear mostly in the early adulthood and late adolescence. It has also been proven that more women than men suffer from this disorder.
Dr Linehan PhD came up with a therapy procedure that helps patients recover from this disorder. Through this invention many patients have been able to recover from the disorder. It was also revealed that Dr Linehan also suffered from the disorder at one point. This helps patients to trust Dr Linehan`s method since they feel that the inventor is also one of them. The invention by Dr Linehan is known as Dialectic Behavioral Therapy.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Bell, B. Van Pelt, C. & Kridzelis, L. (2014). Treatment of Personality Disorders Debate. The university of Phoenix.
- Chanen, A. M., & Thompson, K. N. (2016). Prescribing and borderline personality disorder. Australian Prescriber, 39(2), 49-53.
- Gunderson, J., & Berkowitz, C. (2003). An Introduction to Borderline Personality Disorder, Diagnosis, Origins, Course, and Treatment. New York, New York: NEA-BPD and NEPDA
- Hoermann, S. Zupanick, C. & Dombeck, M. (2016). DSM-5: The Ten Personality Disorders
- Cluster B. Linehan, M. (2012). Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder.