Borderline Personality Disorder

Introduction

Borderline personality disorder is a type of disorder characterized by unusual variability of moods and also depth of moods. In general, it is the disturbance of self identity, image behavior and the overall personality function. It is manifested in unstable interpersonal relationships and sometimes dissociation from people. According to the New England Journal of Medicine, borderline personality disorder, also abbreviated as BPD, can lead to suicidal thoughts and attempts (MacMahon, 2011).

Discussion

The key features of BPD are affective distress, marked impulsivity, unstable self-image and unstable interpersonal relationships. In general, people with BPD have unstable feelings about themselves and others. Their opinion of others and themselves borders on the extremes. Individuals with BPD are often intelligent, and appear friendly, warm and competent. They can sometimes remain this way until they crumble, often because of a stressful situation such as death of a close relative or end of a close relationship. The individual may exhibit constant brooding and bitterness, feelings of deficiency, and a loss of control. There are also mixed identities and confusion on issues such as life goals, sexuality, career choices, values and friendships. There is an intense feeling that one is defective or flawed. Furthermore, there is a propensity to go to extremes in thinking, behavior or feeling. In less severe cases, an individual may be greatly disrupted and therefore underperform their duties. Under extreme instances, one may experience loss of contact with reality and thus reveal weird behavior within those moments.

Individuals with BPD are likely to experience aversive tension, often caused by perceived rejection, perceived failure or loneliness. These individuals may show some forms of behavior ranging between anger, anxiety and depression. They tend to be very sensitive to emotive stimuli. There are various negative emotional states that relate to BPD including: destructive feelings; feelings of fragmentation; extreme feelings in general and feelings of victimization.

Individuals with borderline personality disorder are strongly sensitive to the way others react or behave in response to their actions or feelings. They can experience feelings of emptiness, suffer quick changes in mood and they may harm themselves..

They often perceive that they are being abandoned by close friends and relatives.  They have problems coping with rejection and abandonment. This causes them to shift their feelings towards close relatives and friends. For example, an individual can strongly admire a person but later despise that person in equal measure. Problems coping with abandonment and a rapidly change in the way they view others can contribute, in part, to their difficulties. As a result, their opinion of themselves can greatly change/shift from negative to positive and vice versa (Claud, 2009).

BPD sufferers often do things impulsively. These things can be drug abuse, eating disorders, intense sexuality, gambling and excessive spending. Individuals with borderline personality disorder are mostly hyper alert on signs of devaluation, criticism or rejection. They thus tend to be avoidant. They are mostly cynical, viewing the world as malevolent and manipulative. This leads to high levels of stress and depression. In other cases, relationships are destroyed by frequent conflicts. Romantic relationships are mostly affected since such individuals can easily develop dissatisfaction in the other partner.

According to Times magazine, features such as manipulation and deceit can be associated with BPD (Claud, 2009).  However, some critics observe that these traits can be overemphasized and this may lead to misunderstanding and hence prejudicial treatment of people with BPD.

Having suicidal tendencies is one of the characteristics of people with borderline personality disorder.  According to Claud, about 10% of people with BPD commit suicide and at least 75% do harm to themselves. Self injury is not purely carried with a suicidal intent; it may be carried without it. Suicidal attempts can also be accelerated by stressful events such as sexual abuse.

Borderline personality disorder has been proven to be a factor in the increasing rate of criminal cases. A recent study in Iowa revealed that 29.5% of inmates fit a borderline personality disorder diagnosis. Overall, in USA, the prevalence is at 17% of the total prison population. This is according to the National Education Alliance for Borderline Personality Disorder (NEABPD). The high numbers can be related to increased rate of alcohol and drug abuse among BPD sufferers. According to BEABPD, the rate is 38%.

The most outstanding characteristics BPD sufferers are their hypersensitivity to criticism, rejection, and also fearful preoccupation with anticipated criticism or abandonment (MacMahon, 2011).

Causes, incidence, and risk factors

The primary causes of borderline personality disorder are not known. Social and family issues are among the factors that are viewed as causes of BPD. There are certain known BPD risk factors such as: breakdown in communication among the family members, disrupted family life, abandonment in childhood or adolescence and sexual abuse

Borderline personality disorder, however, tends to occur frequently among hospitalized psychiatric patients and also women. Borderline personality disorder is more common than was in the past. In 2008, there was a study of nearly 35,000 adults. According to the Journal of Clinical Psychiatry, 5.9% of Americans had undergone a BPD diagnosis. In 2000, the American Psychiatric Association had reported that only 2% of the American population had the disorder. In contrast, clinicians diagnose bipolar disorder and schizophrenia in about 1% of the population. While BPD has for a long time been assumed to be greatly affecting women more than men, recent research shows slight difference in prevalence rates for men and women. Individuals in their 20s are at higher risk of having borderline personality disorder than those who are older or younger (Zanarini, Frankenburg, & Fitzmaurice, 2013).

Diagnosis and treatment

Individuals with BPD can be diagnosed based on clinical assessments by qualified professionals in mental health. This process should incorporate the clinician’s observations and also the self-reported experience of the sufferer.  The process should also be supported by reported behavior patterns by close friends and family members among other groups of people that the patient interacts with. In conclusion, diagnosis of BPD is based on psychological evaluation, history of the symptoms and their severity.

BPD has for a long time been viewed as chronic and generally untreatable. recent data shows a there is a high remission rate, (about 45% by 2 years and 85% by 10 years), as defined by meeting fewer than two criteria for at least 12 months, and a low relapse rate (about 15%). Prognosis remains discouraging in certain conditions. The suicide rate is above 8%, with more women than men having the disorder. Most patients with BPD have severe functional impairment even after remission; about 25% of patients have full-time employment and about 40% getting disability payments after 10 years (Dvoskin, 2009).

Antidepressants and selective serotonin-reuptake inhibitors are regularly prescribed to individuals with borderline personality disorder, but in randomized trials, such drugs have little if any help over placebo. Benefits for patients with BPD have been shown for atypical antipsychotic agents (such as olanzapine) and mood stabilizers (such as lamotrigine), predominantly for sinking impulsivity and aggression in those trials. However, there are side-effects.

There are renowned kinds of individual talk therapy that can treat borderline personality disorder. These include dialectical behavioral therapy (DBT). Furthermore, group therapy helps adjust self-destructive behaviors. Often, medication is used to level mood swings or any other disorders that may characterize depression (Zanarini, Frankenburg, & Fitzmaurice, 2013).

Psychotherapy allows patients to talk about both present and past experiences. The therapist needs to be accepting, emphatic and non-judgmental. The therapy should be structured and habitual. The patients need to be encouraged to speak about their feelings. Medications such as lithium carbonate, antidepressants or antipsychotic medication are helpful in the treatment of individual patients during certain times. Any drug or alcohol problem should be treated before therapy is started. Brief hospitalization is recommended for individuals who have attempted suicides in order to avert possible re-occurrence of the same. The objectives of treatment are to instill self-awareness and self-control and increase stability of relationships. At the end of the treatment, mood swings and anxiety should be reduced. Treatment increases capacity for meditation and self-observation.

Etiology

The frequency of borderline personality disorder in women is about two and a half times greater than men. This, according to MacMahon, is attributable to genetic or hormonal influences. MacMahon says that the disorder has been proved to be associated with severe cases of premenstrual anxiety. Since women generally suffer from depression more frequently than men, the increased incidence of borderline disorders among them may also be an outcome of more incestuous experiences during their early years. This constant or periodic ill-treatment and occasional brutalization often leads to impaired relationships. As a result, women develop a mistrust of men. They excessively preoccupy themselves with sexual promiscuity, sexuality, inhibitions, depression and negative self-image. In the process of development, there are multiple failures in forming relationships. This is especially so in the identity- forming phase of childhood.

Conclusion

Borderline personality disorder is the disturbance of self identity, image behavior and the overall personality function. It is also manifested in unstable interpersonal relationships and sometimes dissociation from people. Recent research shows slight difference in prevalence rates for men and women. Individuals in their 20s are at a higher risk of having borderline personality disorder than those who are older or younger.

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