Borderline Personality Disorder Case - Essay Example

Running Head: PERSONALITY DISORDER CASE STUDY Personality Disorder Case Study Name Tutor Date Personality Disorder Case Study Introduction Borderline personality disorder (BPD) refers to one of the psychiatric conditions known as personality disorders (Dean, 2008). Basically, it is a mental disorder typified by distressed and unsteady interpersonal relationships and self-image as well as impetuous, uncontrolled, and frequently self-destructive behavior. Individuals having BPD have problems when relating to other people. However, with treatment, the symptoms can be controlled better, reduced or even eradicated. The most notable symptom with people having BPD includes having difficulties in relating to other individuals and also the world around them. Other symptoms can consist of, idealizing or devaluing other individuals, problems in compromising, notable impulsiveness in activities that can be self-destructive: for instance, overspending their money, sex or drug abuse. Moreover, people with BDP normally display extreme anger outburst, anxiety as well as depression (Moskovitz, 2006). Fundamentally, individuals with BPD may display intense behavior, like recurring self-mutilation or taking overdoses of medication. There could be various reasons for such behavior. An individual having BPD can feel that they are reliant on other people for their identity or might be afraid of being deserted. Their intense behaviors are hysterical efforts to stay away from real or imagined rejection. Such behavior is regularly overlooked as mere attention seeking or manipulation (National Library Australia, 2003). Nevertheless, such behavior is a symptom of BPD and professional assistance is required in addition to education and support for the family and also other carers (Stone, 2006). In Australia, approximately two in every hundred individuals (about 300,000 Australians) will develop BPD. Women are three times more probable than men to develop BPD. To be precise, it is projected that between 2% and 5% of the Australian population are affected by Borderline personality disorder at some stage in their lives. Most people normally experience BPD symptoms when they are in their mid to late teens, or as young adults (British Medical Association, 2004). The main causes of Borderline personality disorder are not clear but might consist of psychological factors, biological factors in addition to social factors. Adults with BPD in most cases have a history of considerable childhood trauma like emotional, physical sexual abuse and parental abandonment or loss (Sophie, 2002). Feelings of insufficiency and self-loathing that develop as a result of these circumstances might be the main cause of BPD. Research has also demonstrated that these patients try compensating for the care they did not get during their childhood through the idealized demand they make when adults on themselves as well as on other people. Studies have also shown that the disorder is linked to mood or impulse control problems and also malfunctioning neurotransmitters. In general, Borderline personality disorder has a genetic correlation because it takes place frequently among first-degree relatives (Cedar et al, 2001). In terms of diagnosis, Borderline personality disorder characteristically appears in early adulthood. Even though the disorder can take place in adolescence, it can be hard to diagnose because symptoms like impulsive and experimental behaviors, insecurity as well as mood swings are common, even developmentally suitable occurrences during adolescence. The symptoms could also be caused by chronic drug abuse or some medical conditions. These are supposed to be ruled out prior to making a borderline personality disorder (Linehan, 2003). Borderline personality disorder mostly occurs with mood disorders, for instance depression and anxiety, post-traumatic disorder, eating disorder, deficit as well as other personality disorders. BPD is diagnosed through interviewing the patient and corresponding symptoms to the DSM criteria. Furthermore, supplementary examination might also be essential (Linehan, 2004). In Australia, BPD patients represent the greatest percentage of diagnosed personality disorders, approximately 60%. This is because these patients seek treatment more because of fear of abandonment. Offering effectual therapy for the BPD patient is essential, but a difficult task. The relationship between the therapist and the patient is subject to the same inapt and impractical demands that borderline personalities place on all their considerable interpersonal relationships (Stone, 2006). They are chronic "treatment seekers" who are easily discouraged by their therapist if they feel they are not getting enough attention or compassion, and symptomatic rage, impulsivity, and self-destructive behavior can hold back the therapist-patient relationship. Nonetheless, their fear of neglect, and of stopping the therapy relationship, can in reality make them terminate treatment as soon as improvement is noted (Tasman, 2010). Psychotherapy normally in the form of cognitive-behavioral therapy, is generally the preferred therapy for BPD. Dialectical behavior therapy, which is a cognitive-behavioral technique, is an efficient therapy for BPD patients who are with suicidal. The treatment majors on providing the borderline patient with self-confidence and coping tools for life outside of treatment through an amalgamation of social skill training, mood alertness and thoughtful exercises, along with education on the disorder. Group therapy is also an effective therapy, though some patients might feel vulnerable by the idea of "sharing" a therapist with others. Medication though considered not very effective can also be used in treating some BDP symptoms. Current clinical studies show that naltrexone can be useful in reducing the physical discomfort associated with dissociative episodes (Tasman, 2010). Part B Management of Short Term Goals The main problems/Issues include: Self harm where Laura is cutting her wrists with a razor and persistent impulsiveness: This is another form of self harm is where Laura has been abusing drugs and alcohol constantly as well as being involved with multiple sexual partners. On the other hand, short – term goals include, building a therapeutic relationship between the therapist and Laura, avoiding deterioration of Laura’s current condition, Limiting harm: This means that the most effective ways of reducing and preventing Laura from self-harm (for example where she cut her wrists with a razor) should be employed immediately, treating comorbid Axis I disorders as well as treating specific areas, for example anger, self-harm, social skills, offending behavior being demonstrated by Laura. For the interventions /strategies: Dialectical behavioral therapy can be employed when handling and treating Laura. This is because this treatment will help Laura in balancing both acceptance and change, with the overall goal of not just assisting Laura to survive and quit from self destructive behaviors but also making her life worth living. This treatment should be delivered in four stages whereby Laura’s self-harm of cutting herself will be given the first priority. In the second stage, Laura will be encouraged to experience the painful emotions she has been avoiding. The necessary rationales in Laura’s case include, the self-damaging behaviors necessitate not only urgent attention but also competent handling, because they are ego-syntonic in the borderline patients, and as a result not as easily discouraged as such hurting and disrupting behaviors would be in ordinary people (Tasman, 2010), (Stone, 2006). Management of Long Term Goals The problems and issues in the management of long-term goals consist of: deep feelings of insecurity: This is depicted where Laura feels that her boyfriend is leaving her and as a result cuts herself is an attempt to attract his attention so that he will not eventually leave her. Confused, contradictory feelings: Initially, Laura says she wanted to harm herself after having a fight with her live-in boyfriend. The patient also has superficial cuts to her abdomen and tells you that she is 6 months pregnant Laura says her boyfriend, who she has been dating off and on for 10 months, is an “evil monster. On the other hand, eventually she says that she cut herself to prevent her boyfriend from leaving her. Apparently she is confused and contradicting herself. Anxiety or mood disorders: Such problems are exhibited by Laura where during the interview she vacillates between anger and tears, with episodes of laughter in between. This signifies severe mood swings as well as excessive worrying. Then again, the short – term goals include: Providing the necessary support: This means that the therapist should establish a way of supporting Laura emotionally. This can include talking to her family as well as her carers for them to offer her the necessary support. Monitoring and supervision: The therapist should ensure that Laura is always monitored and supervised to make sure that even in future she does not engage in activities that are harmful to her. A routine evaluation should be carried out on Laura regularly. In regard to intervening in crises, Laura exhibits bouts anger and therefore the therapist should ensure that the environment is calm. It is also important to try to understand why Laura is distressed and stimulate reflection regarding solutions. Increasing motivation and compliance: This objective is to make sure that Laura gets motivation in life and complies with the normal life’s obligations. Finally, reducing distress will assist Laura in lowering her stress level as well as the anxiety levels. In regard to interventions /strategies, psychotherapy will be an appropriate intervention for Laura. The therapy can provide Laura with counseling and mind relaxing sessions that will help her calming her mind and in tackling the anger and mood swing. Personal centered care is another strategy that can be used in handling Laura since it will give preference to Laura’s needs and preferences (Ross, 2004). The rationale here is that psychotherapy can be effective in Laura’s treatment because the therapist will not only be focusing on reducing self-damaging acts and other disturbing symptoms like depression, anger and such, but will also be focusing in improving Laura’s ability to function in work, friendship maintenance in addition to fostering to fostering success in intimate relationship (Laura and the husband) (Tasman, 2010). Conclusion Laura needs support such as family as well as community support groups as this will help her and feel involved within the community and be supported by individuals who understand what she is experiencing. Psychological therapy will be important for Laura as she will learn on how to relate with people. Dialectical behavioral therapy will help her in handling her emotions and how she responds to problems and other people as well. Finally, Cognitive Behavioral Therapy will help Laura to identify the problematic thoughts and behaviors and she will eventually be able to replace them with more positive thoughts and behaviors (Otto et al, 2007). References British Medical Association. (2004). Medical journal of Australia, Volume 160, Issues 7-12. Dean, M. (2008). Governing Australia: studies in contemporary rationalities of government. London: Cambridge University Press. Cedar, R, et al. (2001). Efficacy of Dialectical Behavior Therapy in Women Veterans with Borderline Personality Disorder in Australia. Behavior Therapy. 32, 371-390. < http://depts.washington.edu/brtc/files/Koons%20et%20al%202001.pdf>. Linehan, M. (2003). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Austria: Guilford Press. Linehan, M. (2004). Skills Training Manual for Treating Borderline Personality Disorder. Canada: Guilford Press. Moskovitz, A. (2006). Lost in the Mirror: An Inside Look at Borderline Personality Disorder. Dallas, TX: Taylor Publishing. Otto, F, et al. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multi- wave Study. Am J Psychiatry. 164:922–928. < http://www.personalitystudiesinstitute.com/pdf/rct-clarkin-et-al.pdf>. Sophie, D. (2002). Principles of managing patients with personality disorder. Advances in Psychiatric Treatment. Vol. 8/ 1-9. Tasman, A. (2010). Psychiatry. Sydney: Saunders Company. Stone, M. (2006). Management of borderline personality disorder: a review of psychotherapeutic approaches. Columbia College of Physicians and Surgeons. PMCID: PMC1472266. < http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472266/>. National Library Australia. (2003). APAIS, Australian public affairs information service: a subject index to current literature. Singapore: National Library Australia. Ross, A. (2004). The Osiris complex: case studies in multiple personality disorder. Toronto: University of Toronto Press. Read More