Borderline Personality Disorder: Theory and Practice - Essay Example

Borderline Personality Disorder Borderline personality disorder (BPD) has been one of the most important personality disorders defined in DSM-IV and it refers to a protracted disorder of personality function in a human being, usually a person over the age of eighteen years. Significantly, a person with BPD typically exhibits abnormal levels of instability in mood, because this disorder is noted for depth and inconsistency of moods. According to DSM-IV criteria for borderline personality disorder, it is a "pervasive pattern of instability of interpersonal relationships, self image, affects, and control over impulses beginning by early adulthood and present in a variety of contexts" (Diagnosis and Statistical Manual of Mental Disorders, 2000, P 88). It is also important to recognize that a person with a borderline personality disorder frequently has a repetitive pattern of disorganization and volatility in self-image, mood, behavior, and close personal relationships, which normally causes considerable distress or destruction in friendships and work. Also called Emotionally Unstable Personality Disorder, BPD is characterized by impetuous actions, quickly changing moods, and chaotic relationships. As Richard J. Corelli maintains, "a person with this disorder can often be bright and intelligent, and appear warm, friendly and competent. They sometimes can maintain this appearance for a number of years until their defense structure crumbles, usually around a stressful situation like the breakup of a romantic relationship or the death of a parent." (Corelli). As a result of the various characteristics of this disorder, an individual with BPD frequently meets one emotional crisis after another and he often encounters separation anxiety, dependency, unbalanced self-image, chronic feelings of purposelessness, and threats of self-harm. The various disturbances associated with this disorder have a persistent negative impact on the various psychosocial facets of a person's life. This paper makes a reflective exploration of the borderline personality disorder in order to comprehend the various factors and characteristics connected with this disorder. In a profound analysis of borderline personality disorder, it becomes lucid that it is one of the major personality disorders defined by DSM-IV-TR of the American Psychiatric Association. Previously known as character disorders, personality disorders refer to a class of personality types and behaviors which, as the American Psychiatric Association defines, diverge strikingly from the expectations of the culture of the person with BPD. It is important to comprehend that the DSM-IV lists ten types of personality disorders which are classified into three clusters in Axis II and the BPD belongs to the Cluster B (dramatic, emotional or erratic disorders) of the classification. According to the DSM-IV code 301.83, borderline personality disorder is characterized by extreme 'black and white' thinking, instability in relationships, self-image, identity and behavior. "The essential feature of Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts." (DSM IV: Criteria for Borderline Personality Disorder). A reflective analysis of DSM-IV code 301.83 suggests that BPD refer to a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and discernible impulsivity which begins in a person by early adulthood and it is observable in the individual in a variety of contexts. These contexts include hysterical efforts to keep away from real or imagined abandonment, a pattern of unbalanced and extreme interpersonal relationships, identity disturbance, impulsivity in areas that are potentially self-damaging, repeated suicidal behavior, affective instability as a result of a discernible reactivity of mood, constant feelings of barrenness, intense anger, and temporary, stress-related paranoid ideation or severe dissociative symptoms etc. "Individuals with Borderline Personality Disorder may have a pattern of undermining themselves at the moment a goal is about to be realized... Some individuals develop psychotic-like symptoms (e.g., hallucinations, body-image distortions, ideas of reference, and hypnagogic phenomena) during times of stress." (DSM IV: Criteria for Borderline Personality Disorder). Therefore, various types of personality traits are associated with a person with this disorder and recurrent job losses, interrupted education, and broken marriages are common phenomena to them. It is fundamental to realize that Borderline Personality Disorder is the personality disorder that most researched, written about, and studied by several scholars and it remains a major source of concern for clinicians. Although known for its notoriety, there is a large-scale disagreement that it should be listed in Axis II diagnosis category and many argue that it should be regarded as a variant of depression, bipolar disorder, or another Axis I disorder. Borderline personality disorder was historically known as pseudo-neurotic schizophrenia, schizophrenic characters, ambulatory schizophrenia, or latent schizophrenia. There have been several important efforts to understand this disorder which seemed to be between or on the border of neurosis and psychosis made by various psychoanalytic theorists and researchers, and recently, by descriptive and phenomenological researchers. In the beginning, the borderline patents were often diagnosed with the DSM-II category of schizophrenia, latent type, and later BPD was added to DSM-III, largely due to the increasing interest and literature about this disorder. "Dissatisfaction with the failure of DSM-III and DSM-III-R to account for brief psychotic episodes prompted the inclusion of transient, stress-related paranoid ideation of severe dissociative symptoms as a criterion in DSM-IV. Still, there remained concern about the borderline designation: Is it a specific personality disorder, or is it a dimension of personality or personality organization or spectrum disorder" (Sperry, 2003, pp 81-2). Therefore, it is essential to realize that there is a significant debate on the nature of this disorder which has a prevalence rate of 2 percent in the general population. Significantly, the Collaborative Longitudinal Personality Disorders Study supports the viability of BPD as a statistically coherent construct and internally consistent diagnostic category. According to this study, all nine DSM-IV diagnostic criteria can be included under three factors such as affect dysregulation, behavior dysregulation, and disturbed relatedness. "Borderline personality disorder can be recognized by the following descriptors and characteristics: style vs. disorder, triggering event, behavioral styles, interpersonal style, cognitive style, affective style, attachment style, and optimal criterion." (Sperry, 2003, pp 81-2). Thus, it is essential to realize that there is fundamental difference between borderline personality disorder and borderline personality style. In this reflective exploration of borderline personality disorder, it is fundamental to recognize this disorder as a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. It has also been maintained that the BPD affects one's family life, relationships in workplace, long-term planning, and the sense of self-identity in the individual. Significantly, a high rate of self-injury without suicide intent as well as a considerable rate of suicide attempts and completed suicides is associated with people with borderline personality disorder. It is important to offer extensive mental health services to such people with BPD. In a profound analysis of the important symptoms of borderline personality disorder, it becomes lucid that people with BPD normally experience extreme bouts of anger, depression, and anxiety which often may last only for few hours, or at most a day. "These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are." (Borderline Personality Disorder, 2009). Most importantly, these symptoms are most heightened when people with BPD feel isolated and lacking in social support, and such people make frenetic efforts to stay away from being alone. It is widely recognized that people with BPD habitually experience highly unbalanced patterns of social relationships and their attitudes towards others abruptly shift from idealization to devaluation. This particular characteristic in the personality style of the person with BPD makes him appear inconsistent with his relationships and he is highly sensitive to rejection even with family members. Similarly, the fears of abandonment very often offer serious difficulties to these people who are left feeling lost and perhaps worthless. "Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments. People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders." (Borderline Personality Disorder, 2009). Borderline Personality Disorder has become one of the most important concerns for psychoanalysts and the nine diagnostic criteria provided by DSM-IV have been fundamental to the diagnosis of the disorder. There have been several researches into the validity of these diagnostic criteria and it is important to recognize that there has been only partial validation for the disorder. According to Alv A Dahl, there is face validity and procedural validity for these criteria and some family studies of Borderline Personality Disorder have supported construct validity as well. "Considerable research has shown that Borderline Personality Disorder overlaps with other personality disorders and with mood disorders. Thus the amount of non-redundant information provided by a Borderline Personality Disorder diagnosis is still modest. If Borderline Personality Disorder is to survive in DSM-V, more construct and predictive validity must be demonstrated by the DSM-IV concept." (Dahl, 1995, p 163). Therefore, the nine diagnostic criteria for Borderline Personality Disorder provided by DSM-IV have come under considerable debates and researches and it is important to observe the construct and predictive validity for these criteria. It is important to comprehend that Borderline Personality Disorder has been recognized as a discrete diagnosis only over the past few decades and the term "borderline" reflects early psychoanalytic conceptions - i.e. this personality disorder is straddled 'borderline' between neurosis and psychosis. There have been various pertinent developments in the treatment of Borderline Personality Disorder in the recent times and it is essential to undergo such psychiatric treatments. "The characteristic problems that these individuals encounter with their therapists parallel the difficulties that they encounter with other important figures in their lives. They alternate between overriding and devaluing them, and their relationships therefore tend to be both intense and unstable." (Cohen, 2003, p 307). It is essential to recognize that the people with BPD have a highly intense and unstable behavior, just as their moods and views of themselves and others. As Cohen maintains, a cornerstone of psychotherapy is the belief that the patients with BPD try to do the best that they can with the skills they possess. Thus, the psychotherapy is focused on helping these patients to learn new skills. Although medications have not proven to be a panacea, they can sometimes plat a very useful complementary role. As mentioned before, treatments for BPD have improved in the recent years and group and individual psychotherapy are at least partially effective for many patients. "Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies." (Borderline Personality Disorder, 2009). Similarly, pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Also, the treatment of these patients makes use of antidepressant drugs, mood stabilizers, and antipsychotic drugs. In conclusion, borderline personality disorder (BPD) is an essential personality disorder defined in DSM-IV which requires crucial psychiatric treatments and assistance. References "Borderline Personality Disorder." (2009). The National Institute of Mental Health (NIMH). Retrieved 19 March 2010, from http://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/index.shtml Cohen, Bruce J. (2003). Theory and practice of psychiatry. New York: Oxford University Press US. p 307. Corelli, Richard J. "Borderline personality disorder." Stanford Edu. Retrieved 19 March 2010, from http://www.stanford.edu/corelli/borderline.html Dahl, Alv A. (1995). "Commentary on Borderline Personality Disorder." The DSM-IV personality disorders. W. John Livesley. Guilford Press. p 163. "Diagnosis and Statistical Manual of Mental Disorders." (2000). American Psychiatric Association. Reprinted: Sperry, Len. (2003). Handbook of diagnosis and treatment of DSM-IV-TR personality disorders. New York: Routledge. p 88. "DSM IV: Criteria for Borderline Personality Disorder." Fortunecity.com. Retrieved 19 March 2010, from http://www.fortunecity.com/campus/psychology/781/bpd-dsm.htm Sperry, Len. Handbook of diagnosis and treatment of DSM-IV-TR personality disorders. New York: Routledge. pp 81-2. Read More