Borderline Personality Disorder & The Female Patient Disorder - Research Paper Example

Abstract Borderline Personality Disorder is a condition that cripples the socialization of those who are suffering from its effects. Wirth-Cauchon (2001) identifies eight symptoms that can be associated with the disorder. These symptoms are emotional instability, inappropriate or intense anger, self-destructive acts, impulsivity, unstable relationships, identity disturbance, and chronic feelings of emptiness or boredom. These broad identifying symptoms can be refined through a thorough examination of the personality of the patient in order to create a more refined diagnosis. Often patients who are difficult are labeled with the disorder without fully exploring all other possible explanations for behavior (Wirth, 2001). While it is considered one of the most often diagnosed conditions in the clinical setting with 10% of the population suffering from the disorder, one of the problems in asserting a defined prevalence of the disorder is that often it is associated with addictive behaviors or misdiagnosed (Swift 2010). There are three primary theories that guide the treatment of borderline personality disorder. Clinicians look to biological, cognitive-behavioral, and psychodynamic causes in order to approach an effective course of treatment (Gunderson and Links, 2008). In the assessment of behavior disorders, finding a cause can be an illusive prospect. One of the predominant issues with the disorder is the overwhelming feminization of the condition, the diagnosis being one of the first areas of concern when treating a female patient. The relationship that women have with their social environment is a primary concern in the diagnosis of borderline personality disorder. This study will examine the way in which society and the female experience within society allows for an increased prevalence of the condition among women and the ways in which it can best be addressed from a clinical point of view. Borderline personality disorder and the female patient Disorder Borderline Personality Disorder (BPD) is a crippling affliction that affects about 10% of the population (Swift 2010). Often, however, it is misdiagnosed where PTSD is the underlying cause of the social problems that a patient is experiencing due to abuse or neglect as a child (Baker & Velleman, 2007). The disorder can define the future of those who suffer from its effects with a series of unstable and unsuccessful relationships. Self-destructive behaviors will also be common creating an inability to find success and move forward into a stable and secure life. The criteria for diagnosis will appear in early adulthood marked by a variety of effects within variations of context. The primary diagnostic criteria include emotional instability, inappropriate or intense anger, self-destructive acts, impulsivity, unstable relationships, identity disturbance, and chronic feelings of emptiness or boredom (Wirth-Cauchon, 2001). These basic criteria is further defined by a list of contexts from which a refined diagnosis can be assessed (see Appendix 1). The condition has the highest prevalence amongst women, one of the primary causes appearing to be sexual abuse in childhood with a variety of effects then manifesting as a result later in adulthood. As well, other forms of abuse such as neglect, emotional abuse, or physical abuse have appeared as precursors to the development of the disorder. In a study that compared other patients to BPD patients, 71% had suffered traumas of physical abuse while 68% had suffered sexual abuse, while 62% had witnessed serious domestic violence (Wirth-Cauchon, 2001, p. 66). The most common comorbidity associated with BPD is that of substance abuse. However, according to Lee, Bagge, Schumacher, and Coffey (2010), the effects of BPD are no higher or lower in substance abusers as they are in non-substance abusing patients. Therefore, the substance abuse seems to be a part of the of the self-destructive behavior rather than a result of self-medicating to relieve symptoms. Treatment In order for a patient to receive solid treatment for the disorder, clear boundaries must be established so that the patients can find social structure for an appropriate therapeutic setting. Often patients suffering from BPD will engage staff in concepts of emotional engagement that will defy professional boundaries and create an adverse environment in from which to create improvement. This can include, but not be limited to sexual advances, friendships that become too personal, and engaging staff in their dramas in order to create emotional chaos. The staff must be prepared to successfully navigate the emotional instability while not becoming involved in the dramas that will play out for the patient. Boundary issues on behalf of the staff are one of the most often causations for a lack of progress for a patient (Swift, 2010). Most treatment is founded in the cognitive-behavioral aspects of countering the effects of the disorder. While biological and psychodynamic etiologies are often examined in regard to BPD, it is most often treated through the cognitive-behavioral methodologies. Through providing frameworks for a patient in order to promote changes in behaviors that are self-destructive, the patient can eventually begin to start more meaningful relationships. The feelings of shame that often accompany the causal issues that may have helped to form BPD must also be addressed in order to move forward and form a more stable and meaningful life (Wirth-Cauchon, 2001). In addition to psychotherapy with an emphasis on behavior, pharmacotherapy is used to target specific symptoms of the disease in order to frame the experiences of the patient with relieve from pharmaceutically treatable symptoms. The treatment of the condition is dependent on identifying which modes of expression of BPD the patient is experiencing and tailor his or her treatment to those specific needs. Future Directions There are two key factors in the treatment of BPD that cause patients to have a more difficult time in recovery. The first issue is in the information and education that the treating staff have when confronting the problems of the patient. BPD patients will have an innate ability to notice all the details that reflect the personal lives of the staff that they encounter, making it very difficult for the staff to establish boundaries that the patient must not cross. The patient will often notice when a staff member does not feel well, or when something is wearing on their mind. The sensitivity of the BPD patient to the personal lives of others is part of the way in which they develop inappropriate relationships (Gunderson & Links, 2008). The second factor in the treatment of BPD is in defining more clearly the diagnosis as many of the criteria for BPD do not separate the experience from PTSD (post traumatic stress disorder) in patients who have suffered from traumas in their early life. The separation of the criteria through more developed responsive criteria to the aspects of the different experiences that form similar problems is essential in developing better care for patients suffering from the effects of these disorders (Wirth-Cauchon, 2001). Future directions of study on the topic will have to include more clearly defined criteria. The issues that are externalized by those who suffer from BPD must be discussed through the aspect of how those issues are manifestations of suppressed problems that stem from experiences from youth. This is a common problem among women, thus the feminization of the research is essential in discovering how to best approach the disorder. The way in which past trauma is handled in female patients will best serve to inform the researcher on further discovery on the topic. References American Psychiatric Association. (2001). Practice guideline for the treatment of patients with borderline personality disorder. Washington, D.C: American Psychiatric Association. Baker, A. & Velleman, R. (2007). Clinical handbook of co-existing mental health and drug and alcohol problems. New York: Routledge. Gunderson, J. G., & Links, P. S. (2008). Borderline personality disorder: A clinical guide. Washington, DC: American Psychiatric Pub. Lee, H.J., Bagge, C. L., Schumacher, J. A. & Coffey, S.F. (2010). Does comorbid substance abuse disorder exacerbate borderline personality features? A comparison of borderline personality disorder individuals with vs. without current substance abuse dependence. Personality Disorders: Theory, Research, and Treatment. 1(4), 239-249. Swift, E. (2010). Borderline personality disorder: Aetology, presentation and therapeutic relationship…first of two articles. Mental Health Practice. 13(3), 22-25. Wirth-Cauchon, J. (2001). Women and borderline personality disorder: Symptoms and stories. New Brunswick, NJ: Rutgers University Press. Appendix 1 Diagnostic Criteria for Borderline Personality Disorder A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: ______________________________________________________________________________ Frantic efforts to avoid real or imagined abandonment A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, Identity disturbance: markedly and persistently Persistently unstable self-image or sense of self, impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating) Recurrent suicidal behavior gestures or threats of self-mutilating behavior, affective instability due to marked reactivity of mood (e.g. intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days) Chronic feeling of emptiness, Inappropriate, intense aner or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights) Transient, stress-related paranoid ideation or severe disassociative symptoms (American Psychiatric Association, 2001, p. ix) Read More